Blood and Blood Products Transfusion Nursing Implications
Aug 19, 2014
Blood and Blood Products
Transfusion
Nursing Implications
An adult human has about 4–6 An adult human has about 4–6 liters of blood circulating in the liters of blood circulating in the body. Among other things, blood body. Among other things, blood transports oxygen to various transports oxygen to various parts of the body.parts of the body.
Blood consists of several types of Blood consists of several types of cells floating around in a fluid cells floating around in a fluid called plasma.called plasma.
The red blood cellsThe red blood cells contain hemoglobin, a contain hemoglobin, a protein that binds oxygen. Red blood cells protein that binds oxygen. Red blood cells transport oxygen to, and remove carbon transport oxygen to, and remove carbon dioxide from, the body tissues.dioxide from, the body tissues.The white blood cellsThe white blood cells fight infection.fight infection.The plateletsThe platelets help the blood to clot .help the blood to clot .The plasmaThe plasma contains salts and various kinds contains salts and various kinds of proteins.of proteins.
Blood Groups
AB blood are often called universal recipients group O people are often called universal donors
The Rh factor is an inherited antigen in human The Rh factor is an inherited antigen in human blood. Blood that contains the Rh factor is known as blood. Blood that contains the Rh factor is known as Rh positiveRh positive, when it is not present the blood is said , when it is not present the blood is said to be to be Rh – negativeRh – negative. Rh blood does not naturally . Rh blood does not naturally contain Rh antibodies. If Rh-positive blood is contain Rh antibodies. If Rh-positive blood is injected into an Rh-negative person, the recipient injected into an Rh-negative person, the recipient develops Rh antibodies. Subsequent transfusion develops Rh antibodies. Subsequent transfusion with Rh-positive blood may cause serious reactions with Rh-positive blood may cause serious reactions with clumping and hemolysis of red blood cells.with clumping and hemolysis of red blood cells.
Rhesus (RH) Factor
Blood Transfusion
A blood transfusion is the infusion of whole blood or its components into the patient's venous circulation. Blood components includes:
1.PRBC – Packed Red Blood Cell2.Platelets3.Fresh Frozen Plasma4.Cryoprecipitate
Blood TransfusionProcedures- The nurse shall verify the physician's order in the patient's file. The order should include:
Urgency of the transfusion, including date and timeType of blood/blood productsAmount of blood to be transferredThe duration of the transfusion
Any special instructions (e.g. medication required before or during the transfusion).
-Secure Informed consent for blood transfusion.-Check for patient's blood type and collect sample for cross-matching.
-Physician shall enter the ordered blood or blood products in the computer.
Blood TransfusionProcedures- Blood transfusion request must be sent in the Blood Bank by the responsible nurse. The blood or blood products is usually ready;
Emergency request – 30 minutesRoutine request – 3 hours
-Start IV open by starting flow of Normal Saline solution.18-20G size is recommended for adults. 22-24G or larger is recommended for pediatric patients
-Check the bag of the blood and compare it with Blood Bank transfusion certificate with the following items:
Patient's nameFile numberSerial numberBlood group and typeExpiry date-Double check the blood against patient's data with the physician with his signature on the Blood Transfusion Certificate.
Blood TransfusionProcedures-Take baseline vital signs before beginning transfusion.-Use warmer to warm blood not exceeding 41˚C-Unused donor units must be returned to the Blood Bank within 30 minutes (not exposed to extreme heat)-Identify the patient correctly (3 names, MRN,(medical record number)-Then start the administration slowly (no more than 25-50ml for the first 15 minutes). Stay with the patient for the first 15 minutes of transfusion.-Check vital signs at least every 15 minutes for the first half hour after the start of the transfusion. Then every 30 minutes for the next hour until stable.- Observe patient for flushing, dyspnea, itching, hives, or rash, and back pain.
A. Immediate reactionsA. Immediate reactions– Febrile reactionFebrile reaction– Allergic reactionsAllergic reactions– Hemolytic transfusion reaction (HTR)Hemolytic transfusion reaction (HTR)– Circulatory over loadCirculatory over load– Air embolismAir embolism– Potassium toxicityPotassium toxicity– Citrate toxicityCitrate toxicity– Reaction due to infected blood Reaction due to infected blood
Complication of Blood Transfusion
– ThrombophlebitisThrombophlebitis– AIDS (HIV) Hepatitis (HBV, HCV)AIDS (HIV) Hepatitis (HBV, HCV)
Syphilis (Treponema pallidum / Spirochetes)Syphilis (Treponema pallidum / Spirochetes)Malaria (M.P), C.M.V & otherMalaria (M.P), C.M.V & other
– Immunological sensitization or all Immunological sensitization or all immunizationimmunization
– Transfusion haemosiderosisTransfusion haemosiderosis– Post transfusion purpuraPost transfusion purpura– HTRHTR– Complication of massive transfusion Complication of massive transfusion
Delayed transfusion reactions
A.A. Incompatibility between donors and recipientIncompatibility between donors and recipient
99% caused of human error preventable by99% caused of human error preventable by– Adequate knowledge of blood groupsAdequate knowledge of blood groups– Careful attention to all details of the Careful attention to all details of the
techniquestechniques– Blood group incompatibleBlood group incompatible– Outdated and infected blood Outdated and infected blood – Haemolysed blood Haemolysed blood – Incorrect anticoagulantIncorrect anticoagulant
Hemolytic transfusion reaction Hemolytic transfusion reaction
SymptomsSymptoms– Severe aching in the transfused veinSevere aching in the transfused vein– Pain in lumbar region & back Pain in lumbar region & back – DyspnoeaDyspnoea– NauseaNausea– Vomiting Vomiting – Flushing of the face Flushing of the face – Chill & rigorsChill & rigors– AnxietyAnxiety– Restless Restless – Feeling of constriction of chestFeeling of constriction of chest
Hemolytic transfusion reaction Hemolytic transfusion reaction
SignsSigns– ↑ ↑ Temp.Temp.– TachycardiaTachycardia– ↓ ↓ B.PB.P– Unexplained bleeding Unexplained bleeding – Shock - ↓ urinary outputShock - ↓ urinary output
↓ ↓ AnuriaAnuria
↓ ↓ DeathDeath
Hemolytic transfusion reaction Hemolytic transfusion reaction
Under anesthesia and sedationUnder anesthesia and sedation
– SymptomlessSymptomless– SignsSigns
Bleeding from wound / needle sitesBleeding from wound / needle sitesPersistent hypotensionPersistent hypotensionTachycardiaTachycardia
Hemolytic transfusion reaction Hemolytic transfusion reaction
FOR ANY BLOOD TRANSFUSION ADVERSE REACTION
Localized Urticaria:a.Do not discontinue the transfusion but infuse at a slower rateb.Notify the physician
Generalized Urticaria:a.Stop the transfusionb.Notify the physician
-Notify Blood Bank of suspected reaction-Collect blood sample from the patient.
Adult-2-5 mlPediatric -1 to 3 ml
-Fill up Transfusion Reaction Form and send to Blood Bank together with the collected blood sample, the remaining blood bag and its tubing as soon as possible.
FOR ANY BLOOD TRANSFUSION ADVERSE REACTION
-Fill up Transfusion Reaction Form and send to Blood Bank together with the collected blood sample, the remaining blood bag and its tubing as soon as possible.-HERF(Health care event reporting form).All
hospital organizations have their own criteria.-Obtain urine specimen as soon as possible and send to lab for urinalysis.