Professional Documents
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BLOOD TRANSFUSION and Blood Pressure Monitoring
BLOOD TRANSFUSION and Blood Pressure Monitoring
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
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
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.
8 Check the vital signs before starting To do the initial assessment of the baby.
the procedure.
11 Check the urine color and output of To detect renal function and bleeding if any
the baby. (haemolysis).
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.
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