67585737 8 Blood Transfusion

8/11/2019 67585737 8 Blood Transfusion

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White bloo d cells

Platelet s
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BLOOD

A mixture of cells

A complex TRANSPORT mechanism Transports hormones

Removes waste products

Regulates body temperature Protects the body

Promotes hemostasis

Supplies oxygen


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BLOOD VOLUME: 8% of total body weight = varies by age & body composition

BloodVolume

Kilograms ofBody Weight

30 kg = 2400mL

80 mL/kgChild

3 kg = 255 270 mL

85 90mL/kg

Neonate

60 kg = 4200mL

70 mL/kgAdultFemale

90 kg = 6300mL

70 mL/kgAdult Male

Blood VolumemL/kgCategory


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COMPOSITION OF BLOOD Temperature 38 C (100.4 F) pH 7.35 - 7.45 Specific Gravity 1.048 1.066 Body weight 7% 5 times the viscosity of water Volume

Male 5 6 Liters Female 4 5 Liters


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Composed of: 55% plasma 45% cellularcomponents

Plasma = fluid portion Coagulation factors Inorganic substances Antibodies

RED BLOOD CELLS

GRANULOCYTES

PLATELETS

PLASMA

Portions of the Blood


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Liquid part of the blood

Consists of serum and fibrinogen

Contains plasma proteins such as:

Albumin = regulates & maintains Serum globulins = for transportation Fibrinogen, prothrombin, plasminogen = to stop the

bleeding

Plasma
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Cellular Components Formed elements of blood

RBC = responsible for oxygen transport

WBC = play a major role in defense againstmicroorganisms

Platelets = function in hemostasis
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Blood: An Emotional Topicthe sweeping story of a

substance that has been feared,revered, mythologized, andused in magic and medicine

from earliest times asubstance that has become thecenter of a huge, secretive, and

often dangerous worldwidecommerce.

From the publishers description of the book


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TRANSFUSION Refers to the administration of any of

several blood products.
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Blood Transfusion may be necessary for anyof the following reasons:

Hemorrhage (blood loss) caused by trauma orhigh blood loss surgery

Red cell destruction

Decreased red cell production


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National Blood Services Act of 994

Also known as the Republic Act 7719 AN ACT PROMOTING VOLUNTARY BLOOD DONATION

PROVIDING FOR AN ADEQUATE SUPPLY OF SAFE BLOOD,REGULATING BLOOD BANKS, AND PROVIDING PENALTIES FORVIOLATION THEREOF.


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Who C N and C NT give Blood

Eligible Donors Must:

Be at least age 18 Weigh at least 110 lb (50 kg) Free from skin disease Not have donated in the past 56 days Have a hemoglobin level of at least 12.5 g/dl

(women) or 13.5 g/dl (men)


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Ineligible Donors include those:

Who have HIV or AIDS Who have taken illegal drugs I.V. Who have had sex with prostitutes in the past

12 months Who have had sex with anyone above

categories Who have had hepatitis With certain types of cancer (other than

minor skin cancer) With hemophilia Who have received clotting factor

concentrations


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Blood Collection Methods 3 Types of Blood Donor Sources for Routine

Blood Collection:

Unrelated Donor (Allogeneic) Directed Donor

Autologous Donor (Self)


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NURSES MUST BE: Knowledgeable about blood products

Safe administration

How to monitor patients before , during andafter therapy


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Assure that informed consent has been obtained before starting a transfusion.

Appropriate information to include in patient educationincludes: Benefits Risks

Alternatives to transfusion

Document all patient education regarding transfusiontherapy , and the responses of patients and familymembers after teaching.

NURSES MUST BE:


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Patient Education Provide patient and family information to blood transfusion

therapy: The need for blood transfusion Advantages of blood transfusion Possible reactions related to the blood transfusion therapy Voluntary blood donation act


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Transfusion Precautions Dont add medications to the blood.

Dont transfuse the blood product if you discover adiscrepancy in the blood number, blood slip type, or

patient identification number. Dont piggyback blood into the port of an existing

infusion set.


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Stop transfusion if your patient shows :

Shows changes in vital signs

Is dyspneic or restless

Develops chills , hematuria , or pain in the

flank, chest or back


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BEFORE TRANSFUSION When assessing your patient before a

transfusion:

Obtain important medical history information Review pertinent laboratory values

Review the doctors order, including any specialprocessing requested

Perform physical assessment


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When you received the delivery from the blood bank,you should receive both the product and thetransfusion record that corresponds to it.

