BLOOD TRANSFUSION Review:

-is the infusion of the whole blood or blood

component, such as plasma, red blood
cells, or platelets, into a patient’s venous ANATOMY AND PHYSIOLOGY
circulation.

PURPOSE: Circulatory System

 To replace blood that is lost through
surgery or injury to provide it if your
body is not making blood properly
Common Types of BT:
 Red Blood Cell Transfusion
 Platelet Transfusion
 Plasma Transfusion
-also called the cardiovascular system, is an
organ system that permits blood to circulate
and transport nutrients (such as amino
acids and electrolytes), oxygen, carbon
dioxide, hormones, and blood cells to and
from the cells in the body to provide
nourishment and help in fighting diseases,
stabilize temperature and pH, and maintain
homeostasis.

INDICATIONS:

RBC Transfusion

 For surgical and trauma patients, as

well as people with anemia (such as
dialysis pts). Red blood cells can be
stored and refrigerated for 42 days.

Platelet Transfusion

 To control bleeding. They are given

to help treat leukemia pts and
cancer pts who are undergoing
chemotherapy. Platelets only last 5
days.

Plasma Transfusion

 To treat victims of burn, shock or

dehydration. It can be frozen and
stored for up to one year
3 main parts of
Circulatory System

Blood Products:  Heart

Packed RBC, Platelets, Cryoprecipitate,
Fresh-frozen plasma, Albumin
 a. Size of your fist
b. Made of specialized striated cells
called cardiac muscle
c. Located in the left center of the
chest and protected by the sternum.
d. Divided into 4 chambers. Left and
right atria/ventricles.
 Blood
 Blood vessels- hollow tubes that
circulate your body. VEINS,
ARTERIES, CAPILLARIES.
3 Types of Circulation
> Plasma - is the liquid portion of blood. It
helps support immune system and plays a
critical role in blood clotting to prevent
excessive bleeding.
> Red Blood Cells (Erythrocytes) - the
cells that carry oxygen and carbon dioxide
through the blood.
> White Blood Cells (Leukocytes) – the
cells of the immune system that are
involved in protection the body against both
infectious dse and foreign invaders.
> Platelets (Thrombocytes) – are small
colorless cell fragments in our blood that
form clots and stop or prevent bleeding.

1. Systemic Circulation- largest part of

the circulatory system in which TYPES OF BLOOD
oxygen-rich blood flows to all organs ARTERIES
and body tissues, except the heart,
-are blood
and lungs.
vessels that
2. Coronary Circulation- movement of deliver
blood through the tissues of the oxygen-rich
blood from
heart.
the heart to
3. Pulmonary Circulation- movement of the tissues
blood from the heart, to the lungs, of the body.
and back to the heart again.

BLOOD

-a transport liquid pumped by the heart to all

parts of the body, after which is returned to
the heart to repeat the process.

-is a fluid that transports oxygen and

nutrients to the cells and carries away
carbon dioxide and other waste products.

Blood Components:
 vessels that carry blood towards the heart.
Most veins carry deoxygenated blood from
tissues back to the heart; exceptions are the
pulmonary and umbilical veins, both of
which carry oxygenated blood to the heart.

The most readily accessible artery for blood

donation is the radial artery at the wrist, and
this is indeed almost the only artery that is
available.

