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What is Blood transfusion?
Introduction of whole blood or components into the venous circulation Blood Transfusions can save LIVES ! A mainstay in the treatment of patients whose low blood count can compromised their lives Carries risk in various degrees of transfusion reactions as well as transmission of blood-borne pathogens
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Purposes of Blood Transfusion To restore blood volume after severe hemorrhage To restore the capacity of the blood to carry oxygen To provide plasma factors (antihemophilic factor . factor VIII) or platelet concentrates which prevent bleeding 1/30/2011 v3/CoN/CvSU 4 .
B . The presence of a specific antigen in the erythrocytes¶ surface determines the blood type of the person Antigens can cause antibody reactions when in contact with mismatched blood Mismatched blood can cause a hemolytic reaction 1/30/2011 v3/CoN/CvSU 5 . AB and O.Blood groups Human blood is classified into 4 groups Blood type A.
Rh Factor Rh or Rhesus factor was discovered in 1940 Rh antigens are also present in the surface of erythrocytes Present in about 85% of the population Can cause hemolytic reactions in persons with antibody to that antigen Referred to as Rh positive or Rh negative 1/30/2011 v3/CoN/CvSU 6 .
Blood Products for Transfusions BLOOD COMPONENTS 1/30/2011 v3/CoN/CvSU 7 .
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) and plasma One unit of whole blood is 500 ml Replaces blood volume and blood products: ( RBCs.Whole blood Includes all the blood cells ( RBCs. plasma protein. WBCs. plasma. fresh platelets and other clotting factors Primarily used for cardiac surgery or acute hemorrhage 1/30/2011 v3/CoN/CvSU 9 .
Packed Red blood cells PRBCs are left after the plasma is separated out of whole blood Used for routine blood replacement during surgery Used to increase the oxygen.carrying capacity of blood in anemias and disorders with slow bleeding 1 unit raises hematocrit by approx 4 % 1/30/2011 v3/CoN/CvSU 10 .
Platelets May come as a single unit from multiple donors or multiple units from a single donor Used in patients with bleeding disorders from illness. trauma or organ dysfunction or with platelet deficiency Fresh platelets are most effective 1/30/2011 v3/CoN/CvSU 11 . medications.
Plasma Expands blood volume and provide clotting factors No need to be typed and crossmatch 1/30/2011 v3/CoN/CvSU 12 .
Albumin A protein manufactured by the liver Blood volume expander and provides plasma proteins Maintains osmotic pressure that causes fluid to remain within the bloodstream instead of leaking out into the tissues Needs to be transfuse if albumin gets low Is not a component that must be cross-matched but is considered as a blood product v3/CoN/CvSU 13 1/30/2011 .
Clotting factors and cryoprecipitate Obtained by slowly thawing a unit of FFP or fresh frozen plasma ³Cryo´ is the recovered cold precipitate which is rich in certain clotting factors Used for clients with clotting factor deficiencies ( factor VIII and XIII) and those with DIC syndrome 1/30/2011 v3/CoN/CvSU 14 .
Transfusion Reactions 1/30/2011 v3/CoN/CvSU 15 .
Transfusion Reactions Blood from the donor and from the recipient are tested for compatibility Referred to as typing and crossmatching Used to assess a client closely for transfusion reactions 2 types of transfusion reaction: Hemolytic Nonhemolytic 1/30/2011 v3/CoN/CvSU 16 .
backache. dyspnea. Keep the vein open with normal saline or accdg to agency protocol 3. fever. and a urine sample to the laboratory 4. headache. Hemolytic Reaction Incompatibility between client¶s blood and donor¶s Clinical signs: Chills.I. Monitor vital signs 1/30/2011 v3/CoN/CvSU 17 6. Monitor intake and output .Discontinue the transfusion immediately 2. a sample of the client¶s blood . Notify the physician immediately 5. hypotension Nursing intervention 1. Send the remaining blood. cyanosis. tachycardia . chest pain.
II. Nonhemolytic reactions Febrile reactions Allergic reactions Fluid overload Sepsis 1/30/2011 v3/CoN/CvSU 18 .
platelets. Notify the physician 1/30/2011 v3/CoN/CvSU 19 . Give antipyretics as ordered 3. headache. Discontinue the transfusion immediately 2. flushed skin. anxiety. or plasma proteins Clinical signs: chills.Febrile reactions Febrile reactions Sensitivity of the client¶s blood to white blood cells. warm. muscle pain Nursing intervention 1.
administer medication (antihistamine) as ordered v3/CoN/CvSU 20 1/30/2011 . depending on agency protocol 2. urticaria.Allergic reactions (mild) Sensitivity to infused plasma proteins Clinical signs: flushing. stop or slow the transfusion. bronchial wheezing Nursing intervention 1. notify the physician 3. itching.
chest pain. Administer CPR if needed 5.Allergic reactions (severe) Antibody-antigen reactions Clinical signs: dyspnea. Monitor vital signs. Keep the vein open with PNSS 3. Notify the physician immediately 4. Administer medications and/or oxygen as ordered 1/30/2011 v3/CoN/CvSU 21 . stop the infusion 2. cardiac arrest Nursing intervention: 1. circulatory collapse .
distended neck veins.Circulatory Overload When blood is administered faster than the circulation can accommodate Clinical signs: cough. tachycardia.with feet dependent 2. Stop or slow the transfusion 1/30/2011 v3/CoN/CvSU 22 . Place the client upright . Notify the physician 4. dyspnea. Administer diuretics and oxygen as ordered 3. hypertension Nursing intervention: 1.crackles (rales).
diarrhea. Stop the infusion 2. Send the remaining blood to laboratory 3. antibiotics 1/30/2011 v3/CoN/CvSU 23 . hypotension Nursing intervention 1. Administer IV fluids. vomiting . Notify the physician 4.Sepsis Contaminated blood administered Clinical signs: High fever. Obtain a blood specimen from the client for culture 5. chills.
