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Slide 2 Blood Administration Slide 3 Your patients Hgb & HCT is 6.2 & 18.4; the doctor orders 3 units of packed RBCs! What actions do you take? Slide 4 Blood Administration Right If you said: Check for T&C Verify informed consent Insure IV access; need large bore catheter (18-20 gauge); smaller bore can cause destruction of RBCs Gather equipment: Y-tubing blood administration set with filter NS solution IV pump Prime tubing with Normal Saline. Slide 5 What is T&C vs T&S What does TYPE mean? What does crossmatch mean? T&S chance blood will be needed allows blood bank to be flexible with blood T&C pt will need blood ties up inventory, blood is set aside for that particular patient for 3 days How long are they good for? Why? Slide 6 Blood Administration Objectives Discuss: Common blood products Steps in blood administration Complications of blood administration Slide 7 Types of Blood Components Types of Blood Components Whole Blood Whole Blood To replace blood volume and O2 carrying capacity in To replace blood volume and O2 carrying capacity in Treat hemorrhage and shock Treat hemorrhage and shock Contains PRBC, plasma proteins, clotting factors and plasma Contains PRBC, plasma proteins, clotting factors and plasma (few platelets & granulocytes) Volume = 500ml/unit __________________ Packed Red cells (PRBCs) Packed Red cells (PRBCs) Treat anemia, replace blood volume ( ordered when Hgb 8-9 & HCT 24-27 ) Treat anemia, replace blood volume ( ordered when Hgb 8-9 & HCT 24-27 ) 1 unit PRBC = Hgb by 1/HCT by 3 1 unit PRBC = Hgb by 1/HCT by 3 From whole blood (2/3 of plasma removed) From whole blood (2/3 of plasma removed) Only RBCs used Only RBCs used Purpose: O2 carrying capacity in patients with slow bleeding, anemia, leukemia, surgery Purpose: O2 carrying capacity in patients with slow bleeding, anemia, leukemia, surgery Volume = 300-350ml/unit Risks & Benefits Risks & Benefits Possible incompatibility issues Possible incompatibility issues Circulatory overload Circulatory overload **Deficient in some clotting factors **Deficient in some clotting factors Rarely used Rarely used Use Lasix to prevent overload Use Lasix to prevent overload________________ Risks & Benefits Use leukocyte poor red cells or leukocyte filter if history of febrile reaction Use leukocyte poor red cells or leukocyte filter if history of febrile reaction No viable platelets or granulocytes No viable platelets or granulocytes Incompatibility may cause hemolytic reaction Incompatibility may cause hemolytic reaction Less chance of fluid overload than whole blood Less chance of fluid overload than whole blood Takes 4-6 hours for Hgb & HCT to change Takes 4-6 hours for Hgb & HCT to change Shelf life: 42 days Shelf life: 42 days (takes 1 day to process) (takes 1 day to process) Most commonly used!! Most commonly used!! Slide 8 Current Blood Preparation Leukocyte reduction prior to storage Leukocyte reduction prior to storage Removal of most WBCs and Plasma reduces the risk of reactions Removal of most WBCs and Plasma reduces the risk of reactions Irradiated Irradiated for those with CA or risk for GVHD for those with CA or risk for GVHD good for 28 days good for 28 days Drawback Drawback bacterial growth if contaminated during collection/processing bacterial growth if contaminated during collection/processing Slide 9 Types of Blood Components Cont Platelets Platelets To control or prevent bleeding in platelet deficiencies, i.e. thrombocytopenia To control or prevent bleeding in platelet deficiencies, i.e. thrombocytopenia (ordered when platelets count Hemolytic/Transfusion Reaction ! Hemolytic/Transfusion Reaction ! Hemolytic/Transfusion Reaction ! Hemolytic/Transfusion Reaction ! Most dangerous! Develops within first 15 minutes of transfusion: free hemoglobin in blood and urine specimens provide evidence of acute hemolytic reaction; delayed at 2-14 days Develops within first 15 minutes of transfusion: free hemoglobin in blood and urine specimens provide evidence of acute hemolytic reaction; delayed at 2-14 days Occurs in 1:25,000 Occurs in 1:25,000 Usually occurs after 50-100 ml blood infused! ( possibly 200mls) Usually occurs after 50-100 ml blood infused! ( possibly 200mls) ABO/Blood incompatibility *RBCs clump (lysis of RBCc), block capillaries, decrease blood flow to organs. *RBCs clump (lysis of RBCc), block capillaries, decrease blood flow to organs. Hgb released (myogloburia), blocks renal tubules > acute renal failure=ATN (acute tubular necrosis) Hgb released (myogloburia), blocks renal tubules > acute renal failure=ATN (acute tubular necrosis) Potassium released Potassium released Fever/chills SOB/dyspnea/wheezing Apprehension Headache/low back pain Chest pain/chest tightness Urticaria Tachycardia N&V Hematuria Burning at IV site Slide 37 Hemolytic/Transfusion Reaction! Hemolytic/Transfusion Reaction! If hemolytic reaction occurs: Stop transfusion, keep IV line open with new tubing, saline, colloid solution to maintain BP; monitor Notify MD of patient signs and symptoms Treat shock (anaphylactic) if present (epinephrine, oxygen, antihistamines, vasopressors, fluids, corticosteroids) Draw blood samples for serologic testing; send urine to lab and return blood tubing to blood bank for free Hgb testing Prevent acute renal failure: give diuretic, fluid challenge Stop the blood, send tubing and remaining blood to lab; urine to lab! Follow facility policy and procedure for administering blood, blood products and transfusion reaction! Slide 38 ABO incompatibility causes RBCs to clump, block capillaries, decreasing blood flow to organs. ABO incompatibility causes RBCs to clump, block capillaries, decreasing blood flow to organs. Slide 39 Hgb is released blocking renal tubules Can cause renal failure. Impact of K+ ? Hemolytic Reactions Hemolytic Reactions Slide 40 Key Indicators: Apprehension Fever/chills Apprehension Fever/chills Headache Burning at IV site Headache Burning at IV site Chest pain Low back pain Chest pain Low back pain Tachycardia Hypotension Tachycardia Hypotension Urticaria Urticaria N/V N/V Acute-usually occurs after Acute-usually occurs after 50 ml. infused 50 ml. infused Lewis can occur within infusion of as little as 10mls Lewis can occur within infusion of as little as 10mls Slide 41 Circulatory overload Circulatory overload Fluid given too fast & too much Fluid given too fast & too much Note cough, dyspnea, lung sounds, HTN etc Note cough, dyspnea, lung sounds, HTN etc Slow infusion, elevate HOB, treat overload, phlebotomy Slow infusion, elevate HOB, treat overload, phlebotomy Iron overload Iron overload Delayed reaction Delayed reaction Vomiting diarrhea, hypotension, altered hematological values Vomiting diarrhea, hypotension, altered hematological values Administer deferoxamine (Desferal) Iv to remove accumulated iron via the kidneys (urine red) Administer deferoxamine (Desferal) Iv to remove accumulated iron via the kidneys (urine red) Reactions/Complications Slide 42 Nursing actions if reaction occurs Stop transfusion immediately Stop transfusion immediately Continue N/S IV with new tubing Continue N/S IV with new tubing Provide appropriate care for client Provide appropriate care for client Notify physician of client signs and symptoms Notify physician of client signs and symptoms Follow facility policy and procedure Follow facility policy and procedure Obtain urine specimen for free hemoglobin test Obtain urine specimen for free hemoglobin test Slide 43