1. BLOOD ADMINISTRATION NRS 108 ESSEC COUNTY COLLEGE Majuvy L. Sulse MSN, RN,CCRN

2. Objectives: Use safe accurate techniques and apply the nursing process when caring for clients who are receiving blood and blood products.

3. Definition of terms Antigen-substance that elicits an immune response; mostly proteins (can also be lipoproteins, polysaccharides and nucleic acids. Antibody-substances produced by the plasma (300 molecules/sec) secreted into the blood & other extracellular fluids Agglutination-a clumping like antibody action that results from an antibody molecules having at least two antigen binding sites

4. Definition of terms cont’d Lysis-cell membrane destruction, occurs because of antibody binding to membrane- bound antigens of some invaders. Blood transfusion- are actual transplantation of tissue from one person to another. Donor and recipient must be checked for compatibility to prevent lethal reactions.

5. Blood Transfusion cont’d Compatibility is determined by 2 different types of antigen systems (Cell surface proteins) ABO system antigen & the Rh antigen (membrane surface of the RBCs) RBC antigens are inherited and maybe one of the following: A antigen (type A blood) B antigen (type B blood) Both A & B antigen (type AB blood) No antigen (type O blood)

6. Compatibility Chart for Red Blood Cell Transfusion Recipient ___________________________________ Donor _______A______B______ AB_____0_ A X X B X X AB X O X X X X

7. Rh Compatibility An Rh negative person is born without the antigen and does not form antibodies unless he or she is spefically sensitized to it. Sensitization can occur with RBC transfusions from an Rh positive person or exposure during pregnancy and birth. An Rh positive person can receive an RBC transfusion from an Rh negative donor Rh negative people MUST NEVER receive Rh positive blood.

8. Blood Product Components & Indications for Usage Red Blood Cell (RBC)- administered to  replace erythrocytes lost from trauma  Erythrocytes lost from surgical intervention  clinical conditions that result in destruction or abnormal maturation of RBCs  Hgb less than 6 g/dL or 6- 10 g/dL if clinical symptoms are present.

9. Blood Product Components & Indications for Usage-cont’d Platelet Transfusions are administered  Platelet counts below 20,000 mm3  Thrombocytopenic patients actively bleeding or going for an invasive procedure

10. Blood Product Components & Indications for Usage-cont’d Cryoprecipitate-  product derived from plasma. Clotting factors (Vlll, Xlll), fibronectin, and fibrinogen are precipitated from pooled plasma.  Clients with fibrinogen level less than 100 mg/dL or clotting factor disorder at a volume of 10-15 ml/unit usually IV push within 3 minutes

11. Blood Components continued Plasma  Replaces blood volume.  Used for clients with clotting disorders.  Actively bleeding with PT or PTT greater than 1.5 times than normal.  ABO compatibility is required for transfusion of plasma products.  FFP volume is about 200 cc is given as rapidly as the pt. can tolerate while the clotting factors are viable generally over a 30-60 minute period. Use a regular Y set or straight filtered tubing.

12. Nurses responsibilities when Initiating, Maintaining & terminating A Blood transfusion Therapy 1. Assess lab values 2. Verify medical order 3. Send blood specimen for type & cross-matching 4. Obtain blood consent from client or next of kin if unable/incompetent to sign 5. Assess VS, urine output, skin color, and history of transfusion reactions

13. 6. Obtain venous access- large bore needle g.19 7.Obtain blood product from the blood bank 8. With another RN, verify client’s name, & number, blood compatibility and note expiration time. 9. Administer blood using appropriate filtered tubing as soon as possible 10 Use only normal saline for priming the tubing or for dilution

14. Nurses responsibilities when Initiating, Maintaining & terminating A Blood transfusion Therapy 11.Infuse slowly at about 2 ml/min during the 1 st 15 minutes then adjust at ordered rate 12.Remain with the client for the first 15-30 minutes of infusion 13. Take VS and record as per facility’s policy 14.Upon completion of transfusion, discontinue infusion & dispose of bag & tubing properly. 15. Document.

15. Transfusion Reactions An adverse reaction to blood transfusion therapy ranging from mild to life threatening condition. If this occurs: Stop the transfusion Maintain a patent IV line with Normal saline Notify the healthcare provider & blood bank Recheck identifying tags & numbers Monitor VS and urine output

16. Transfusion Reactions Treat symptoms per physicians order Save blood bag and tubing and send to blood bank for exam Complete transfusion reaction reports Collect required blood and urine specimen at intervals per hospital policy to evaluate for hemolysis Document on transfusion reaction form and patient chart

17. Acute Transfusion Reactions Acute Hemolytic Reaction- Cause by ABO or Rh incompatibility Clinical signs Mild reaction with fever and chills or life threatening like DIC & circulatory collapse Apprehension Headache Chest pain low back pain Tachycardia/tachypnea Hypotension Hemoglobinuria

18. Acute Reactions cont’d. Febrile Reactions Caused by leukocyte incompatibility Prevented by using leukocyte filter tubing Clinical signs Sensation of cold Tachycardia Fever Hypotension Tachypnea

19. Acute Reactions cont’d Allergic reactions Results from sensitivity to plasma proteins of the donor or history of allergy Antihistamines ( Epinephrine/corticosteroids) are used to prevent reaction Washed RBCs are given for those with history of allergy Signs: Urticaria Itching Bronchospasm or anaphylactic reactions

20. Acute Reactions cont’d Circulatory overload Occurs when blood product is administered too quickly Cardiac or renal insufficiency and older population at risk Signs: Hypertension Bounding pulse Distended jugular veins Dyspnea Restlessness confusion

21. Acute Reactions cont’d Bacterial transfusions reactions (Sepsis) Blood products infected from improper handling and storage May cause bacteremia or septic shock Massive transfusion reactions-due to large volume of transfusions and can cause: Hypothermia Cardiac arrythmias Citrate toxicity Hypocalcemia Hyperkalemia

22. Delayed transfusion Reactions Delayed hemolytic reactions Hep B Hep C HIV Iron overload Graft versus host disease