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Code 164- PNCM 10912 Skills Laboratory

MODULE 4-Blood Transfusion

Blood Transfusion
Weekly Study and Assessment Guide
 

Day Topic Activities or Tasks

Initiating , Maintaining, and ·         Read the lessons in Module 4

Terminating a Blood
Transfusion Using a Y-Set ·         Actual Discussion
Day 4
  ·         Post test

  ·         Actual Return Demonstration

Content Initiating , Maintaining, and Terminating a Blood Transfusion Using a Y-Set

·         Identify factors affecting normal body fluid, electrolyte, and acid–
base balance.

·         Implement measures to correct imbalances of fluids, electrolytes,

acids, and bases, such blood transfusion.
Learning Outcomes
·         Verbalize the steps used in Initiating, maintaining, and terminating
a blood transfusion using a Y-set.

·                Demonstrate appropriate documentation and reporting of fluid,

electrolyte, and acid–base balance activities.

 LEARNING CONTENT

Blood Transfusion

IV fluids can be effective in restoring intravascular (blood) volume; however, they do not affect the oxygen-carrying capacity of the blood. When
red or white blood cells, platelets, or blood proteins are lost because of hemorrhage or disease, it may be necessary to replace these
components to restore the blood’s ability to transport oxygen and carbon dioxide, clot, fight infection, and keep extracellular fluid within the
intravascular compartment.
A blood transfusion is the introduction of whole blood or blood components into venous circulation.  

Blood Groups: Human blood is commonly classified into four main groups: A, B, AB, and O. The surface of an individual’s red blood cells
contains a number of proteins known as antigens that are unique for each person. Many blood antigens have been identified, but the A, B, and
Rh antigens are the most important in determining blood group or type. Because antigens promote agglutination or clumping of blood cells, they
are also known as The A antigen is present on the RBCs of people with blood group A, the B antigen is present on the RBCs of people with blood
group B, and A and B antigens are both present on the RBCs in people with group AB blood. Neither antigen is present on the RBCs of people
with group O blood. 

Preformed antibodies to RBC antigens are present in the plasma; these antibodies are often called People with blood group A have B antibodies
(agglutinins); A antibodies are present in people with blood group B; and people with blood group O have antibodies to both A and B antigens.
People with group AB blood do not have antibodies to either A or B antigens. These naturally occurring antibodies are responsible for the rapid
and severe reaction that occurs when ABO-incompatible blood is administered.

Rhesus (Rh) Factor: The Rh factor antigen is present on the RBCs of approximately 85% of the people in the United States. Blood that
contains the Rh factor is known as Rh positive (Rh+); blood that does not contain the Rh factor is known as Rh negative (Rh−). In
contrast to the ABO blood groups, Rh− blood does not naturally contain Rh antibodies. However, after exposure to blood containing Rh factor
(e.g., an Rh− mother carrying a fetus with Rh+ blood, or transfusion of Rh+ blood into a client who is Rh− ), Rh antibodies develop. Subsequent
exposure to Rh+ blood places the client at risk for an antigen–antibody reaction and hemolysis of RBCs.

Blood Typing and Crossmatching: To avoid transfusing incompatible red blood cells, both blood donor and recipient are typed and their blood
crossmatched. Blood typing is done to determine the ABO blood group and Rh factor status. This test is also performed on pregnant
women and neonates to assess for incompatibility between their blood types (particularly Rh factor incompatibilities).
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Selection of Blood Donors; Screening of blood donors is rigorous. Criteria have been established to protect the donor from possible ill effects
of donation and to protect the recipient from exposure to diseases transmitted through the blood. Blood donors are unpaid volunteers. Potential
donors are eliminated by a history of hepatitis, HIV infection (or risk factors for HIV infection), heart disease, most cancers, severe asthma,
bleeding disorders, or seizures. Donation may be deferred for people who have malaria, have been exposed to malaria or hepatitis, are anemic,
have high or low BP, have low body weight, or who are pregnant, have had recent surgery, or take certain medications.
Ph: HIV 1 & 2, Malaria, Syphilis, Hep B & C

Blood and Blood Products for Transfusion: Most clients do not require transfusion of whole blood. It is much more common for clients to
receive a transfusion of a particular blood component specific to their individual needs.

Product Use

Not commonly used except for extreme cases of acute hemorrhage. Replaces
Whole blood blood volume and all blood products: RBCs, plasma, plasma proteins, fresh
platelets, and other clotting factors.

