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BLOOD TRANSFUSION

Transfusion is performed much less often in older infants and children. The most
commonly transfused groups are children on paediatric intensive care units (PICUs), those
undergoing cardiac surgery, transfusion-dependent children with inherited conditions such as
thalassaemia major, and those following intensive chemotherapy for haematological malignancy or
cancer. Transfusion guidelines and blood components for older children are similar to those for
adult patients (see appropriate sections of the handbook). Blood transfusion for children with
haemoglobinopathies

The dose of blood components for infants and children should always be carefully calculated and
prescribed in mL, rather than as ‘units’ to prevent errors and avoid potentially dangerous circulatory
overload. Dedicated paediatric transfusion charts or care pathways can also reduce dosing and
administration errors.

PURPOSE

To raise the haemoglobin level.


To raise the deficiency of plasma
proteins. To restore the blood volume.
To replace the blood with clotting agents with fresh blood.
SCOPE
All babies who require transfusion of blood/blood products.

EUIPMENTS

Neoflon No -24G
Blood transfusion set
Syringes 50ml
3-way extension with 100cm
Normal saline and heplock flush
Blood and blood products
Plaster and Scissors
Infusion or syringe
pumps Blood warmer
Pre- medications if
required Sterile swabs
Spirit and betadine
PROCEDURE

Sl. No. PROCEDURE RATIONALE

1 Obtain consent. To explain the procedure and to have a legal


permission from the parents to carry out the
procedure.

2 Wash hands. To prevent cross and auto infection.

3 Assemble the equipments. To economize time and energy.

4 Wash hands and put on gloves. To prevent cross infection.

5 Keep the blood in appropriate To avoid hypothermia (use blood warmer to


temperature. bring down the temperature to normal body
temperature).

6 Check the bag number, date of the To prevent from complications related to
expiry and date of collection and blood transfusion and infectious disease.
grouping and Rh typing, cross
matching report and screening report.

7 Bloods has to checked by two nurses To avoid complication and wrong


and document the same. transfusion and to safeguard the life of the
child.

8 Check the vital signs before starting To do the initial assessment of the baby.

the procedure.

9 Check the existing Neoflon for To prevent extravasation.


potency, if not existing start a fresh
one.
10 Blood should be started initially at the To detect early deviation from normal and to
slow rate and gradually increase to the maintain the parameters.
actual rate.

11 Check the urine color and output of To detect renal function and bleeding if any
the baby. (haemolysis).

12 Inform the pediatrician if any For early detection of complications.


complication occurs.

13 Record the procedure with the time Documentation to have a legal evidence of
started, blood group and Rh, screening the procedure being carried out, the initial
and cross matching status, name of the state of the client to detect early deviation
person who started and who checked from normal and to avoid complications.
and the rate of flow and along with
vital signs, also enter the procedure in
system.

14 Close monitoring is important before To detect transfusion reactions at the earliest.


during and after the procedure.

In case of transfusion reaction, stop the


transfusion reaction,stop the transfusion
immediately and send the blood bag to
15 blood bank with the reaction observed. To detect reason for the transfusion reaction

Continous monitoring and after care is For early detection of complications.


very essential including the charting.
16.

Once the transfusion is over To have clear record of the procedure.


17 documentation is done with the time,any
adverse reactions that is noticed etc.
BLOOD PRESSURE MONITORING

