1. Blood Administration Austin Community College Charlene Morris

2. Types of Blood Components CURRENTLY USED –Packed RBC’s –Frozen RBC’s –Platelets –Fresh Frozen Plasma –Albumin –Cryoprecipitates & commercial concentrates NO LONGER USED –Whole blood

3. Whole Blood No Longer Used Was used most often for volume and RBC’s Contained RBC’s, plasma proteins, some clotting factors, few platelets, & granulocytes Significant Dangers / Problems: –Incompatibility reactions –Circulatory overload –Febrile reactions –Infection transmission –Increased hospital stay –Increased cost of care

4. Current Blood Preparation Leukocyte reduction prior to storage More effective than previous washing process Packed RBC’s are removed from plasma Removal of most WBC’s and Plasma reduces the risk of reactions Drawback – bacterial growth if contaminated during collection/processing

5. Packed Red Cells (PRBC’s) Used to treat anemia and replace blood volume (Additional NS used for volume) May need Lasix for overload Usually ordered when Hgb 9 and Hct 27 **1 unit of PRBC’s will increase the Hgb by 1 and the Hct by 3 Usually contains 250 ml. Usually not use a leukocyte filter

6. Blood components cont. Platelets –To control or prevent bleeding in platelet deficiencies - thrombocytopenia –To treat platelet dysfunction Risks –Not a substitute for plasma or clotting factors –May form antibodies –Hypersensitivity reaction

7. Platelets One unit contains 30-60 ml platelet concentration Expected increase is 10,000 per unit Outcome: measured by platelet counts at 1 hour and 18-24 hours post transfusion

8. Blood components cont. Albumin –To expand blood volume or replace protein –Used to treat shock from trauma, infection and in surgery Risks –Vascular overload –Hypersensitivity reaction

9. Albumin: Plasma derivative (Plasma protein fraction is similar product) As a volume expander… –Used for patients 3 rd spacing and are hypovolemic, liver patients –Hyperosmolar solution acts by moving water from extravascular to intravascular space –Outcome: adequate blood pressure and volume

10. Blood components cont. Plasma –Contains clotting factors & protein –Used only for clotting problems Risks –Vascular overload –Hypersensitivity reaction –Hemolytic reactions

11. Fresh Frozen Plasma (FFP) Contains clotting factors No platelets Used for DIC (Disseminated intravascular coagulation), liver patients One unit = 200-250mls Outcomes: improved coagulation, PT and PTT

12. Blood components – cont. Prothrombin Complex – Prothrombin, Factors VII, IX, X, and part of XI –Used to treat clients with specific clotting factor deficiencies Cryoprecipitate – Clotting Factors VIII, XIII, von Willebrand’s factor, & fibrinogen from plasma –Used to treat clients with specific clotting factor deficiencies –May cause ABO incompatibilities

13. WBC’s or Granulocytes Outcomes & Rare uses –Improvement of infection is measure of treatment effectiveness –Cancer patients –Chemotherapy –Hazards - febrile reaction & new infections carried in WBC’s

14. RBC & Plasma Transfusions

15. Initiation of Transfusion Obtain permit & Check MD’s order ID patient, draw blood for T+C in red top tube, place blood band and label tube. Start 18-20 gauge IV.

16. Initiation Cont. 2 people check unit of blood with laboratory slip, patient’s chart, forms should include patient’s name, unit #, and blood type, etc. Expiration date Patient’s ID and blood band and state name Blood band number – blood armband, at Seton - transfusion card Blood component, donor number, expiration date, Group and Rh factor

19. Compare all labels second time Check vital signs and record

20. 0.9% Sodium Chloride (NS) only!!! Prime Y-type blood tubing with NS Invert unit to mix cells Spike blood bag, clamp off NS Cover blood filter with blood

22. Use appropriate filters For intraoperatively salvaged washed blood.For intraoperatively salvaged washed blood. Significantly reduces leukocytes in salvaged blood Substantially decreases fat globules in salvaged blood Reduces microaggregates present in salvaged blood u For intraoperatively salvaged washed blood. u Reduces leukocytes u Decreases fat globules u Reduces microaggregates

23. Use blood administration set no more than 4 hours – each infusion must be completed in 4 hours Check facility policy re: # units per administration set Use IV pump

24. Important Points Drip rate no higher than 2 ml per minute X 15 minutes (30 ml per 15 minutes or 120 ml/hr.) Seton etc. set pump at 75 to 80 ml/hr. for 15 min. Remain with pt for first 15 minutes or first 30 ml

25. Important Points Vital signs prior to administration & in 15 min. X 4, –then q 30 minutes, until transfusion complete--then X 2 No meds or fluid other than NS to be given in line with blood!!! CHECK POLICY AND PROCEDURE of facility!!

26. Infuse over period specified (2-4 hours) Blood cannot be out of refrigerator more than 30 minutes prior to administration –PLAN AHEAD!! BE READY TO START BEFORE GETTING BLOOD!! Allow blood to hang no longer than 4 hours

27. Transfusion Reactions Anaphylactic Allergic or Hypersensitivity Hemolytic Febrile

28. Transfusion Reactions Occur when there is some degree of incompatibility between donor and recipient's blood –What changes in vital signs would you expect to see? –Consider a temperature increase of 2 degrees significant –What drugs are commonly given prior to transfusion?