VEINS

-are
blood

The most accessible vein for blood

transfusion is the MEDIAN BASILIC or the
MEDIAN CEPHALIC at the elbow
 ASSESSMENT
1. Obtain a baseline assessment of the
patient, including vital signs, heart,
and lung sounds, and urinary output.
2. Review the most recent laboratory
values, in particular, the complete
blood count (CBC).
3. Ask the patient about any previous
transfusions.
4. Inspect the IV insertion site, noting
that the gauge of the IV catheter is a
20 gauge or larger.
Materials:
 Blood product
 Blood administration set (tubing with
in-line filter and Y for saline
administration)
 0.9% normal saline for IV infusion
 IV pole
 Venous access; if peripheral site,
preferably initaiated with a 20 gauge
catheter or larger
 Clean gloves
 Additional PPE, as indicated
 Tape (hypoallergenic)
Procedure:
1. Check the Physician’s order
2. Obtain the blood products from the
laboratory room immediately before
using.
3. Blood should be warm before the
transfusion.
4. Carefully identify the blood before
administration.
5. Wash hands.
6. Gather necessary equipment.
7. Identify the patient.
8. Explain the procedure: the product
to be administered, how long the
blood transfusion will take and tell
the patient to report if he/she
experiences any blood reactions.
9. Take vital signs and record for
baseline data.
10. Wear clean gloves and hang the
blood bag on the IV stand.
11. Prepare the blood and blood set,
12. Close all control clamps on the Y-
set.
13. Insert spike of the administration set
in to the blood bag.
14. Fill the drip chamber half full and
open the clamp by allowing blood to
flow until it reaches on the tip and
reclamp.
15. Keep the set sterile.
16. Prepare the patients arm to be used.
17. Assist the physician in insertion.
18. Give the materials for cleaning the
site, and offer the tourniquet.
19. Once backflow is seen release the
tourniquet and quickly attach the
tubing and open the regulator.
20. Secure the needle with plaster
together with the tubing and place a
splint as necessary.
21. Regulate the number of drops/min
as ordered.
22. Make patient comfortable and give
further instructions on what to watch
and report
23. Do after care.
24. Wash Hands.
25. Do charting (serial number, time
started, rate of flow, amount of blood
and V/S).
 IV THERAPY
-Intravenous Therapy is a medical
technique that delivers a liquid directly into a
person’s vein.
PURPOSE:
 To prevent or correct problems in
fluid and electrolyte balance.
SELECTED IV SOLUTIONS:
Isotonic- used to increase cellular fluid
volume due to blood loss, surgery,
dehydration, fluid loss that has been loss
extracellularly.
 5% dextrose in water (D5W) RED
 0.9% NaCl (normal saline) GREEN
 Lactated Ringer’s solution (PLR)
BLUE
Hypotonic- used to give fluids
intravenously to hospitalized patients in
order to treat or avoid dehydration.
 0.33% NaCl (1/3 strength normal
saline)
 0.45% NaCl (1/2 strength normal
saline)
Hypertonic- used to replace electrolytes, to
treat hypotonic dehydration, and to treat
certain types of shock.
 5% dextrose in 0.45% NaCl
 10% dextrose in water (D10W)
 5% dextrose in 0.9% NaCl (normal
saline)
COMPLICATIONS ASSOCIATED WITH
INTRAVENOUS INFUSIONS:
 Infiltration- the escape of fluid into
the subcutaneous tissue.
- Dislodged needle
- Penetrated vessel wall
 Sepsis- microorganisms invade the
bloodstream through the catheter
insertion site.
- Poor insertion technique
- Multilumen catheters
- Long-term catheter insertion
- Frequent dressing changes
 Phlebitis- an inflammation of a vein
- Mechanical trauma from needle or
catheter
- Chemical trauma from solution
- Septic (due to contamination)
 Thrombus- a blood clot.
- Tissue trauma from needle or catheter
- Speed shock- the body’s reaction to a
substance that is injected into the circ.
system too rapidly
 Fluid overload- the condition
caused when too large a volume of
fluid infuses into the circ. system.
- Too large a volume of fluid infused
into circulation.
 Air embolus- air in the circ. system
- Break in the IV system above the
heart level allowing air in the circ.
system as a bolus.
 10 Rights of Drug
Administration
1. Right Drug
2. Right Patient
3. Right Dose
4. Right Route
5. Right Time and Frequency
6. Right Documentation
7. Right Assessment
8. Right to Refuse
9. Right Evaluation
10. Right Education and Information
ASSESSMENT
1. Review the patient’s record for
baseline data, such as vital signs,
intake and output balance, and
pertinent laboratory values, such as
serum electrolytes.
2. Review assessment and laboratory
data that may influence solution
administration.
3. Assess arms and hands for potential
sites for initiating the IV. Determine
the most desirable vein. The
cephalic vein, accessory cephalic
vein, metacarpal, and basilic vein.
Materials:
 IV solution, as prescribed
 Medication Administration Record
(MAR)
 Gauze pad or disposable pad
 Non-allergenic tape
 IV administration set
 Label for infusion set
 Tourniquet
 Cotton balls w/ alcohol
 Dry cotton balls
 Clean gloves
 PPE, as indicated
 IV pole
 IV catheter or butterfly needle
 Short extension tubing
 Prefilled 2-mL syringe with sterile
normal saline for injection
Procedure:
1. Prepare necessary equipment.
2. Check the doctor’s order
3. Read label on fluid reservoir
carefully.
4. Check fluid reservoir for expiration
date and cloudy solution.
5. Prepare needle (butterfly or IV
catheter)
6. Calculate infusion rate
7. Wash hands
8. Identify the pt and explain the
procedure.
9. Connect tubing to fluid
bottle/reservoir and flush tubing with
fluid removing air from the tubing.
10. Position patient in comfortable
manner.
11. Adjust lighting for good visualization.
12. Choose hand or arm vein
13. Apply tourniquet to arm above the
site
14. Scrub IV site with cotton balls with
alcohol, using and outward circular
motion and let it dry.
15. Hold skin taut over injection site with
thumb and fingers of non-dominant
hand encircling the extremity.
16. Hold needle with bevel up at 45
degrees angle to skin.
17. Pierce skin
18. Lower needle until almost parallel to
skin
19. Pierce vein and advance needle. If
using an IV catheter, slide catheter
into vein while holding the catheter.
20. Once backflow is seen, release
tourniquet.
21. Quickly attach tubing and begin
infusion by opening clamp.
22. Tape needle securely
23. Loop and tape tubing
24. Regulate infusion to previously
calculate drip rate.
25. Label IV tag (date type of solution, #
of drops, time the solution started)
26. Do the after care
27. Record date, time, site, type of
needle or cannula and type of
solution on patient’s chart.
 IV INCORPORATION  Fluid overload- the condition
caused when too large a volume of
- is a medical technique of administering fluid infuses into the circ. system.
drugs to the IV solution or IV line - Too large a volume of fluid infused
into circulation.
attached to the patient’s bloodstream.
 Air embolus- air in the circ. system
- Break in the IV system above the
PURPOSE:
heart level allowing air in the circ.
system as a bolus.
 To administer medication
continuously mixed in the main IV
solution.