Definition

 Blood pressure (BP) is the force of the blood against the wall of any blood
vessel
 The systolic BP is the pressure of the blood against the artery walls
when the heart contracts (beats)
 The diastolic BP is the pressure of the blood against the artery walls
between heartbeats, when the heart relaxes 
 Mean arterial pressure (MAP) is the average pressure during the entire
cardiac cycle and integrates the area under the arterial pressure waveform
Indications
 Chronic disease
 Symptoms of hypertension
 Children in emergency departments/intensive care units
 High-risk infants
 Children > 3 should have their BP measured annually as part of a routine
preventative health screening
Equipment
 Stethoscope and manual blood pressure cuff with sphygmomanometer
 Automated oscillometric device and cuff
 Appropriate size blood pressure cuff
 Length of the inflatable bladder should be 80% (almost long enough to
encircle the arm) 
 Width of the inflatable bladder should be at least 40% of the
circumference of the upper arm (about 12-14 cm in the average adult)
 Errors occur when the cuff is too small (measurement is high) or too
large (measurement is low) 
 Avoid using a cuff with a width that extends over a joint  
Methods of Measurement
 Direct: catheter placed directly into an artery to obtain BP measurement
 Most accurate method but invasive
 Indirect:
 Manual cuff and sphygmomanometer:
 Observer and methodology errors can occur
 Automated oscillometric device
 Device can be inaccurate
 Ambulatory (monitors BP during 24 hr period)
 Valuable method for assessing/managing suspected
hypertension
 Doppler ultrasound
 Useful for systolic BP but is unreliable for diastolic BP
Korotkoff Phases
 Phase I:
 Appearance of clear tapping sounds
 Correlates with systolic blood pressure
 Phase II:
 Sounds become softer and longer
 No clinical significance
 Phase III:
 Sounds become crisper and louder
 No clinical significance
 Phase IV:
 Sounds become muffled and softer
 Correlates as alternate measure of diastolic blood pressure
 Phase V:
 Sounds disappear completely
 Correlates with diastolic blood pressure
Technique
Tips to Ensure Accurate Measurement
 Delay BP reading if patient has consumed caffeine (increase BP) or exercised
(lower BP) within the past 30 minutes
 Make sure arm is free of clothing (rolling up the sleeve can cause a tourniquet
around the upper arm)
 Do not place the cuff on a limb being used for intravenous or intra-arterial
infusions, any area where circulation is potentially compromised, has an
arteriovenous fistulas, where lymphedema exists, or nonintact or injured skin
 If bilateral, use lower extremities to obtain a measurement
 Palpate the brachial artery to ensure it has a viable pulse
 Position the arm so that the brachial artery is at heart level (if below the
reading will be higher, if above the reading will be lower)
 While obtaining the blood pressure, neither the patient nor the person
obtaining the blood pressure should talk
 Hold the dial so it faces you directly
 Avoid slow or repetitive inflations of the cuff (produces venous congestion
which can falsify readings)
Manual BP Measurement:
 Have the patient sit or lay down (comfortable, relaxed, legs uncrossed, feet
resting on the floor; younger children may sit in the parents lap) for 2-5 minutes
before obtaining measurement
 Arm should be supported at the level of the heart and slightly flexed at the
elbow
 Place the BP cuff with the bladder midline over the brachial artery pulsation 
 The lower border of the cuff should be about 2.5 cm above the
antecubital crease
b. To determine the inflation level, palpate the radial artery and rapidly inflate
the cuff until the pulse disappears, read this pressure on the manometer and add 30
mmHg to it
c. Deflate the cuff and wait 15-30 seconds
d. Place the stethoscope lightly over the brachial artery
 The Korotkoff sounds are best heard with the bell of the stethoscope
since they are relatively low in pitch
 Ensure a proper seal is obtained
e. Inflate the cuff rapidly to the predetermined inflation level (see step 4)
f. Turn the bulb?s screw counterclockwise to deflate slowly at a rate of 2-3
mmHg/second
g. Note the level at which you hear the sounds of at least two consecutive beats
(Korotkoff phase I). This represents the patient?s systolic BP
h. Continue to deflate the cuff until the sounds become muffled and disappear
(Korotkoff phase V). This represents the patient?s diastolic blood pressure
 To confirm disappearance of sound, listen as the pressure falls another
10-20 mmHg
i. Deflate the cuff rapidly
j. Read the systolic and diastolic levels to the nearest 2 mmHg
k. Record the BP, arm used, the arm position, and the cuff size used
l. If repeating measurement, wait Ú 2 minutes
Automated Device:
m. Have the patient sit (comfortable, relaxed, legs uncrossed, feet resting on the
floor; younger children may sit in the parents lap) for 2-5 minutes before obtaining
measurement
n. Arm should be supported at the level of the heart 
o. Place the automated oscillometric cuff on the arm 
 Ensure that the cuff is the appropriate size
p. Initiate the automated device, causing it to inflate and then deflate
q. Record the BP, MAP, arm used, the arm position, and the cuff size used
r. If repeating measurement, wait Ú 2 minutes
BP Classification/Interpretation:
a. BP is classified by systolic BP (SBP) and diastolic BP (DBP) percentiles for
age/sex/height. If SBP or DBP >90th percentile, repeat twice at same office visit
before interpreting result
b. Normal BP: SBP and DBP <90th percentile
 Recheck in 1 year    
 Prehypertension: SBP or DBP 90th percentile to <95th percentile or
BP >120/80 mmHg to <95th percentile 
 Recheck in 6 months
 Begin weight management (as appropriate)
 Stage 1 Hypertension (HTN): SBP and/or DBP 95th percentile to 99th
percentile plus 5 mmHg 
 Recheck in 1 to 2 weeks
 If BP remains at this level on recheck, begin evaluation and treatment
including weight management if appropriate
 Stage 2 HTN: SBP and/or DBP >99th percentile plus 5 mmHg
 Begin evaluation and treatment within 1 week, immediately if
symptomatic
Pearls
 To obtain a more accurate BP, the average of at least 2 measurements
should be used
 Blood pressure should be taken in both arms at least once due to
normal variance in pressure
 Subsequent readings should be taken in the arm with the higher
pressure
 If BP is high by automated device, repeat by auscultation
 Automated oscillometric device is used most often in infants
 Generally, systolic BP in the lower extremeties is > than in upper
extremeties

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