2011. objectives identify various blood products available for transfusion identify possible blood...

Blood Administration

2011Blood AdministrationObjectivesIdentify various blood products available for transfusionIdentify possible blood transfusion side effectsIdentify the various blood product forms

2Blood Components

3ABO Blood Group SystemThere are four major blood groups determined by the presence or absence of two antigens A and B on the surface of red blood cells:Group A has only the A antigen on red cells (and B antibody in the plasma) Group B has only the B antigen on red cells (and A antibody in the plasma) Group AB has both A and B antigens on red cells (but neither A nor B antibody in the plasma); Universal recipientGroup O has neither A nor B antigens on red cells (but both A and B antibody are in the plasma); Universal donor

American Red Cross. 2011. Blood Types.4Blood Compatibility

5Did You Know?Every two seconds someone in the U.S. needs blood.

American Red Cross. 2011. Blood Facts and Statistics.

6Types of Blood ProductsPacked Red Blood Cells (PRBCs)Leukocyte-poor RBCsPlateletsFresh Frozen Plasma (FFP)AlbuminFactor VIII Concentrate (antihemophilic factor)Cryoprecipitate7Packed Red Blood Cells (PRBCs)Indications:To restore or maintain oxygen-carrying capacityTo correct anemia and surgical blood lossTo increase RBC massRed cell exchange

Lippincott Williams & Wilkins. 2011. Blood and blood product transfusion.8Packed RBCsNursing Considerations:Use blood administration tubing to infuse within 4 hours.Use only with normal saline (0.9% NaCl) solution.Avoid administering packed RBCs for anemic conditions correctable by nutritional or drug therapy.Lippincott Williams & Wilkins. 2011. Blood and blood product transfusion.

9Leukocyte-Poor RBCs(Same as packed RBCs with about 70% of the leukocytes removed)Indications:Same indications as packed RBCsTo prevent febrile reactions from leukocyte antibodiesTo treat immunocompromised patientsTo restore RBCs to patients who have had two or more non-hemolytic febrile reactions

Lippincott Williams & Wilkins. 2011. Blood and blood product transfusion.

10Leukocyte-Poor RBCsNursing Considerations :Use blood administration tubingMay require a 40-micron filter suitable for hard-spun, leukocyte-poor RBCs.Use only with normal saline solution (0.9% NaCl) .Cells expire 24 hours after washing.Rh type must match.


11Platelets(Platelet sediment from RBCs or plasma products)Indications:To treat bleeding caused by decreased circulating platelets or functionally abnormal plateletsTo improve platelet count preoperatively in a patient whose count is 50,000/l or less.


12PlateletsNursing Considerations:Use a blood filter or leukocyte-reduction filter.As prescribed, premedicate with antipyretics and antihistamines if patients history includes a platelet transfusion reaction or to reduce chills, fever, and allergic reactions.Complete transfusion within 20 minutes or at the fastest rate the patient can tolerate.Use single donor platelets if patient has a need for repeated transfusions.Platelets are not used to treat autoimmune thrombocytopenia or thrombycytopenic purpura unless the patient has a life-threatening hemorrhage.ABO compatibility identical; Rh-negative recipients should receive Rh-negative platelets.


13Fresh Frozen Plasma (FFP)Indications:To correct a coagulation factor deficiencyTo replace a specific factor when that factor is not availableWarfarin (Coumadin) reversalTo treat thrombotic thrombocytopenic purpura


14Fresh Frozen Plasma (FFP)Nursing Considerations:Use a blood administration setComplete transfusion within 20 minutes or at the fastest rate the patient can tolerateKeep in mind that large-volume transfusions of FFP may require correction for hypocalcemia because citric acid in FFP binds calcium.Must be infused within 6 hours of being thawed.ABO compatibility required; Rh match not requiredOnly blood product that is not received from Blood Bank it is issued by Pharmacy and no consent is required.Lippincott Williams & Wilkins. 2011. Blood and blood product transfusion.

15Albumin(a small plasma protein prepared by fractionating pooled plasma)Indications:To replace volume lost because of shock from burns, trauma, surgery, or infectionsTo treat hypoproteinemia (with or without edema)Nursing Considerations:Use administration set supplied by manufacturer and set rate based on patients condition and response.Keep in mind that albumin is contraindicated in severe anemiaAdminister cautiously in cardiac and pulmonary disease because heart failure may result from circulatory overload.


16Blood TransfusionA blood transfusion is a safe, common procedure in which blood is given to someone through an intravenous (IV) line.It is done to replace blood lost from surgery, injury, or illness.Each year, nearly 5 million Americans require a blood transfusion.National Heart Lung and Blood Institute. 2009. Blood Transfusion.