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Blood Administration 1/30/2011 v3/CoN/CvSU 25 .
a unit f PRBC is 200-250 mL Ensure that blood is typed and cross matched properly Blood administration is not delegated to a UAP.Important considerations Gather the pertinent data. schedule the administration (usually 30 minutes prior to transfusion) v3/CoN/CvSU 26 1/30/2011 . place the blood in a tray covered with a towel One unit of whole blood is 500 mL. but UAP must know the complications or adverse effects of blood transfusion and report it to the nurse Note any premedication ordered by the physician. know the purpose of the transfusion Confirm the physician¶s order for the number and type of units and the desired speed of infusion Obtain blood in plastic bag from the blood bank.
g 19 in some agencies Alcohol swabs Tape Sterile gloves v3/CoN/CvSU 27 1/30/2011 . or other component Blood administration set with 170-200 u filters Supplemental blood filters . packed RBCs. if needed IV pump if needed 250 ml normal saline for infusion IV pole Venipuncture start kit ( including a gauge 20 needle or catheter).Equipment Unit of whole blood.
Equipment 1/30/2011 v3/CoN/CvSU 28 .
check whether the needle is appropriate to administer blood 1/30/2011 v3/CoN/CvSU 29 .Preparation Verify client consent and obtain baseline data before the transfusion Assess vital signs for baseline date Determine any known allergies or previous reactions to blood Note specific signs related to the client¶s pathology and the reason for the transfusion Establish the intravenous line.
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Check the client¶s identification. Provide for client privacy and prepare the client. start the saline solution 1/30/2011 v3/CoN/CvSU 31 . ensure the right patient Assist the client in a comfortable position. why it is necessary and how she can cooperate. ensure that blood filters inside the drip chamber is suitable for the blood component Put on gloves. expose the IV site but provide for client privacy Wash hands and observe appropriate infection control procedures Prepare the infusion equipment. close all clamps on the Y-set Insert the piercing pin (spike) into the saline solution and hang on IV pole about 36 inches above the venipuncture site Prime the tubing.Preparing the IV infusion Explain to the client what you are going to do.
blood donor number and expiration date of the blood Observe the blood for abnormal color. gas bubbles and extraneous material Compare the laboratory blood bag label with client¶s data If any information does not match exactly. notify the charge nurse and the blood bank v3/CoN/CvSU 32 1/30/2011 .Performance Obtain the correct blood component for the client. blood type and Rh group. clumping. ID no. check the physician¶s order with the requisition Check the requisition form and the blood bag label with a lab tech or according to agency policy Check the client¶s name.
Important considerations Make sure that RBC are left at room temperature for no more than 30 minutes before starting the infusion If the start of the transfusion is unexpectedly delayed return the blood into the blood bank Do not store blood in the unit refrigerator DO NOT ADMINISTER BLOOD UNTIL DISCREPANCIES ARE CORRECTED OR CLARIFIED 1/30/2011 v3/CoN/CvSU 33 .
open the upper clamp below the blood bag. closed the upper clamp below the IV saline solution.Prepare for transfusion Invert the blood bag gently several times to mix the cells with the plasma Expose the port on the blood bag by pulling back the tabs Insert the remaining Y spike into the blood bag Suspend the blood bag Establish the blood transfusion. readjust the flow rate with the main clamp Run the blood slowly for the first 15 minutes at 20 drops/ minute Observe the client closely for the first 15 minutes Note any adverse reactions and remind the client to call a nurse immediately if any unusual symptoms are felt during the transfusion v3/CoN/CvSU 34 1/30/2011 .
Document relevant dta Record starting the blood. type of blood. blood unit. 1/30/2011 v3/CoN/CvSU 35 . including vital signs. site of venipuncture. sequence number. size of the needle and drip rate.
depending on the health status Terminate the infusion if no infusion is to follow Discard the administration set according to agency policy Fill in the time the transfusion was completed on the requisition or monitoring sheet and the amount transfused Document relevant data v3/CoN/CvSU 36 1/30/2011 .Care of the client Monitor the client fifteen minutes after initiating the transfusion Establish the required flow rate if there are no signs of reaction Do not transfuse a unit of blood for longer than 4 hours Assess the client including V/S every 30 minutes or more often.
10 ml /minute 1/30/2011 v3/CoN/CvSU 37 . Do not refrigerate platelets and keep them agitated at all times Fresh frozen plasma: 200 to 250 mL/unit. at 5. infuse within 24 hours of thawing .Variation: Infusing other blood components Platelets: pooled platelets usually contain 200 ± 400 mL.
et al Brunner and Sudarth Medical.References: Clinical Nursing Techniques :Kozier et al Contemporary Medical-Surgical Nursing: Daniels.Surgical Nursing : Smeltzer and Bare 1/30/2011 v3/CoN/CvSU 38 .
Thank you« Vina Virgo-Velasco RN 1/30/2011 v3/CoN/CvSU 39 .
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