blood and blood product administration

NUR 140 IV Therapy:

NUR 140 IV Therapy Blood and Blood Product Administration Presented by: Karen Larson, MBA/TM, MSN, RN

RN Responsibilities for Blood Administration:

RN Responsibilities for Blood Administration Identify client according to facility/agency policy prior to administration of red blood cells/blood products (e.g., prescription for administration, correct type, correct client, cross matching complete, consent obtained) ..Check client for appropriate venous access for red blood cell/blood product administration (e.g., correct gauge needle, integrity of access site) ..Document necessary information on the administration of red blood cells/blood products ..Administer blood products and evaluate client response*

Blood Typing and Crossmatching:

Blood Typing and Crossmatching Blood Typing- is the test run on a person’s blood, according to specified protocols, to determine what his/her blood type is Crossmatching- is the process in which compatibility between the blood of donor and the recipient is determined

Slide 4:

Blood Typing Blood typing involves determination of the antigens present on an individual’s RBCs. type A blood – contain “A” antigen on RBCs type B blood – contain “B” antigen on RBCs type AB blood – contains both A and B antigens type O blood – contain no A or B antigens

Group O:

Group O Approximately 45% of the population is group O. No A or B antigens present, think of as “0” antigens present. These individuals form potent anti-A and anti-B antibodies which circulate in the blood plasma at all times.

Summary:

Summary Blood Group Antigens on cell Antibodies in plasma Transfuse with group A A Anti-B A or O B B Anti-A B or O AB A and B none AB, A, B or O O None Anti-A & B O

RH determination:

RH determination The RH factor is the protein that is found on the covering of the RBC if RH factor is present on the cell the patient is RH +

Blood Tested for transmittable diseases:

Blood Tested for transmittable diseases HIV Hepatitis viruses Human T-cell lymphotropic virus (HTLV) Serologic test for Syphyilis (STS)

Why do we give blood products?:

Why do we give blood products? To increase the ability to carry oxygen To restore blood volume when there has been a great loss To improve the blood’s clotting ability To improve a recipient's immunity

Whole Blood:

Whole Blood Whole blood consist of RBCs, WBCs, platelets, electrolytes, plasma and stable clotting factors Must be stored in a monitored blood bank refrigerator Must not be removed from the refrigerator for more than 30 minutes prior to the start of a transfusion Must not store blood in a nursing unit refrigerator If there is a delay the blood should be returned to the blood bank for storage

WHOLE BLOOD:

30/11/49 MD-3-49 13 WHOLE BLOOD Administration - Must be ABO and RhD compatible - Never add medication to a unit of blood - Use blood administration set - Infusion should never exceed 4 hours - Prime with only 0.9% normal saline Dosage 1 unit  Hct 3 % or Hb 1 g / d L

Indications for Whole Blood:

Indications for Whole Blood Acute Massive blood loss Trauma

Packed Red Blood Cells :

Packed Red Blood Cells Packed red blood cells provide the same quantity of RBCs as whole blood, but have 80% of the plasma removed Use a standard straight or Y-type blood administration set primed with 0.9% saline Must be stored in a monitored blood bank refrigerator not nursing unit refrigerator Must not be removed from the refrigerator for more than 30 minutes prior to the start of a transfusion

RBC Transfusion:

RBC Transfusion The signs and symptoms associated with the need for red blood cell transfusion, include the following -decreased hematocrit -decreased hemoglobin -dyspnea -fatigue -pallor -tachycardia

Special Nursing Considerations for administering blood:

Special Nursing Considerations for administering blood Consent Vital signs should be taken immediately prior to obtaining the blood product from the blood bank. Vital signs should be taken immediately prior to administering the blood product Any temperature of 38.8 degrees C (100 degrees F) should be reported to the physician. Prime tubing with NS Nurse should remain in room with patient for first 15 minutes

Blood Component Verification:

