Nursing

Responsibilities

on Blood Transfusion

BLOOD TRANSFUSION
 The transfer of blood or blood components from one

person (the donor) into the bloodstream of another person (the recipient). This may be done as a lifesaving maneuver to replace blood cells or blood products lost through bleeding. Transfusion of your own blood (autologous) is the safest method but requires advance planning and not all patients are eligible. Directed donor blood allows the patient to receive blood from known donors. Volunteer donor blood is usually most readily available and, when properly tested has a low incidence of adverse events. Blood conserving techniques are an important aspect of limiting transfusion requirements.

BLOOD AND BLOOD COMPONENTS COMMONLY USED IN INFUSION THERAPY

BLOOD/BLOOD INDICATIONS AND CONSIDERATIONS COMPONENTS WHOLE BLOOD Volume replacement and oxygen-carrying capacity; usually used only in significant bleeding (.25% blood Volume lost) Packed red blood cells Increases RBC mass. Symptomatic anemia: platelets in the units are not functional; WBCs in the unit may cause reaction and are not functional. Bleeding due to severe decrease in platelets. Prevent bleeding when platelets <5,000 10,000/mm Survival decrease in the presence of fever, chills, infection.

(PRBCs) Platelets random

BLOOD/BLOOD COMPONENTS Platelets single donor

INDICATIONS AND CONSIDERATIONS Used for repeated treatment: decreases alloimmunization risk by limiting exposure to multiple donors. Bleeding in patients with coagulation factor deficiencies, plasmapheresis. Severe neutropenia in selected patients; controversial.

Plasma (FFP)

Granulocytes

Lymphocytes (WBCs) (apheresed) Cryoprecipitate

Stimulate graft-versus-disease effect.

Von Willebrand s disease Hypofibrinoginemia Hemophilia A Hemophilia A

Antihemophilic factor (AHF)

Standard of care guidelines

 Follow up on results of complete blood count

   

and report to health care provider so appropriate blood product can be ordered based on patient s condition. Establish a patent I.V. line with compatible I.V. fluid. Use appropriate administration setup, filter, warmer,, etc. Obtain baseline vital signs. Make sure proper blood product is given to the right patient.

 Transfuse at prescribed rate during prescribed

time, as tolerated by patient.  Observe for acute reactions allergic, febrile, septic, hemolytic, air embolism, and circulatory overload by assessing vital signs, breath sounds, edema, flushing, urticaria, vomiting, headache, back pain.  Notify patient s health care provider or available house officer if signs of reaction or other abnormality arise.  Be aware of delayed reactions and educate patient on risk and what to look for: hemolytic, iron overload, graft-versus-host disease, hepatitis, and other infectious diseases.

Nursing Considerations Before administration 1. Assess laboratory values.

Rationale Many institutions have specific guidelines for blood product transfusions. Legally, a physician s prescription is required for transfusion. The order should state the type of product, dose, and transfusion time. Determine whether the client can tolerate infusion. Baseline information may be needed to help identify transfusion reactions. The large-bore needle allows cells to flow more easily without occluding the lumen of the catheter. Human error is the most common cause of ABO incompatibility reactions.

2. Verify the medical prescription.

3. Assess the client s vital signs, urine output, skin color, and history of transfusion reaction.

4. Obtain venous access. Use a central catheter or 19-gauge needle if possible. 5. With another registered nurse, verify the client s name and number check blood compatibility, and note expiration time.

Nursing Considerations During administration 1. Administer the blood product using the appropriate filtered tubing.

Rationale Filters are needed to remove aggregates and possible contaminants.

2. If the blood product needs to be diluted, use only normal saline solution.

Hemolysis occurs if any I.V. solution is used.

3. Remain with the client for the first 15 to 30 minutes of the infusion.

Hemolytic reactions occur more often within the first 50 mL of the infusion.

4. Infuse the blood product at the prescribed rate.

Fluid overload is potential complication of rapid infusion.

5. Monitor vital signs.

Vital sign changes often indicate transfusion reactions.

Nursing Considerations After transfusion 1. When the transfusion is completed, discontinue infusion and dispose of the bag and tubing properly. 2. Document.

Rationale Blood borne pathogens may be spread Inadvertently through improper disposal.

The client record should indicate the type of product infused, product number, volume infused, time of infusion, and any adverse reactions.

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