Wk 2 Blood Component Therapy: Nursing Implications Flashcards
What are four different types of blood products?
Packed red blood cells (PRBCs)
Platelets
Fresh frozen plasma
Albumin
What are packed red blood cells?
Doesn’t have plasma, wbcs, or platelets
When a patient needs, PRBCs, what will the provider order?
Type and cross match
What is a type & cross match?
Determines person’s blood type
Determines compatibility between blood specimens, making sure no hemolysis takes place
What is a cross match called?
Indirect Coombs test
What type of reaction happens if someone receives a wrong blood type transfusion?
Hemolytic
What blood type is the universal donor?
O-
What blood type is the universal recipient?
AB+
What labs do you need to assess pretransfusion?
H&H
For a Hgb <6, a blood transfusion is recommended…
except in exceptional circumstances
For a Hgb of 6-7, a blood transfusion is..
Likely to be indicated
For a Hgb 7-8, a blood transfusion is…
May be appropriate in patients undergoing orthopedic or CT surgery, and in those with stable CVD
For a Hgb 8-10, a blood transfusion is…
Not indicated unless symptomatic anemia, hemorrhaging, acute coronary ischemia, thrombocytopenia with high risk of bleeding
For a Hgb greater than 10, a blood transfusion is
Not indicated unless in exceptional circumstances
How often should a type & cross match be completed?
Every 48 hours
For a blood transfusion, what must a patient do?
Sign a consent form
What might be indicated before a blood transfusion?
Pre-medicate
About how much volume is given during a blood transfusion with PRBCs?
250-350mLs
What size of venous access is needed for a blood transfusion?
20 g or larger, 18 g preferred
What type of tubing do you need for a blood transfusion and why?
Y tubing with a filter, one port for blood and one for NS
What type of solution can be used with PRBCs?
NS ONLY, can’t use D5 or LR because it will cause hemolysis of the cells
Can you hang LR and blood?
NO
Can you hang D5 and blood?
NO
How much time do you have to get the blood transfusion started once it arrives on the floor?
30 minutes, so be ready with supplies before it arrives
If you can’t start a blood transfusion within 30 minutes of it arriving, what is the best next nursing action?
Return the blood to the blood bank
What is infused first during a blood transfusion?
The blood bag is hung lower and completely transfused first, and then run the bag of normal saline to make sure all of the blood goes into the patient
The final identity check of the patient should be done at the bedside with…
Two RNs
How long does the nurse stay with the patient when they are receiving a blood transfusion?
15-30 mins
What are s/s to lookout for during the initial start of a blood transfusion?
Chills
SOB
Itching
Back pain
The nurse should take baseline…
VS before and after 15 mins
How slow should you being a blood transfusion for first 15 mins?
1-2 ml/min
60-120 ml/hr
Unless contraindicated, blood transfusions should be given in what amount of time?
2 hrs
How often should you take VS during a blood transfusion?
Start, after 15 mins, every hour, and at the end
What is the maximum amount of time for a blood transfusion and why?
4 hours because of risk for bacterial proliferation
If you don’t get all of the blood in within 4 hours, what should you do?
Take the rest of the blood down and notify the HCP that you didn’t get it all in
If patient is at risk for fluid volume excess, what might the provider order in-between infusions?
Diuretic (furosemide/lasix)
Platelets are prepared from…
Fresh whole blood
What volume are platelets?
30-60 mls (very small)
How many platelet units can be obtained from one donor?
multiple
How should platelet units be kept?
At room temperature
How long are platelet units good for?
1-5 days
How do you prevent clumping in the platelet bag?
Agitate the bag periodically
How fast can platelets be administered?
As fast as they can be tolerated
Does blood compatibility matter with platelets?
No
What are the indications for platelet transfusion?
Platelet count below 20,000
Platelets are not the same thing as…
Clotting factors
Where are clotting factors found?
Plasma
What is fresh frozen plasma?
Liquid portion of the blood separated and frozen
What is the volume of fresh frozen plasma?
About 250 pls
Does fresh frozen plasma contain platelets?
No
Who will receive fresh frozen plasma?
Liver issues
Hemophilia
Von Willebrand’s
Is blood compatibility required for fresh frozen plasma?
Yes
How long is fresh frozen plasma good for?
Up to a year
After thawing, how soon must fresh frozen plasma be used?
Within 24 hrs
What are the indications for fresh frozen plasma?
Bleeding cause by deficiency is clotting factors
Fluid volume expander
Albumin is a __ and has __ power
colloid, pulling
What does albumin do?
Keeps fluid inside the intervascular space
What is a normal albumin?
3.5-5
Who might be low on albumin?
Malnourished Liver disease (can't make albumin)
Albumin is prepared from…
plasma
What percent albumin is oncotically equivalent/isotonic?
5%
What percent albumin is oncotically hypertonic?
25%
Is blood compatibility important for albumin?
No