10 Rights of Drug Administration

COMPLICATIONS ASSOCIATED WITH

INTRAVENOUS INFUSIONS: 1. Right Drug
2. Right Patient
 Infiltration- the escape of fluid into
3. Right Dose
the subcutaneous tissue.
- Dislodged needle 4. Right Route
- Penetrated vessel wall 5. Right Time and Frequency
6. Right Documentation
 Sepsis- microorganisms invade the
bloodstream through the catheter 7. Right Assessment
insertion site. 8. Right to Refuse
- Poor insertion technique 9. Right Evaluation
- Multilumen catheters 10. Right Education and Information
- Long-term catheter insertion
- Frequent dressing changes

 Phlebitis- an inflammation of a vein

- Mechanical trauma from needle or
catheter
- Chemical trauma from solution
- Septic (due to contamination)
 Thrombus- a blood clot.
ASSESSMENT
1. Assess the patient for any allergies.
2. Check the expiration date before
administering medication.
3. Assess the appropriateness of the

- Tissue trauma from needle or catheter drug for the patient.

- Speed shock- the body’s reaction to a 4. Assess the compatibility of the
substance that is injected into the circ.
system too rapidly orders medication, diluent, and the
infusing fluid.
 5. Review assessment and laboratory 4. Verify for skin test of drug for IV
datd that may influence drug incorporation (if skin testing is
administration. necessary)
6. Assess the patient’s knowledge of 5. Do hand hygiene before and after
the medication. the procedure.
7. Assess the IV insertion site, noting 6. Prepare necessary materials needed
any swelling, leakage of fluid at site, for the procedure.
redness or pain. 7. Disinfect injection port of the vial and
ampule before breaking then
aspirate the right dose aseptically.
Materials:
8. Remove the cover of the
 Prescribed medication incorporated administration set, maintain sterility
either in vial or ampule and incorporate prepared drug into
 Syringe with the needless device or the airway aseptically. Recap airway
blunt needle after.

 Cotton balls with alcohol 9. Swirl the IV bottle to mix the drug

 Dry cotton balls with IVF and regulate the flow rate
accordingly.
 Date label for tubing
10. Observe for 5-10mins for any drug
 PPE, as indicated
interaction while reassuring the
patient; monitor VS.
11. Document the patient’s chart
Procedure:
12. Discard shard and other wastes.
1. Verify the written medication card
against the MD prescription; observe
hospital policy on drug
administration.
2. Observe 10 R’s when preparing and
administering medication.
3. Explain procedure (medication and
action) to reassure patient &
significant others and check patency
and IV site.