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Blood Administration
Your patients Hgb &
HCT is 6.2 & 18.4; the
doctors orders 3 units
of packed RBCs!
What actions do you
take first?
Blood Administration
Right If you said:
Check for T&C
Verify informed consent
Insure IV access; need large
bore catheter (18-20 gauge);
smaller cause destruction of
RBCs
Gather equipment:
Y-tubing blood
administration set with filter
NS solution and pump
Prime tubing with saline.
Blood Administration
Learn:
Common blood products
Steps in blood
administration
Complications of blood
administration
*Transfusion reactions
Circulatory overload
Septicemia
Iron overload
Disease transmission
Whole blood:
Replace blood volume
Inc. O2 carrying capacity in
hypovolemic shock
Contains RBCs, plasma proteins,
clotting factors and plasma
Few platelets or granulocytes
Platelets:
To control, prevent bleeding in
platelet dysfunction,
thrombocytopenia
Vol. 250-300 cc
Only RBCs used (remaining platelets,
albumin, plasma used for other
purposes)
Less chance for fluid overload!
*Ordered when HGB 8-9 and HCT 24-27;
each unit inc. HGB by 1g/dl & HCT by 3
takes 4-6 hrs for lab values to chg.
No viable platelets or granulocytes
Vol. 500 cc
Danger of fluid overload and
incompatibility
Deficient in some clotting factors
Rarely used!
Albumin-Plasma derivative
Prepared from plasma
Volume expander
Use for clients who are 3rd spacing
and hypovolemic (hyperosmolar
solution moves water from
extravascular space to
intravascular space)
Outcome: adequate BP and
volume
!
Cryprecipitates- Clotting factors VIII,
Xiii< von Willebrands factor & fibrinogen
from plasma and commercial
concentrates
Prepared from fresh frozen plasma
Store for 1 year, once thawed, must be
used.
Prothrombin complex-Prothrombin,
factors Vii, IX, X and part of Xi
WBCs or Granulocytes
Improvement of infection
Autotransfusion;
Cell-saver" technology
collects blood lost during
surgery, cleanses it, and
places it back in the
patient's body, all in a
continuous loop.
Compatibility Chart
Recipient
Donor
A B AB
A
X
X
B
X X
AB
X
O
X X X X
Initiation of
Transfusion
Verify informed consent for blood
Check physicians orders
ID patient, draw blood for T&C in red top tube;
start 18-20 gauge IV (if not already done), place
blood band and label tube. Blood tubing & 0.9NS
IV fluid ready!
T&C to lab!
Cont***
Verify identification!
Example of filters
Use appropriate
filters
Platelet filter:
Patient protection against
leukocyte-related transfusion
complications
Primes directly with platelets
quickly and conveniently
High platelet recovery achieved
without saline flush
Critical Points
Client identification and blood compatibility!
Drip rate no higher than 2 cc per minute X 15
minutes (25-50 cc)
Remain with pt for first 15 minutes
*Vital signs prior to administration, in 15 minutes,
then q 30 minutes, until transfusion complete--then X
2
No meds or fluid other than NS to be given in line
with blood (Saline ONLY)!!!
*Do not allow blood to hang no longer than 4 hours (longer time,
greater chance of bacterial contamination/septicemia)
If multiple units being given for rapid blood loss; may have to
give under pressure and warm blood prior to administration (only
agency approved warming devices)
1.
cells.unable to initiate an IV access. What actions
should you take?
Ask An
Expert
Return
Double
Click to blood bank within 20 minutes if left out
longer run risk of bacterial growth and sepsis; get
help with starting IV (should have started IV before
requestingplan ahead) blood)
Ask An Expert
Double Click
3.
this unit of blood is anticipated?
Ask An Expert
Double Click
Transfusion
Reactions/Complications
Febrile (most common)
Sensitization to donor WBC,
platelets, plasma proteins
Bacterial (pyrogenic or sepsis) (not in
text)
Transfusion of bacterially infected
components
Transfusion Reactions
Blood transfusion reaction: adverse reaction to
blood therapy: range from mild symptoms to life
threatening; can be acute or delayed!
What vital signs would you expect to see?
Ask An Expert
Vital signs taken prior to start of infusion critical; may
actually give blood even if patient has slight temp
elevation; must inform MD and Tylenol might be
administered!
Febrile
Caused by leukocyte
incompatibility; sudden
onset: usually within first 15
minutes of transfusion!
Fever/chills (^1 degree)
Sensations of Cold
Hypotension/Shock
Flushed skin, abdominal
pain, vomiting and diarrhea
**Bacterial (pyrogenic): similar
Mild (initially)
*Urticaria
Pruritis
Itching
Severe (text does not
include this description)
Wheezing
Dyspnea
Bronchospasm
Swelling of tongue,
face
Shock, pulmonary
edema
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 214 days
Occurs after 100-200 ml blood infused!
Blood incompatibility
*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)
Fever/chills
SOB/dyspnea/wheezing
Apprehension
Headache/low back pain
Chest pain/chest
tightness
Urticaria/tachycardia
*Hematuria
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 testing
Prevent acute renal failure: give
diuretic, fluid challenge
Reactions/complications
*Circulatory overload
Fluid given too fast & too much
Note cough, dyspnea, HTN, etc
Slow infusion, elevate HOB, treat overload,
phlebotomy
Iron overloaddelayed reaction
Vomiting diarrhea, hypotension, altered
hematological values
Administer deferoxamine (Desferal) Iv to remove
accumulated iron via the kidneys (urine red)
Hypocalcemiacitrate in blood binds with calcium & is excreted
Check lab values
Also hyperkalemia: stored blood liberates potassium
through hemolysis (older blood greater risk for
hemolysis)
Review
What is the purpose of administering
Good job
blood and blood components?
A.
treat hypervolemia.
NOBlood and its components increase intravascular volume, not
decrease. In fact, a potential complication with the administration of
blood when given too rapidly is hypervolemia.
or False
Hemophilia
B.
Thrombocytopenia
C.
Polycythemia
polycythemia No Polycythemia is the presence of excess
RBCs; administration of platelets would not decrease the
abnormal amount of RBCs in fact would cause increased
problemsincreased viscosity and more likely to form clots.
Good job
D.
Congratulations on Your
Successful Completion!