Blood Transfusion Therapy
What are the seven procedures for hanging blood?
1)Ensure Patent IV 2)Close Y clamps 3)Spike Normal Saline 4)Prime 5)Spike Blood 6)Adjust Flow 7)Medications ? 8)Multiple Units
IV fluid can restore Intravascular volume- but
does not affect Oxygen carrying capacity of the blood.
Why is blood typing done?
done to determine the ABO group and Rh factor
When should vitals signs be taken?
Before infusion, 15 mins after infusion began and at completion
What would happen or occur if a person is given the wrong blood type?
destruction of the RBC's (hemolysis)
What are some reasons that a person may need a blood transfusion.
Blood transfusions given for: trauma, accidents, burns, heart surgery, other surgical losses, organ transplants, leukemia, CA, and sickle cell
ALBUMIN AND PLASMA PROTEIN FRACTION-
Blood volume expander; provides plasma proteins
How long do blood cells live?
4 months
When does a person donate blood for an Autologous red blood cell transfusion?
4-5 weeks before surgery
What are the seven things that should be checked when blood enters the floor?
1. Client's name and Id number Verify the same key transfusion number on the recipient band, on the unit of blood, and on the cross-match form. The armband is applied at the time the blood sample is obtained for type and cross-match. 2. The number on the requisition and number on the bag of blood. 3. Type and Rh 4. Expiration date 5. Inspect for discoloration, gas bubbles, or cloudiness. Return any questionable blood to lab. 6. Date and time indicate blood started time. 7. Two nurses sign requisition form indicating that they have both checked the above
Procedure for Hanging Blood
1. Ensure patent IV 2. Close all clamps on Y tubing 3. Spike 250ml of normal saline. Open clamp and prime tubing and filter by opening lower tubing. 4. Invert bag gently several times to mix cells with plasma. Spike blood bag. Open clamp on blood arm. 5. Adjust flow rate with lower clamp to run at 2ml/min. or 30 gtts./min. for 15 minutes then as MD ordered. 6. No meds are to be given during administration without flushing line with 10ml of Normal Saline before and after medication. Transfusion stopped during this time. 7. If more than 1 unit is to be given flush IV with normal saline between each unit.
For Blood Product Identification The RN must:
1.Check doctor's order against requisition 2.Check requisition form and blood bag label with a lab tech when blood is picked up from lab. Check: Client's name, ID number, blood type, Rh group, blood donor number, and expiration date
A nurse has just received an order to transfuse a unit of packed red blood cells for an assigned client. In planning coverage for the client assignment, the nurse asks if another nurse will be available to check on the other assigned clients for how long went eh unit of blood is hung?
15 mins
How long after a transfusion should a Nurse stay with the patient?
15 minutes
How long do WBC stay?
18-36 and then they are removed.
6. IV started with
19 gauge or larger needle. Y tubing and Normal saline used. LR and D5 never used- they cause clotting
Who must check blood when it arrives on the floor?
2 RNs
The surface of an individual' red blood cells contain a number of proteins known as
Antigens that are unique to each person.
What percent of blood is used?
44% is used and the rest of it is disposed of
What is the longest amount of time that blood should hang?
4hrs
What are the four different human blood types?
A AB B O
What type of tubing is used for a platelet transfusion?
A special transfusion set with a smaller filter and short tubing is used.
What is important in determining blood type or blood group?
A, B, RH Antigens
A nurse has just received an order to transfuse a unit of packed red blood cells for an assigned client. In planning coverage for the client assignment, the nurse asks if another nurse will be available to check on the other assigned clients for how long went eh unit of blood is hung?
A. 5 minutes B. 15 minutes C. 30 minutes D. 45 minutes
Which of the following lab data would indicate a need for possible transfusion of PRBC's?
A. Hbg/Hct = 6.8/ 29 B. Platelet count = 86,000 C. PTT = 74 D. Trauma patient with BP 70/40 and HR 138
Antibodies to these antigens are present in the plasma. For example: Type A people have B antibodies, Type B people have A antibodies, Type O have A and B antibodies and Type AB do not have A or B antibodies.
Antibodies to these antigens are present in the plasma. For example: Type A people have B antibodies, Type B people have A antibodies, Type O have A and B antibodies and Type AB do not have A or B antibodies.
What is the example of documentation?
EXAMPLE: Date and Time-Vital signs: T.98.4, BP 132/86, Pulse 74, R16. First unit of packed RBC's via 18 Angiocath in right forearm. Begun at 20gtts./min. No signs of adverse effects in 15 min. Vital signs:T 98.4, BP136/86, P 76, R 16. Rate increased to 100ml/hour. Patient voiced no complaints. Transfusion completed at 1600, line flushed with 10ml normal saline. No adverse effects noted.
A nurse enters a client' room to assess the client, who began receiving a blood transfusion 45 minutes earlier. The client is flushed and dyspneic. On assessment the nurse auscultates the presence of crackles in the lung bases. The nurse determines that this client is most likely experiencing which of the following complications of blood transfusion therapy?
