CARE OF THE PATIENT RECEIVING BLOOD/BLOOD COMPONENTS

OBJECTIVE  DEMONSTRATE SAFE NURSING INTERVENTIONS IN BLOOD TRANSFUSIONS

PT EDUCATION  EXPLAIN RISKS AND BENEFITS  WHAT TO EXPECT  WHAT SIGNS/SYMPTOMS TO LOOK FOR  Discuss possible alternatives if unable to accept donation  What Religion will not accept transfusions?  JEHOVAH’s WITNESS

Other Alternatives  Volume Builders  Crystalloids  Artificial Crystalloids  Dextran for example  May cause bleed problems or allergic reactions  THEY ONLY REPLACE VOLUME  DONATIONS  Autologous  Predonation by the client themselves  Client will donate blood 1 unit/week for 3-4 weeks taking FE and/or EPO

Infusion Therapy Risks  Risk factors:  Disease transmission  Hepatitis B 1:140,000  Hepatitis C 1: 225,000  Hepatitis A 1:1 million  HIV 1: 1.5 million  Syphillis 1: 1 million  Bacterial contamination  Acute or delayed transfusion reactions  Mismatched ABO 1: 35,000  Incompatible Death Rate 1:600,000  Circulatory overload

Infusion Therapy Risks  Risk factors:  Disease transmission  Bacterial contamination  Acute or delayed transfusion reactions  Circulatory overload

Infusion Therapy Risks  Each unit of blood currently undergoes tests for nine diseases  Bacterial contamination is very rare, but may occur at any point  Refrigeration helps prevent bacterial growth  Transfusion reactions  Allergic reactions, incompatibilities, anaphylactic response to plasma proteins

Infusion Therapy Hazards  Some risks specific to massive transfusion (replacement of > one blood volume in 24 hours):  Hypothermia  Hemodilution  Platelet dysfunction  Electrolyte problems  BUT WHICH ONES???  Calcium toxicity: LOW  Iron overload

Infusion Therapy Risks  Noninfectious Serious Hazards  Mistransfusion and ABO/Rh incompatibility  Cardiopulmonary toxicity/circulatory overload  Transfusion-related graft-vs.-host disease  Transfusion-related acute lung injury  Metabolic derangements in pediatric and massive transfusion  Under-transfusion

ADMINISTRATION PROCESS  ASSESS Transfusion history  Previous transfusions, allergies and reactions  Type of transfusion reaction, manifestations, and treatment  GET SET OF BASELINE VITALS

Interventions  Once the blood has been taken from the blood bank, it must be administered within 30 minutes  The nurse must ensure:  Positive patient identification  Appropriateness of blood component  Blood product inspection  Verification of donor – recipient compatibility  Verification of product expiration date

adminstration of blood  Pt needs 18 or 20 gauge IV needle so cells are not lysed (destroyed)  Prior to administration, blood needs to be checked by 2 licensed nurses. Check the expiration date, name, medical record number, type of blood, blood band id, pt birthday  Check vitals prior to administration  **blood must be initiated with in 30 minutes of arrival from lab to floor  Use blood tubing for administration  Monitor for blood reactions  Monitor vitals continuously during administration

Y-type blood tubing.

Figure 23.2 Sample blood administration record fromMy Nursing Lab

OBJECTIVE  ASSESS TRANSFUSION REACTIONS AND SAFE INTERVENTIONS

Transfusion Reactions

RX continued  Circulatory overload: dyspnea, tachycardia, cough, frothy sputum, cyanosis, increased BP that drops suddenly, distended neck veins, crackles  High risk are elderly and those with history of CHF  cardio system is unable to manage the additional fluid load  Occurs anytime during transfusion and up to several hours after completion  Occurs if infusing too rapidly or too much quantity  Tx: stop infusion, call for help, be prepared for code, be prepared to administer oxygen and Lasix

The END