Week4- Blood transfusion Flashcards
1
Q
blood composition
A
55% plasma
- water
- proteins
- electrolytes
42% formed elements
- 98-99% RBC
- 1-2% WBC
2
Q
- role of WBC
- created where
A
inflammatory and immune response
created in bone marrow
3
Q
role of RBC
created where
A
transport oxygen, contains hemoglobin
bone marrow
4
Q
role of platelets
created where
A
clotting process
bone marrow
5
Q
plasma role
A
transporting fluid
contains nutrients and electrolytes
6
Q
1 unit of whole blood = approx ____ml of fluid and cells
A
475ml
7
Q
1 unit of PRBC= approx
A
300ml of cellular replacement without fluid
8
Q
frozen plasma will manage
A
coagulopathies
9
Q
cryoprecipitate
A
clotting factors and protein
10
Q
albumin role
A
maintain blood volume, attracts fluid
11
Q
immune globulin to replace
A
antibodies to fight infection
not compatible with NS
12
Q
when to give blood or blood products
4
A
- Increases circulatory blood post trauma / hemorrhage (PRBC)
- Increases RBC to maintain hemoglobin with anemias (PRBC)
- Cellular replacement
- Used in emergencies due to accidents, during surgery, to treat bleeding and clotting disorders, for supportive treatment of illnesses (i.e. sickle cell, anemia)
13
Q
type and screen then cross match valid for
A
96 hours if pt has been transfused with RBC or platelet or pregnant in the last 3 months
14
Q
o=
AB+ =
A can receive
B can receive
AB can receive
O can receive
A
universal donor
universal recipient
A or O
B or O
A B O
O
15
Q
Rh + can get
Rh - can get
A
Rh + or neg
just Rh neg
16
Q
who can receive platelets
A
preferably ABO compatible but any group is safe for an adult
17
Q
order must contain
6
A
Patient identifiers
Date and Time
Rate and duration of transfusion
Amount and type of blood components
Sequence of products
Any special requirements or medications
18
Q
required equipment
5
A
- Product information sheet (comes with blood product from Transfusion services)
- Blood administration set (single spike shown below, may be double spike, vented tubing for IVIG glass bottle)
- 500 -1000 mL NS (primed on standby)
- Compatible IV fluid to flush line 30-50 mL following transfusion (and sometimes between units
- PVAD - #20 gauge preferable, may use smaller if it is the only access you can obtain (18g preferable for rapid infusion) or CVAD
- Assess patency of line prior to ordering blood product
- IV pump
19
Q
IV G for blood
A
18 or 20
20
Q
notify MRP if temp
A
> 37.5
21
Q
visual blood bag check
6
A
integrity
clotting
purplish coloring
bubbling
expiry
label intact and legible without alterations
22
Q
BPV
blood product verifiction record
A
check by both nurses and signed by both
pt ID to all the forms
23
Q
section C or form is completed
A
a bedside and sign
24
Q
Transfusion must start within ___ of product issue from Transfusion medicine services
A
30 mins
25
transfusion must be completed within a max of
4 hours
26
what to look for in RBC bag
- expiry date and time
- label with type of product
- verify identity
- at least one port cover sterile and intact
- no black or purple discoloration of the red cell mass
- no evidence of hemolysis (redness in the plasma portion)
- no clots
- no bubbling or foaming
- no leaks
27
what to look for with platelets FFP or cryoprecipitate
- expiry date and time
- at least one port cover sterile and intact
- color clear to slightly opaque, beige to yellow or salmon to pink color
- bright yellow to greenish brown discolorations are acceptable
- no clots or fibrin stands
- no excessive bubbling or foaming
- no leaks
28
what to look for with other blood products
- expiry date and time
- if product is pooled, ensure label indicates the number of units in the pool
- no cloudiness
- no cracks
- no leaks
29
2 nurse system check - bedside check (verbal)
- Confirm patient identification and blood type and verbal consent
- Assess previous reactions and allergies
- Transfusion number with blood band and compatibility tag
- Confirm patient name and ID number on all documents
- Unit number (serial number) matches blood bank slip
- Blood type and components, including Rh factor, expiry, volume
** if any discrepancy - DO NOT proceed, return blood to lab
30
return TMS compatability tag when
| 2
the blood component was issued from another hospital and transfused during transport
there is a transfusion reaction
31
use a new transfusion set for
each different product
32
same transfusion set can be used for
multiple units of the same product if transfused within required time and quantity limits (within 4 hours or 4 units of blood)
33
blood must be connected
directly to IV extension set
34
blood must be administered within
30 mins of leaving the blood bank
stamp time on pink card
35
infusion set must be completed within
4 hours
36
start infusion
slowly (50 mL/hr) for first 15 mins (test dose) observe directly for 5 mins
37
RN must be present for minimum first ___minutes, at ___ minutes they need to reassess patient, once deemed stable rate can be increased- indirect supervision with q _h vs and assess until completion of infusion and _hr post.
5
15
1
1
38
Once transfusion is complete the remaining bag and tubing is discarded in the
Biohazard bin. Check institution policy.
