Blood tranfusion doc PDF

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Little summary guide for blood tranfusions ...

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BLOOD TRANFUSIONS INDICATIONS FOR BLOOD TRANFUSION Blood transfusions are indicated for the client who has hypovolemia secondary to hemorrhage, anemia or another disease process that is associated with a deficiency in terms the client's clotting or another component of blood. BLOOD PRODUCTS: 

Packed red blood cells: Packed red blood cells are used when the client is in need of increased oxygen transporting red blood cells as may occur post operatively and with an acute hemorrhage.

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Platelets: Platelets are administered to clients who are adversely affected with a platelet deficiency or a serious bleeding disorder, such as thrombocytopenia or platelet dysfunction that requires the clotting factors that are in platelets.

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Fresh frozen plasma: Fresh frozen plasma, which does not contain any red blood cells, is administered to clients who are in need of clotting factors or are in need of increased blood volume as occurs with hypovolemia and hypovolemic shock. Fresh frozen plasma does not have to be typed and cross matched to the client's blood type because plasma does not contain antigen carrying red blood cells.

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Albumin: Albumin is administered to clients who need expanded blood volume and/or plasma proteins.

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Clotting factors and cryoprecipitate: Clotting factors and cryoprecipitate are administered to clients affected with a clotting disorder including the lack of fibrinogen.

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Whole blood: Whole blood is typically reserved for only cases of severe hemorrhage. Whole blood contains clotting factors, red blood cells, white blood cells, plasma, platelets, and plasma proteins

BLOOD TRANFUSIONS GATHER EQUIP Blood order sheet - Equipment required to initiate an IV of normal saline. - A blood transfusion giving set An infusion pump. A blood warmer may also be required. - 18 gauge catheter Gloves and any other appropriate PRE-TRANFUSION Two clinicians must complete the patient and blood product identification check at bedside 1. Establish therapeutic interaction. 2. Check patient ID and blood order again. 3. Check for allergies. 4. Ask patient about past reactions to blood transfusions. 5. Explain the procedure to the patient. 6. Alert them re signs to report.

- Complications 1. Allergic Reaction – it is caused by sensitivity to plasma protein of donor antibody, which reacts with recipient antigen. Assess for: Flushing, Rash, hives, Pruritus, Laryngeal edema, difficulty of breathing 2. Febrile, Non-Hemolytic – it is caused by hypersensitivity to donor white cells, platelets or plasma proteins. This is the most symptomatic complication of blood transfusion Assess for: Sudden chills and fever, Flushing, Headache, Anxiety 3. Septic Reaction – it is caused by the transfusion of blood or components contaminated with bacteria. Assess for: Rapid onset of chills ,Vomiting, Marked Hypotension, High fever 4. Circulatory Overload – it is caused by administration of blood volume at a rate greater than the circulatory system can accommodate. Assess for: Rise in venous pressure, Dyspnea, Crackles or rales,Distended neck vein, Cough, Elevated BP 5. Hemolytic reaction – it is caused by infusion of incompatible blood products Assess for: Low back pain (first sign). This is due to inflammatory response of the kidneys to incompatible blood, Chills, Feeling of fullness, Tachycardia, Flushing, Tachypnoea, Hypotension, Bleeding, Vascular collapse, Acute renal failure Ensure informed consent is obtained RN collects blood, performs checks with another nurse. Blood checks: group, Rh factor, expiry date, delivery time, ID number. Any discrepancies – do not administer. Perform hand hygiene. Establish an IV infusion with normal saline. NS is compatible with blood, so will not cause RBC lysis or clumping. 13. 18-20 gauge cannula. 14. Obtain a baseline set of observations. 15. Record any rashes or other pathology noted prior to commencing the transfusion 7. 8. 9. 10. 11. 12.

BLOOD TRANFUSIONS TRANFUSION PROCEDURE 1. Invert the bag several times (whole blood). 2. Stop the normal saline infusion. 3. Swab, then stab the port on blood bag. 4. Prime the line. 5. Program the infusion pump. 6. Attach the line to the cannula. 7. Commence the infusion slowly. 8. Remain with patient 15-30 mins. 9. Put blood ID label on patient document. 10. Continue to monitor the patient. 11. Obs every 15 minutes for first hour, then every 30 minutes (check policy and use clinical reasoning). 12. Delivered over 90 minutes to four hours. POST TRANFUSION: - Don gloves or other appropriate PPE. - When transfusion is complete, flush the line with saline to ensure all blood is transfused. Disconnect the blood unit and giving set. Check policy re retention of blood unit. Discontinue IV if no further IV solutions to be delivered. Continue to monitor the patient 1/24 for four hours, then 4/2 - Complete required paperwork....