17History of Blood Transfusions1628 .William Harvey discovers the circulation of blood; first known attempt of blood transfusion soon afterwards.1665 ............First successful transfusion occurred in England using dogs1818 ..James Blundell performs the first successful transfusion of human blood to a patient for treatment of postpartum hemorrhage.1901 ..Karl Landsteiner discovers the first three human blood groups.1907 First blood typing and cross-matching1914 ..Anticoagulants developed for blood preservation1939 ..Rh system developed1940 ..Albumin, gamma globulin and fibrinogen used clinically1947 ABO blood-typing and syphilis testing is performed on each unit of blood1971 Hepatitis B surface antigen testing of blood began1985 HIV testing on all donated blood began

American Red Cross. 2011. History of Blood Transfusion.18Did You Know?A totalof 30 million blood components are transfused each year in the U.S. American Red Cross. 2011. Blood Facts and Statistics.

19Blood Pick-UpOnly Registered Nurses, Licensed Practical Nurses, Nursing Assistants, Physicians and Physicians Assistants are authorized to transport blood components from the Blood Bank to the patient care unit.No one will be issued blood for more than one patient.When picking up blood products from the Blood Bank, a copy of the physician order is required.

20Administration TimeThe time that blood is removed from the refrigerator in the Blood Bank to the time that the transfusion is started should not exceed 30 minutes.The transfusion must be completed within four hoursIf a specimen is in the Blood Bank from a previous draw, less than 72 hours old, match the patient with the doctor order and the patients arm band to request for additional crossmatch.

21Final Identification VerificationPrior to initiating the transfusion, two (2) qualified persons will identify:Patient states name and SSNName and SSN match armband, Blood Transfusion Record Form, and the blood unit labelABO Group, Rh type, crossmatch result, unit identification number, expiration date on unit label match the Blood Transfusion Record FormThe two persons must sign the Blood Transfusion Record Form in indicated areas and place a check to ensure that there is a signed consent on the patients record. SEE NEXT SLIDE.

Qualified persons include physicians, physician assistants, and nurses (nurse practitioners, registered nurse, licensed practical nurses or nurse anesthesiologists). One must be a registered nurse.22

Administration of BloodObtain vital signs prior to, at 15 minutes, mid-point, and immediately post-transfusion at a minimum and document on Blood Transfusion Record Form.Additional vitals may be obtained and can be documented in patients chart.Start and titrate the rate as tolerated based on component being transfusedSevere reactions can occur with as little as 10 ml transfused; therefore, the registered nurse must remain with the patient during first 15 minutes to monitor for reaction.

23Administration of BloodOnce the transfusion is completed, the nurse must complete the remaining (post-transfusion) areas, indicating the total volume infused, if the transfusion was completed/interrupted, and if there was any reaction.The nurse should then sign the form to verify the information provided is correct.

24Transfusion ReactionIf you suspect an adverse reactionStop the transfusion Notify the doctor and blood bank immediatelyTake a post-transfusion blood sample (pink top tube) from the arm opposite the infusionReturn the blood sample along with the Blood Transfusion Record Form, the remainder of the unit of blood, and the blood administration tubing to the lab.Send a post-reaction urine specimen to the lab

25Did You Know?Your risk of getting HIV from a blood transfusion is lower than your risk of getting killed by lightning (about 1 in 2 million donations).The risk of having a donation that carries hepatitis B is about 1 in 205,000. The risk for hepatitis C is 1 in 2 million.National Heart Lung and and Blood Institute. What are the Risks of a Blood Transfusion?

26Immediate Transfusion ReactionsHemolytic Transfusion ReactionFebrile Transfusion ReactionAllergic ReactionTransfusion Related Acute Lung Injury (TRALI)

27Hemolytic Transfusion Reaction Caused by administration of incompatible bloodSigns and Symptoms include:Chest PainDyspneaFacial FlushingFeverChillsHypotensionFlank PainNauseaTachycardia

Lippincott Williams & Wilkins. 2011. Blood and blood product transfusion reaction management.

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Hemolytic Transfusion ReactionWays to PreventCompare patient ID bracelet against blood productMonitor patient closely at start of infusionLabel all blood samples and request forms correctly

Nursing ActionsMonitor patient closelyAdminister I.V. fluids, oxygen, epinephrine, and a vasopressor as orderedObserve patient for signs of coagulopathyLippincott Williams & Wilkins. 2011. Blood and blood product transfusion reaction management.

29Bacterial Contamination Caused by a contamination of blood productSigns and SymptomsChillsFeverVomitingAbdominal CrampingDiarrheaShock


30Bacterial ContaminationWays to PreventUse careful technique when collecting or administering bloodChange blood tubing and filter at least every four (4) hoursTransfuse blood or blood product within 30 minutes of receivingComplete transfusion of blood within four (4) hours

Nursing ActionsMonitor patient for fever for several hours after completion of transfusionObtain blood cultures from site other than I.V. infusion siteKeep all blood bags and tubing and send to the blood bankProvide broad-spectrum antibiotics, as prescribedLippincott Williams & Wilkins. 2011. Blood and blood product transfusion reaction management.