Used to increase the oxygen-carrying capacity of blood in anemias, surgery,

and disorders with slow bleeding. One unit of PRBCs has the same amount of
Packed red blood cells oxygen-carrying RBCs as a unit of whole blood. One unit raises hematocrit by
(PRBCs) approximately 2% to 3%.

Storage: +2-+6 C

Used for blood replacement following planned elective surgery. Client donates
Autologous RBCs
blood for autologous transfusion 4–5 weeks prior to surgery

Replaces platelets in clients with bleeding disorders or platelet deficiency. Fresh

platelets are most effective. Each unit should increase the average adult client’s
Platelets platelet count by about 5,000 platelets/microliter

+20-+24 C

Provides clotting factors. Does not need to be typed and crossmatched

(contains no RBCs)
Fresh frozen plasma
Frozen State

Albumin and plasma protein

Blood volume expander; provides plasma proteins.
fraction

Clotting factors and Used for clients with clotting factor deficiencies. Each provides different factors
cryoprecipitate involved in the clotting pathway; cryoprecipitate also contains fibrinogen

Transfusion Reactions: Transfusion of ABO- or Rh- incompatible blood can result in a hemolytic transfusion reaction, which causes destruction
of the transfused RBCs and subsequent risk of kidney damage or failure. To avoid hemolytic transfusion reactions, blood from the donor and from
the recipient is tested for compatibility. This is referred to as a type and crossmatch. Other forms of transfusion reactions may also occur,
including febrile or allergic reactions, circulatory overload, and sepsis.

Administering Blood

Special precautions are necessary when administering blood. When a transfusion is ordered, the nurse or other personnel obtain blood in plastic
bags from the blood bank just before starting the transfusion. One unit of whole blood is 500 mL; a unit of packed red blood cells (RBCs) is 200
to 250 mL. Do not store the blood in the refrigerator on the nursing unit; lack of temperature control may damage the blood. Once blood or a
blood product is removed from the blood bank refrigerator, it must be administered within a limited amount of time (e.g., packed RBCs should
not hang for more than 4 hours after being removed from the blood bank refrigerator). Follow agency policies for verifying that the unit is correct
for the client.

Traditionally, blood has usually been administered through an #18- to #20-gauge IV needle or catheter with the belief being that using smaller
needles may slow the infusion and damage blood cells (hemolysis). However, studies have shown that blood infusions through smaller gauge
catheters can be completed within 4 hours without hemolysis.

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5/19/22, 1:05 PM Code 164- PNCM 10912 Skills Laboratory - https://usl-tuguegarao.neolms.com/student_lesson/show/3431870?from=%2Fstudent…
 

INITIATING, MAINTAINING AND TERMINATING A BLOOD

TRANSFUSION USING Y- SET

PREPARATION

1. Gather all materials needed for the procedure.

·         Blood product

·         Blood administration set
·         250ml normal saline for infusion
·         IV pole
·         Venipuncture set containing a #18 or 19 gauge needle or catheter or if blood is to be administered quickly,
a #15 gauge needle or a larger catheter.
·         Chlorhexidine solution
·         Alcohol swabs
·         Tape
·         Clean gloves

2. Assess:

·         Clinical signs of reaction

·         Manifestation of hypervolemia.
·         Status of the infusion rate.
·         Any unusual symptoms.
·         Vital signs for baseline data.

3. Determine:

·         That a signed consent form was obtained.

·         Any known allergies or previous adverse reaction to blood.

PROCEDURE

4. Prepare the client. Introduce yourself and verify the client’s identity.

5. Verify the client’s identity.

6. Set up the infusion equipment.

7. Prime the tubing.

8. Start the saline solution.

9. Prepare the blood bag.

10. Establish the blood transfusion.

11. Observe the client closely for the first 5-10 minutes.

12. Document relevant data. Record:

·         Starting the blood

·         Vital signs

·         Type of blood

·         Blood unit number

·         Sequence number

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5/19/22, 1:05 PM Code 164- PNCM 10912 Skills Laboratory - https://usl-tuguegarao.neolms.com/student_lesson/show/3431870?from=%2Fstudent…
·         Site of the venipuncture

·         Size of the needle

·         Drip rate

13. Monitor the client.

14. Terminate the transfusion.

15. Follow agency protocol for appropriate disposition of the blood bag.

16. Document relevant data.

Record:

·         Completion of the transfusion

·         The amount of blood absorbed

·         The blood unit number

·         Vital signs

·         If the primary intravenous infusion will continue, record connecting it.

·         Also record the transfusion on the IV flow sheet, and intake and output record

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