Fluid overload
What is most effective for a platelet transfusion?
Fresh platelets most effective.
Which of the following lab data would indicate a need for possible transfusion of PRBC's?
Hbg/Hct = 6.8/ 29 I AM NOT SURE ABOUT THIS ANSWER
Hemolytic-incompatability between client's blood & donor's blood. May be immediate or may not occur until later units. s/s may be mild or life threatening (with DIC)-chills, fever, HA, backache, dyspnea, cyanosis, chest pain, tachycardia, hypotension Action: D/C transfusion(remove tubing), keep vein open with NS, send remaining blood to lab with urine sample, notify MD, monitor VS, monitor I & O Febrile-sensitivity of the patient's blood to WBCs, platelets, or plasma proteins. Seen after multiple transfusions s/s: fever, chills, warm flushed skin, HA, anxiety, muscle pain, tachycardia, hypotention Action: D/C, give antipyretics as ordered, contact MD, keep vein open with normal saline Allergic (mild)-sensitivity to infused plasma proteins s/s flushing, itching, urticaria(multiple, red, raised itching areas on skin), bronchial wheezing Action D/C, keep vein open with NS, notify MD, monitor vs, administer antihistamines Allergic (severe)-antibody-antigen reaction- s/s dyspnea, CP, circulatory collapse, cardiac arrest Action: D/C, keep vein open with NS, notify MD, monitor vs, begin CPR if needed, adm. Meds/O2 as ordered Circ. Overload-Bl.adm. Faster than circulation can accommodate s/s: cough, dypnea, rales, distended neck veins, tachycardia, Hypertension Action: pt. Upright with feet dependent, adm. Diuretics & O2, call MD. stop/slow infusion, Sepsis:contaminated blood, s/s high fever, chills, vomiting, diarrhea, hypotension Action: D/C, send blood to lab, call MD, obtain blood culture, adm IV & antibiotics as ordered
Hemolytic-incompatability between client's blood & donor's blood. May be immediate or may not occur until later units. s/s may be mild or life threatening (with DIC)-chills, fever, HA, backache, dyspnea, cyanosis, chest pain, tachycardia, hypotension Action: D/C transfusion(remove tubing), keep vein open with NS, send remaining blood to lab with urine sample, notify MD, monitor VS, monitor I & O Febrile-sensitivity of the patient's blood to WBCs, platelets, or plasma proteins. Seen after multiple transfusions s/s: fever, chills, warm flushed skin, HA, anxiety, muscle pain, tachycardia, hypotention Action: D/C, give antipyretics as ordered, contact MD, keep vein open with normal saline Allergic (mild)-sensitivity to infused plasma proteins s/s flushing, itching, urticaria(multiple, red, raised itching areas on skin), bronchial wheezing Action D/C, keep vein open with NS, notify MD, monitor vs, administer antihistamines Allergic (severe)-antibody-antigen reaction- s/s dyspnea, CP, circulatory collapse, cardiac arrest Action: D/C, keep vein open with NS, notify MD, monitor vs, begin CPR if needed, adm. Meds/O2 as ordered Circ. Overload-Bl.adm. Faster than circulation can accommodate s/s: cough, dypnea, rales, distended neck veins, tachycardia, Hypertension Action: pt. Upright with feet dependent, adm. Diuretics & O2, call MD. stop/slow infusion, Sepsis:contaminated blood, s/s high fever, chills, vomiting, diarrhea, hypotension Action: D/C, send blood to lab, call MD, obtain blood culture, adm IV & antibiotics as ordered
Give examples of deferred donors.
History of Hepatitis HIV infection Risk Factors for HIV infection Heart Disease CA Severe Asthma Bleeding Disorders Convulsions Malaria Pregnancy Anemia Hyper or Hypo Tension Anyone in United Kingdom 3 months or more (1980-1996) anyone 5 years in Europe from 1980-present Blood is screened for HIV, Hepatitis, and Cruetzfeldt-Jacob disease( the neuro disease that develops from Mad Cow exposure)
A nurse enters a client' room to assess the client, who began receiving a blood transfusion 45 minutes earlier. The client is flushed and dyspneic. On assessment the nurse auscultates the presence of crackles in the lung bases. The nurse determines that this client is most likely experiencing which of the following complications of blood transfusion therapy?
Hypovolemia Transfusion reaction Fluid overload Bacteremia
What lets the tester know that there is a small chance of transfusion reaction?
If antibodies to the donated RBC's are present in the recipient's serum agglutination does not occur and the risk of transfusion reaction is small.
What does the Rh factor mean?
It means that it is either positive or negative for antigens.
What is a major part of the immune system?
Lymphocytes (WBC)
What is the longest amount of time that blood can be on a floor?
No more than 30 minutes prior to starting due to RBC
Are whole blood transfusions common?
No they are not common but they are used in cases that a person has acute hemorrhaging.
Do platelets have to be the same blood type as the donor?
No they can be from 10 different donors
What blood type has no antigens?
O Blood type
What should be kept in mind for fresh frozen plasma?