39
reactions can be reduced by
autologous donations
40
Medications are not to be
administered into Blood or Blood Products or transfusion line
41
Between units, components and following infusion flush IV access with
30-50ml NS
42
blood math 295 ml over 2 hours
(295-12.5ml)= 282.5
2hr-15min= 1.75hours
282.5/1.75= 161.4= 161ml/hr
43
transfusion reaction s/s
| 9
Fever and chills
SOB
Back / flank pain
Skin rash and itchiness
Nausea and vomiting
Tachycardia / Hypotension
Restlessness / Anxious
Dyspnea (high or low RR)
44
typical response
small variation in vs
usually no reaction
45
abnormal response
- hives/itching
- fever/chills
- hypotension
- dyspnea
signs/symptoms
potential reaction
hives/itching- mild allergic
fever/chills - febrile non-hemolytic or acute hemolytic bacterial contamination
hypotension-acute hemolytic bacterial contamination or acute lug injury
dyspnea- volume overload
46
fever in transfusion=
anything >38 or 1 degree higher than baseline prior
47
If symptoms of reaction occur …
IMMEDIATELY stop the transfusion and disconnect
Restart Normal Saline to dilute components
Assess ABCs / VS
Apply oxygen as required to maintain > 94%
Contact physician and do symptom management
Monitor urinary output
All blood, tubing, labels, paperwork and transfusion reaction record is sent back to lab (TMS)
Documentation
Remaining blood product and tubing is bagged and sent to lab with documents
Document incident and complete Clinical Transfusion Reaction Report
Lab work will be ordered (hemoglobin, culture, type and crossmatch)
Urine specimen will be ordered
Continuing assessment q 5min
May need to administer emergency medications
Prepare for CCOT / ICU transfer / CODE
48
Acute Hemolytic Reaction - Incompatibility
what
s/s
Antibodies attack and destroy RBC
Usually occurs quickly (first 25 mL of blood), most life threatening
Mismatched blood, immune system attacks and destroys RBC
Chills
Lumbar / IV site pain
Hypotension / Tachycardia
Tachypnea / dyspnea
Nausea
Flushing
Can be delayed as well (2-14 days) - jaundice
49
Anaphylaxis Reaction / Minor or Major Allergic
Often occurs
why
s/s
Often occurs quickly (first 10 mL of blood) / can be later
Sensitivity to donor components
Rash / Itchiness / Hives
Flushed
Wheezing / Respiratory distress
Swelling
Emesis
Hypotension / Tachycardia
50
Febrile Reaction
| when it develops
why
manifestation (HHMMFC)
Usually develops later during infusion
Reaction to proteins in blood products
Fever increase of 1+ degree / Tachycardia /
Hypotension
Sudden chills
Flushing
Malaise
Muscle pain
Headache
51
Fluid Volume Overload (Side Effect)
| why
manifestations (6)
what to use
Increased volume or increased rate of infusion with decreased cardiac or renal function or in frail elderly
Hypertension
Dyspnea
Bounding pulse
Moist breath sounds
Cough
JVD
Possible use of Furosemide
52
Bacterial Sepsis
| what
most common with which product
potentially fatal reaction caused by bacteria inadvertently introduced into the blood component/product or originating from the donor. More common in platelets due to room temperature storage”.
53
what are pooled platelets
platelets derived from whole blood of 4 random donors
54
how long before a bag of platelets will expire
5 days from date of preparation
55
how soon after platelet infusion must platelets count be done
15 mins-1 hour post transfusion
56
what rate are platelets given
50ml/hr for the first 15 mins
suggested one dose over one hour
57
how many hours must a platelet transfusion be complete
4 hours
58
what is the osmolality of albumin
isotonic (equivalent to plasma)
59
how is albumin supplied
5%- 50-500mL
25%- 50 or 100mL
60
If a client received 500 mL of Albumin 5%, how much would the circulating plasma volume
expand?
500 mL expands circulating blood volume by 750 mL
61
How much does Albumin 25% expand plasma volume?
Will expand plasma volume 3-4 times the amount delivered
62
what solution is albumin compatible with
plasbumin 25= D5W, NS, RL
Alburex= D5W, NS
63
risks with albumin transfusion
| 3
virus transmission
circulatory overload
electrolyte imbalances
64
what rate is albumin given
5%- max 300ml/hr (5 ml/min)
25%- 60-100ml/hr (1-2ml/min)
65
on average, what does each unit of cryoprecipitate contain?
| 4
Factor VIII, Factor XIII, von Willebrand Factor, and fibrinogen
66
what temp is cyroprecipitate stored
18 degrees or colder (12 months max)
67
What are two indications for cryoprecipitate?
Hypofibrinogenemia
hemophilia A
68
What is the maximum rate that a 10 unit dose of cryoprecipitate can be infused?
30 minutes (10-30 minutes)
69
What are 3 risks associated with a cryoprecipitate infusion?
Infectious disease
bacterial contamination
allergic reaction
70
How many hours before a transfusion does Immune Globulin need to be removed from the fridge?
24 hours
71
What is an indication for Immune Globulin?
immune thrombocytopenia purpura (ITP)
72
The infusion rate for Immune Globulin may be gradually increased every 15-30 minutes. What is the maximum rate?
7.2 mL/kg/hr
73
What are some adverse reactions associated with an Immune Globulin transfusion?
Headache, fever, fatigue, chills, flushing, dizziness, urticarial, wheezing, chest tightness, N/V, rigors, back pain, chest pain, muscle cramps, changes in BP
74
how can adverse reactions from immune globulin be stopped
- slowing or stopping the infusion usually allows the symptoms to disappear promptly
75
o blood can receive plasma from
A
B
AB
all groups
A, AB
B, AB
only AB
76
what are some serious symptoms for reaction
- temp > 39
- back/chest pain
- hypotension/shock
red/brown urine
tachycardia
unusual bleeding
- chills
- rigors
- anxiety
- dyspnea
- NV