Inspect for the following:

Labels

Integrity of Unit

Appearance


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Perform the verification process to ensure the correct blood is being given to the correct patient .

Two qualified individuals should verify the patient and unitidentification.

Assess the patency of the patients vascular access.

Check and recheck vital signs 15 minutes after starting thetransfusion.


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DURING TRANSFUSION Administer the blood or component at the

recommended rate .

Stay with the patient for the first fewminutes of the transfusion

Review signs and symptoms of what thepatient should report to you.


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Discontinue transfusion immediatelyonce the patient manifest symptoms of

transfusion reaction, assess the patientand notify the doctor.

Finally, document the transfusion in thepatients chart .


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AFTER TRANSFUSION Continue to monitor patient for any signs and

symptoms of reaction for at least one hourafter the transfusion.

Obtain any ordered post-transfusionlaboratory studies.


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BloodProducts

Indications Nursing Considerations

WholeBlood

To restore bloodvolume inhemorrhaging,trauma, or burn

patients

Dont infuse over more than 4hours. Warm blood if giving a largequantity. Avoid giving when the patientcant tolerate the circulatingvolume.

PRBC To restore ormaintain oxygen carrying capacity To correct anemiaand surgical bloodloss

Dont infuse over more than 4hours. RBCs have the same oxygen carrying capacity as whole blood,minimizing the hazard of volumeoverload.


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Platelets To treat

thrombocytopenia To treat acute leukemiaand marrow aplasia

ABO compatibility isnt necessary butis preferable with repeated platelettransfusions; Rh type match is preferred. Infuse 100 ml over 15 minutes. Administer at 150 to 200 ml / hour, oras rapidly as the patient can tolerate; dontexceed 4 hours. Avoid administering platelets when the

patient has a fever.

FFP To expand plasmavolume To treat postsurgicalhemorrhage or shock To correct anundetermined coagulation

factor deficiency

Cross matching: ABO compatibility

isnt necessary but is preferable withrepeated plasma transfusions; Rh typematch is preferred. Large volume transfusions of FFPmay require correction for hypocalcemia.

Citric acid in FFP binds calcium.

BloodProducts

Indications Nursing Considerations


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SAFETY PRECAUTIONS

Make sure that YOU are protected too by:

Wear proper Personal Protective Equipment (PPE) Always perform disinfection technique . If possible, use a needleless system. If using sharps, do not recap the needle . Always observe proper waste disposal according to your

institutions policy. If there are spills, never touch the blood with bare hands . Make sure that blood bag is secured. Always double or triple check. Always perform HAND HYGIENE


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Acute Transfusion Reactions usually appearwithin the first 5-15 minutes after thetransfusion is started.

Types of Acute Transfusion Reactions: Acute hemolytic Transfusion Reaction Febrile nonhemolytic Transfusion Reaction Mild allergic (Urticarial) Anapylactic

Transfusion Associated Circulatory Overload Transfusion Related Acute Lung Injury Septic Transfusion Reaction


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Symptoms you might see during an acute transfusionreaction include:

Temperature increase of more than 1 C or 2 F Bloody urine Chills Hypotension Severe low back, flank, or chest pain Low or absent urine output Nausea and vomiting Dyspnea, wheezing Anxiety, "sense of impending doom" Diaphoresis Generalized bleeding, especially from punctures and surgical

wounds.


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WHAT TO DO IF TRANSFUSION REACTIOCCURS

When they do occur, it is usually becauseof ABO incompatibility between patient

and donor during transfusion of red cells.

Ensure that the intended recipient is

getting the intended unit at the time oftransfusion.


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Should any of these symptoms occur, discontinue the unit immediately,hang normal saline (on a new tubing) to maintain vascular access, and callfor assistance.

Closely monitor the patients vital signs and symptoms.

Notify the physician and obtain further orders to address the patientssymptoms.

Recheck the patients identifying information against the transfusion

record and blood bag.

All bags, tubings, filters, and paperwork should be retained and forwardedper hospital policy.


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Infusion device used Flow rate and if blood warming was used Vital signs obtain prior to, during, and after the

transfusion Name of the component, unit number Evidence of possible transfusion reaction.

Document interventions done and to whom you notified. Patients outcome.

Documents

67585737 8 Blood Transfusion