29. Allergic Reactions - 1% can occur during or after transfusion Mild –Urticaria –Itching Severe –Wheezing –Dyspnea –Bronchospasm

30. Anaphylactic Reactions Can occur very quickly, with only a small amount of transfusion – usually within 50 mls Hypotension, SOB, Tachycardia Shock Loss of consciousness Facial edema Dizziness Chest tightness, abdominal cramping

31. Hemolytic Reactions - 0.004% or 1:25,000 ABO incompatibility RBC’s clump & block capillaries decreasing blood flow to organs. Hgb released, blocks renal tubules – can cause renal failure. Potassium released.

32. Hemolytic Reactions Key Indicators: –Apprehension Fever/chills –Headache Burning at IV site –Chest pain Low back pain –Tachycardia Hypotension –Urticaria –N/V Acute-usually occurs after 50 ml. infused Lemone – after 100 to 200 ml infused

33. Pyrogenic: (non-hemolytic) Febrile or Bacterial Occurs within first 15 minutes Sensations of Cold Fever Chills Hypotension Shock Reaction to donors WBC’s, or plasma proteins

34. Nursing actions if reaction occurs Stop transfusion immediately Continue N/S IV with new tubing Provide appropriate care for client Notify physician of clients signs and symptoms Follow facility policy and send bag and tubing to lab Obtain urine specimen for free hemoglobin test

35. Critical Thinking Exercise #1 You are hanging a 250 ml. unit of Packed RBC’s to prepare your patient for urgent surgery. Describe how you would set the infusion pump.

36. Critical Thinking Exercise #1 You are hanging a 250 ml. unit of Packed RBC’s to prepare your patient for urgent surgery. What is urgent surgery? Describe how you set the infusion pump. 1. Total time recommended for transfusion of 1 unit of PRBC? Variables as age/condition? 2. First 15 min. of infusion (80 – 120 ml/hr.) 3. Rate after first 15 minutes?

37. Major/Urgent Surgeries Performed in the Inpatient Setting Ablative procedures: –Amputations –Colostomy Reconstructive: –Total joint replacement –Heart bypass surgery Palliative –Colostomy for CA C-sections

38. Pump Settings 2 cc X 15 min. = 30cc 30 cc = X cc 15 min. 60 min. Run pump at 120 for first 15 min. 250 cc – 30 cc = 220cc 2 hr (120 min-15 min.) = remaining run time of 105 minutes 220 cc = X cc = 125.7cc/hr. 105 min. 60 min. Run pump at 126 for rest of transfusion u What is the rate if you started at 80cc/15 min.?

39. Critical Thinking Exercise #2 A The pt.’s Type & Crossmatch report indicates that he is Type A+. The unit of PRBC's that the bank has provided is labeled as Type O negative. Can this patient safely receive this blood? Why or Why not?

40. Critical Thinking Exercise #2 B The pt.’s Type & Crossmatch report indicates that he is Type A-. The unit of PRBC’s that the bank has provided is labeled as Type O+. Can this patient safely receive this blood? Why or Why not?

41. Critical Thinking Exercise #2 B The pt. is Type A-. The unit of whole blood is labeled as Type O+. Can this patient safely receive this blood? Why or Why not? 1.Universal donor in emergency 2.Type O has A & B antibodies but no A or B antigens 3.Rh+ D antigen to a Rh- male vs. female?

42. Rh – mother with Rh + baby What med is used?

43. Major Surgeries Performed in the Inpatient Setting Emergency Surgery Transplants Ruptured aneurysm Life-threatening trauma

44. Critical Thinking Exercise #3 The patient is a Jehovah’s Witness. What factors impact care for bleeding in an emergency situation? Compare this situation to the patient who is concerned about the safety of blood component transfusions?

45. Critical Thinking Exercise #4 The patient is scheduled for an elective procedure such as a total knee replacement. What measures can be taken to decrease the risk of transfusion reaction? What type of reaction might still be possible?

46. Autologous transfusion u What are the benefits of Autologous transfusion? Blood you receive should definitely match yours. Risk of getting any allergic reaction will be very low. Blood will be available if you have a rare blood type. No infectious diseases - hepatitis, syphilis, AIDS, etc. Safe and well-tested procedure.

47. Autologous transfusion Who can have Autologous transfusion? u Patients less than 65 years old. u Patients without serious medical conditions like serious heart and lung diseases. u Patient’s with hemoglobin level of at least 11g / dl before each donation

48. A "cell-saver" technology collects blood as it is lost during surgery, cleanses it, and places it back in the patient's body, all in a continuous loop. u Autologous transfusion

49. Directed donation of blood u Sticker "Directed Donation" affixed directly on the unit. u Note: Directed donations units may also be collected by facilities other than yours. u A complete check of the unit identification compared to the patient identification is performed on each unit to ensure unit is given to the correct patient.

50. Every unit of blood is tested for Antibodies to HIV-1 and HIV-2 (AIDS). Antibodies to HBV produced during and after infection with Hepatitis B Virus Antibodies to HCV produced after infection with the Hepatitis C virus Antibodies to HTLV-I/II produced after infection with Human T-Lymphotropic Virus (HTLV-I and HTLV-II) Antibodies to HBsAg produced after infection with Hepatitis B For blood type (ABO) and Rh factor Tp, the agent that causes syphilis ALT, an elevated ALT may indicate liver inflammation, which may be caused by a hepatitis virus

51. The presence of unexpected antibodies that may cause reactions after the transfusion CMV, a test for the cytomegalovirus (performed on physician request) NAT (Nucleic Acid Testing) - a new technology that can detect the genetic material of Hepatitis C and HIV to identify these viruses faster and more accurately 100% of the blood products are filtered to remove leukocytes that can harbor viruses and infections. u Cont.

52. THE END!