~ administer oxygen in high concentration - avoid high negative pressure ~ assist respiration in case of respiratory arrest ~ catheter aspiration of the right side of the heart a. Disequilibrum syndrome ~ headache - restlessness nausea and vomiting ~ hypertension/hypotension ~ cramps - convulsions Causes: - Reduction of ECF osmolality - Increased ICF and CSF acidosis - reduction of oxygen delivery to the tissue + Possible remedies: - slow infusion of mannitol or hypertonic NaCl - administer glucose - administer dilantin prior to dialysis = reduce duration and flow rate of the first fewdialysis. BLOOD TRANSFUSION: > Blood transfusion is the introduction of whole blood or components of the blood into the venous circulations. BLOOD GROUPS:> Agglul > No one can have the agglutinogens and agglutinins of the same type becase the pesons systems » Human blood is classified into four main group on the basis of polysaccharide antigens (agglutinogens) on the RBC. > Agglutinogens - commonly cause antibody reactions ins- antibodies which are present in the blood plasma. would attack its own cells. They do however have agglutinins to the red cell agglutinongens that they do not have. Blood groups with their constituent agglutinogens and agglutinins: BLOOD TYPES AGGLUTINOGENS ‘AGGLUTININS oO None, ARB A nr 5 B B x AB A&B None. RHESUS (Rh) FACTOR: > There are 6 common types of Rh antigens, each of which is called an RH factor- C,D, E, ¢, d, € > The type Dai ns is considerably more antigenic than others making it the basis for determining whether a person is Rh (+) or Rh (-). Positive meaning that the person has the type D antigen and negative if the person has not. > This can cause hemolysis if a mismatched blood is given unlike the A & B agglutinogens. This is because the Rh antibody is not normally present in the plasma of Rh (-) persons. EQUIPMENTS FOR BLOOD TRANSFUSION: Blood or blood component product Blood administration set Container of 0.9% Nac! solution. IV pole Venipuncture set- usually 2 19 or 18 gauged needle is used, Tourniquet Alcohol swabs Tape Gloves vVvVVVVVVVv STEPS IN ADMINISTERING BLOOD PRODUCTS. > Verify the doctor's order for blood transfusion. Should be counter checked by 2 registered nurses. . > Check if the consent has been signed > Obtain and document baseline vital signs: = Blood pressureTemperature Pulse Respiration Any Previous reaction to a blood transfusion Specific signs to tt z i S paaec dette he client’s pathology & reason for the transfusion {Explain the procedure & its purpose Instruct to report any sudden chills, nausea, itching, rash, dyspnea or other Unusual symptoms, Request for the blood product depending on hospital protocol. the client has an Iv solution, check if the infusion set, the solution & the needle is compatible with blood transfusion. A blood set with a blood filter, 2 Gouge 18 or 20 needle & a O,9%NaCL is recommended. Any other or medications is incompatible, IF there is no existing IV line suitable for blood transfusion, start venipuncture using gauge 18 or 20 IV cannula, Consult with the primary physician for the need for a double intravenous line if the existing IV line is not suitable for blood transfusion. > Prepare the equipment > Obtain the corre fect blood product ordered for the client. Check the/f Blood type = Rheroup "The blood donor number = Expiration date Abnormal color, dark color, cloudiness = ABC clumping = Gas bubbles = Extraneous materials > Type & cross match the blood, 2 registered nurses should verify the following on the cross match result. = Client's name & identification number "The serial number on the blood bag label * The ABO group & Rh on the blood bag label. > Verify the client's identity ~ ask the client to state his/her full name. Check arm band if present. 2 registered nurses are also required for verification. > Recheck the physician’s order for any pre blood transfusion medications/instructions. > Wash hands, > Setting up the equipment & establishing the blood transfusion. Administering blood using a single straight administration set as piggyback (IV update Sept 2008: It is no longer recommended to make your blood administration set as your main intravenous line but as piggyback) © After inserting a G18/G20 IV line using a macroset/microset, prime the tubings of the single straight blood administration set with 0.9% NaCL solution * Wash handsPut on gloves. Prepare the blood bag. Blood products should be transfused within 30 minutes after exposure to room temperature. RBC hemolysis begins after 2 hours of exposure to room temperature. Hemolysis of RBC could cause release of potassium into the blood stream which can result of hyperkalemia. Prolonging the exposure to room temperature could also increase the risk of bacterial growth in the blood product. Warming the blood product to room temperature is done by Wrapping it with clean towel or using the hospital blood warmer if available. Invert the blood bag gently several times to mix the cells. Rough handling can damage the cells. Close the clamp and kink the tubing below the drip chamber Remove the 0.9% NaCL from the blood set Open the port of blood bag, Slowly insert the spike to the blood product. Suspend the bag Slowly fill the drip chamber with blood and prime the tubing’s ‘Wash hands Slowly insert the needle of the blood set at the Y port of the main IV line Insert the needle only 80% halfway thru the Y port. Move the regulator of the main IV line near the Y port Anchor the needle well & cover it with sterile OS Close the regulator of the main IV line Open the clamp of the regulator of the blood set Administering blood using a Y set After inserting a 618/620 IV line using a Y set. Attach 0.9% NaCL solution to one of the two spikes and prime the tubing’s. Connect the blood product to the spike only after patent IV line is established. Wash hands Put on gloves. Prepare the blood bag. Blood products should be transfused within 30 minutes after exposure to room temperature. RBC hemolysis begins after 2 hours of exposure to room temperature. Hemolysis of