Blood Component Verification 2 nurses must verify the blood component The patient blood type and the donor type Expiration date Compare the patient’s name and hospital unique number on their ID armband with the blood/component label and the issue report. A visual assessment of the blood unit should be performed . Abnormal color, rbc clumping, gas bubbles Initially blood infusion should not exceed 100 ml hour for the first 15 minutes, assess patient for transfusion reactions

Vital signs:

Vital signs Document vital signs prior to transfusion, then 15 minutes after transfusion begins, and every one hour until transfusion completed and 1 hour post transfusion Assess breath sounds Prior to transfusion- skin assessment for rashes

Proper Assessment and Documentation:

Proper Assessment and Documentation Perform vital signs per facility policy The blood administration set must be changed after 2 units or every 4 hours A unit of red cells must be infused within 4 hours- because of potential for microbial growth. RBC begin to deteriorate after 2 hours at room temperature. Nursing documentation includes: Type of blood product, unit/product number (do not affix sticker) Time infusion starts and ends Total volume infused (I&O) Vital signs and patient’s response during and after the transfusion

Nursing considerations:

Nursing considerations Patient’s age- elderly run at slower rate Hemodynamic stability Cardiopulmonary or vascular problems Signs and symptoms of blood transfusion reaction

Blood transfusion options:

Blood transfusion options Autologous transfusion – sometimes referred to as Autotransfusion – is a process by which the patient receives blood they donate themselves. Homologous transfusion - is blood collected from donors. (Donors can be volunteer, designated, or cadaver)

Hemolysis:

Hemolysis If an individual is transfused with an incompatible blood group destruction of the red blood cells will occur. This may result in the death of the recipient.

Reactions to blood transfusions- epi will widden air passage of lung:

Reactions to blood transfusions- epi will widden air passage of lung Hemo - Lytic infuision incompatible blood Antigen-antibody reaction “ABO” incompat-ibility Fever, chills, low B/P, dyspnea, chestpainbackpain Usually occurs shortly after starting transf. Stop Transf.! Call MD, Prepare for a Code ? Ana-phylactic Reaction to plasma proteins Uticaria, dyspnea, wheezing broncho-spasms Usually occurs within first 30 minutes Stop the transf. Call MD * epi & steroids–

Blood transfusion reactions:

Blood transfusion reactions Febrile reaction Non he molytic Antibody reacts to donors leuko-cytes Fever and Chills Occurs within the first 30-90 min Stop the transf. Call MD, give tylenol Circula-tory Overload Pt. CV system is unable to handle FVE Cough, frothy sputum, cyanosis, ↑ B/P May occur at any time Stop Transf., call for help,give O2,Lasix

Platelets – one unit 50-70 ml:

Platelets – one unit 50-70 ml Normal platelet count 150,000 – 300,000 Helps with the prevention of blood loss Responsible for conversion prothrombin to thrombin Random or single donors Platelets are given as preventive measures when platelet counts are 10,000 to 20,000 (given prior to surgery. Platelets given to control active bleeding for counts < 50,000 Platelets also given count less than 20,000 when blood in stool, gum bleeding, ecchymoses , hematuria , and petechiae

Platelets:

Platelets

FRESH FROZEN PLASMA:

30/11/49 MD-3-49 28 FRESH FROZEN PLASMA Administration Must be ABO/Rh compatible using standard blood administration set FP contains all clotting factors except platelets Recommended uses: Urgent reversal of warfarin therapy Correction of known coagulation factor deficiencies Volume expansion (monitor closely for FVE)

FRESH FROZEN PLASMA:

30/11/49 MD-3-49 29 FRESH FROZEN PLASMA

Nonblood-Product Volume Expanders:

Nonblood-Product Volume Expanders Complex carbohydrates with molecular weights similar to albumin. Because of their large molecular size, they cannot pass out of the capillaries or vascular walls. Being confined to the vascular space, the increase colloid osmotic pressure, thus generating osmotic forces that draw fluid from the interstitial spaces into the blood Hetastarch (Hespan) Dextran