PLASMA- Expands blood volume and provides clotting factors. The plasma is frozen immediately following donation(this preserves the clotting factors) Should be infused immediately after thawing. Volume is approx. 200ml and is given over 30-60 minutes through a Y set or a straight filtered tubing.
What makes up about 55% of total blood volume?
Plasma
Plasma- water, ions, proteins, hormones, and lipids transports nutrients, waste products, hormones, and carbon dioxide. Also contributes to fluid/electrolyte balance and thermal regulation
Plasma- water, ions, proteins, hormones, and lipids transports nutrients, waste products, hormones, and carbon dioxide. Also contributes to fluid/electrolyte balance and thermal regulation
what is about 1/3 the size of RBC?
Platelets or thrombocytes
Where are RBC made?
Produced in bone marrow continiously from bone cells
The most recognizable component of whole blood are...
RBC
What do RBC do to hematocrit?
Raises approximately 4%
What makes up 40-50% of total blood volume?
Red blood cells or erythrocytes
What does whole blood transfusions replace?
Replaces blood volume and all blood products: RBC's, plasma, plasma proteins, fresh platelets, and other clotting factors
What is the reason for platelet transfusion?
Replaces platelets in clients with bleeding disorders or platelet deficiency
What should return to the lab?
Return Blood bag to lab with appropriate blood tag in ziplock bag.
What is used in cases that a patient loses a lot of blood?
There are now products on the market that collect, filter, and drain the blood from a patient's op site or wound into a transfusion bag to be reinfused within 6 hours.
What should be kept in mind while administering platelets
They are fragile and they should be administered over 15-30 minutes
Where are platelets made and how long do they survive?
They are made in bone marrow and they survive in the circulatory system for 9-10 days.
What do Platelet cells do?
They clot at the site of wounds
How do platelet cells clot?
They stick to each other and the edge of an injured area.
How does blood get its color?
Through by the RBC
So what blood type has no antibodies?
Type AB
What blood type can recieve blood from any blood type?
Type AB
What blood type is the universal recipient?
Type AB
So what blood type has no antigens?
Type O
Which blood type is the universal donor?
Type O
What is the reason for Autologous red blood cell?
Used for blood replacement following planned elective surgery.
What is Clotting factors and Cryoprecipitate used for?
Used for client's with clotting factor deficiencies. Each provides different factors involved in the clotting pathway
Why are RBC used?
Used to increase the oxygen carrying capacity of blood in anemia's, surgery, disorders with slow bleeding
What does a platelet transfusion normally contain?
Usually contains 300ml of pooled platelets
A nurse listening to morning report learns that an assigned client received a unit of granulocytes the previous evening. The nurse makes a note to assess the results of which of the following daily serum laboratory studies to assess the effectiveness of the transfusion?
WBC count
When do Rh bodies develop?
When a person with negative blood is exposed to positive blood (negative mother carrying a positive child, or transfusion of positive blood)
A nurse listening to morning report learns that an assigned client received a unit of granulocytes the previous evening. The nurse makes a note to assess the results of which of the following daily serum laboratory studies to assess the effectiveness of the transfusion?
White Blood cell count Erythrocyte count Hemoglobin Level Hematocrit Level
What makes up about 1% of total blood volume?
White blood cells or leukocytes
What are the four different types of blood transfusion?
Whole blood Red blood cells Autologous red blood cell Clotting factors and Cryoprecipitate
Are red blood cells and white blood cells produced the same way?
Yes
Can a person die from their blood not being matched correctly?
Yes!!!
What should be known for Cryoprecipitate- (Where is it from, how is it given, what does it contain)
a product derived from plasma, given IV push within 3 minutes, contains fibrinogen, dosages are individualized for patient.
1. Nurse must be aware of the
agency's policies regarding blood product administration.
Why can type O give to anyone?
because no antigens are present on RBCs and therefore the person is able to donate to all blood groups
What are some adverse reactions of blood transfusion?
chills, nausea, vomiting, skin rash or tachycardia
2. Requires a doctor's order- type of
component, volume to be infused,and any special conditions to monitor for.
Subsequent exposures to Rh positive blood will place the client at risk for
for an antigen-antibody reaction and hemolysis of RBC's.
5. Blood specimen for
for type and cross-match(takes about 45 minuets in lab)
What are the advantages of Autologous red blood cell transfusion?
guaranteed compatibility and elimination of the risk of transmitting blood borne diseases.
Each RBC has 270,000,000...
iron rich HGB molecules.
7. Medications are
never added to blood products
AB is the universal recipient because
no serum antibodies are present, therefore the person is able to receive blood from all blood groups.
3. Assess need for transfusion-
physical condition and lab values
85% of the population is __________ for antigens
positive
8. A full set of vital signs are taken
prior to going to lab for blood. If temperature is 95 or less or 100.5 or higher- notify MD
What is the job of the Granulocytes & macrophages?
protect our body from infection by destroying bacteria. And they also gets rid of old unneeded blood cells.
4. Consent form if
required by agency
Blood transfusion is the introduction of
the introduction of whole blood or blood components into the venous circulation