RBC could cause release of potassium into the blood stream which can result of hyperkalemia. Prolonging the exposure to room temperature could also increase the risk of bacterial growth in the blood product. Warming the blood product to room temperature is done by wrapping it with clean towel or using the hospital blood warmer if available. Invert the blood bag gently several times to mix the cells. Rough handling can damage the cells.Connect the bi cl lood product to the other end of the tubing. The oe near the spike & the clamp below the drip chamber should be Closed prior to the insertion Oren the clamp near the spike first and then allow the blood Product to drip into the saline filled drip chamber. Once drip chambers 1/3 full, open the clamp below the drip chamber > Stay with client & observe him/h > Obtain & document v/s g 15 reaction during these times, The Ask the client ifshe/he feels, anything unusual > Iftransfusion reaction occurs, close the transfusion immediately, do quick assessment & intervention & : » If no untoward effects are obse protocols. ‘minutes after infusion has started. Take note of any adverse Carlier these reactions appear, the more sever they tend to be. run 0.9 NaCL at 10gtts/min and immediately report to the resident & attending physician. ved, regulate the flow rate according to blood product Most adults can tolerate receiving up to 1 unit in 1-2 hours. For elderly, infusion should be slower. | unit should be transfused Over 3-4 hours or depending on the hospital and blood product Protocols, Do not transfuse a unit of blood for more than 4 hours. @ while to mix solid & liquid elements. > Invert the bag every once in > Wash hands >» Obtain & document v/s every 30minutes for 1 hr until transfusion is complete. Continue monitoring every hour for the next 3 hours after the infusion, > Ask the client to report any signs & symptoms for post transfusion reaction. > If more than 1 unit of blood is required use a new blood admi blood that follows. ration set for every unit of > Follow up post blood transfusion orders such as requesting blood examinations to determine effectiveness of the transfusion. Like repeat CBC 6 hours post BT. > Document all relevant data including assessments before & after procedure. > Remind the doctor about the administration of calcium gluconate if patient had 4-6 or more units of blood transfused. TERMINATION OF THE BLOOD TRANSFUSION > Check doctor’s order and the chart if transfusion is already completed. > Wash hands and wear clean gloves. > Ifno more transfusion follows, terminate the blood line similar to that terminating an IV line.» Ifthe primary IV isto be continued, flush the maintenance line with the saline solution. Disconnect the blood tul prescribed rate, v Discard blood bag and blood transfusion set per hospital protocol system from the primary system and then regulate to the » Remove gloves and then wash hands. Again monitor vital signs for any delayed or untoward reactions > Document any relevant data, BLOOD AND BLOOD PRODUCTS: PRODUCT & | GENERAL INFORMATION | ADVERS EREACTIONS NURSING VOLUME CONSIDERATIONS Citrated whole > Contains RBC, > Reactions are more > Rarely human blood plasma, and anti- common with this, indicated for (500 ml) coagulation type of blood transfusion. Preservatives(cit product Specific blood rate) > Febrile and allergic component > Replenishes both reactions products are the intravascular > Hemolytic usually volume and the reactions recommended. oxygen-carrying > Transfusion capacity of the transmitted blood diseases > Has a Het of 35- 40% Red blood cells > Hasa Het of > Reactions are less > Companion (packed red approximately common than with solution- 0.9% cells) (250 ML) 75% whole blood Nacl > 80% of the > Febrile non- > Use standard plasma is hemolytic blood blood filter removed. > Acute hemolytic > Mix cells every > Restores only the reactions 20-30 minutes coxygen-carrying > Transfusion (squeeze bag) capacity of the transmitted > Give over 2-4 blood diseases hours. > Some are prepared witha preservative solution > Should raise the Het and Hgb. 1 unit will raise Het approximately 3% and Hgb by 1 egal. Platelet Used to treat or > Febrile non- > Administer concentrates(3 prevent bleeding hemolytic and rapidly"allergic reactions through @ > Transfusion filter-4 units transmitted per hour 2 es > Companio! ae solution- 0.9% NaCl Granulocyte > Used to treat > Febrile non- > Administer concentrate infections. hemolytic and only with 0.9 % > Requires pre- allergic reactions Nacl transfusion RBC > Leukoagel > Administer Compatibility reaction possible- ‘through a testing leads to filter. hypotention > Administer > Anaphylaxis slowly over 1-2 > Respiratory distress hours (based > Transfusion on 200 ml transmitted volume) infections Plasma (200 ml) > Provides > Risk of circulatory > Transfuse with coagulation overload afilterina factors > Risk of infections straight line > Can transmit > anaphylaxis-for IgA set deficient recipients > Give as quickly > Febrile and allergic as possible- reactions coagulation factors become unstable Cryoprecipitate [> Contains high > Allergic and febrile | __> Transfuse with (10-20 ml) concentration of reactions are a filter fibrinogen and ‘common > Use anti hemophilic > Transfusion component factor( factor Vil) transmitted drip set or > May transmit diseases. syringe infections > Infuse within 4 hours after preparation > Administer over 30-60 minutes Albumin(50 mi) | > Expands blood > Risk of circulatory > Use volume rapidly overload administration > Increases plasma | > No risk of infection set provided albumin level > 25% albumin > Does not give at 1 transmit ml/min, infection > Give as quickly as possible ifPlasma protein | fraction (Plasmanate) "Expands blood patient is in shock Volume rapidly Increases plasma albumin level Does not transmit infection Clotting actors (fibrinogen)(10 ml) immune globulins, gamma- globulin, hepatitis B globulin Used to prevent or treat bleeding ‘Monitor blood volume ‘Administer IM Used to treat paar exposure to hepatitis A or B