31Febrile NonhemolyticCaused by bacterial lipopolysaccharides or antileukocyte recipient antibodies directed against donor white blood cellsSigns and Symptoms:Fever within two (2) hours of transfusionChillsRigorsHeadachePalpitationCoughTachycardia


32Febrile NonhemolyticWays to PreventPremedicate the patient with antipyreticsLimit the number of transfusions the patient receives, if possible

Nursing ActionsRelieve the symptoms with an antipyreticIf the patient requires further transfusions, consider using a leukocyte removal filterLippincott Williams & Wilkins. 2011. Blood and blood product transfusion reaction management.

33Transfusion-related Acute Lung Injury (TRALI)Caused by granulocyte antibodies in the donor or recipient cause complement and histamine release

Leading cause of transfusion related mortality

Signs and SymptomsSevere respiratory distress within six (6) hours of transfusionFeverChillsCyanosisHypotension


34Transfusion-related Acute Lung Injury (TRALI)Ways to PreventNo prevention known

Nursing ActionsProvide oxygen as neededMonitor pulse oximetryPrepare for intubation and ventilatory support and hemodynamic monitoring


35Allergic ReactionCaused by an allergen in the donor blood

Signs and SymptomsUrticaria (Hives/Rash)FeverNauseaVomitingAnaphylaxis (Facial Swelling, Laryngeal edema, Respiratory Distress)

Lippincott Williams & Wilkins. 2011. Blood and blood product transfusion reaction management.36Allergic ReactionWays to PreventAdminister antihistamines if patient has a history of allergic reaction

Nursing ActionsAdminister antihistamine, corticosteroid, or epinephrine as orderedPrepare for intubation and respiratory support if patient develops anaphylaxis


37Transfusion-Associated Circulatory Overload (TACO)Caused by rapid infusion of blood or excessive volume of transfusionSigns and Symptoms Usually occur 2-6 hours post-transfusionChest tightnessChillsDyspneaTachypneaHypoxemiaHypertensionJugular Vein Distention


38Transfusion-Associated Circulatory Overload (TACO)Ways to PreventInfuse at lowest rate needed while keeping total transfusion time in mindAsk Blood Bank to divide unit

Nursing ActionsMonitor intake and output, breath sounds, and blood pressureAdminister diuretics as neededElderly patients and those with history of cardiac disease at higher risk


39HypocalcemiaCaused by rapid infusion of citrate-treated blood (citrate binds to calcium)Signs and SymptomsArrhythmiasHypotensionMuscle CrampsNausea/VomitingSeizuresProlonged Q-T intervalLippincott Williams & Wilkins. 2011. Blood and blood product transfusion reaction management.40HypocalcemiaWays to PreventMonitor ionized calcium levels in patients receiving large amounts of transfused blood

Nursing ActionsAdminister calcium gluconate I.V., as orderedMonitor ECG for arrhythmias or prolonged Q-T intervalMonitor patients with an elevated potassium level closely; they are more at risk for hypocalcemia

Lippincott Williams & Wilkins. 2011. Blood and blood product transfusion reaction management.41Delayed ReactionsDelayed HemolyticInfection TransmissionPost-TransfusionPost-Transfusion PurpuraGraft-Versus-Host Disease

Lippincott Williams & Wilkins. 2011. Blood and blood product transfusion reaction management.42Delayed HemolyticCaused by production of antibodies by red cells to antigens on transfused red cellsSigns and SymptomsOccurs 5 to 10 days after transfusionFeverAnemiaJaundiceWays to PreventNo known preventionNursing ActionsRecheck the patient's blood groupAdminister antipyretics for fever

Lippincott Williams & Wilkins. 2011. Blood and blood product transfusion reaction management.43Infection TransmissionCaused by transmission of infectious agent in the blood

Signs and symptoms depend on infection transmitted

Ways to Prevent:Careful screening of blood

Nursing Actions:Treatment based on individual infection transmittedLippincott Williams & Wilkins. 2011. Blood and blood product transfusion reaction management.

44Post-Transfusion PurpuraCaused by destruction of autologous and allogenic plateletsSigns and symptoms occur 7 to 10 days post-transfusionThrombocytopeniaBleedingWays to PreventLimit transfusion in patients with history of sensitization through pregnancy or previous transfusionNursing ActionsAdminister high doses of immune globulin intravenous, as orderedLippincott Williams & Wilkins. 2011. Blood and blood product transfusion reaction management.45Graft-Versus-Host DiseaseCaused by T-lymphocytes in blood or blood product react against patients tissue antigensSigns and SymptomsOccurs 10 to 12 days after transfusionFeverSkin Rash and DesquamationDiarrheaPancytopeniaWays to PreventTransfuse irradiated blood components to immunocompromised patientsNursing ActionsProvide supportive care to patient and familyLippincott Williams & Wilkins. 2011. Blood and blood product transfusion reaction management.46In SummaryThere are various blood products available for transfusionThere are many types of immediate and delayed reactionsIn the case of a suspected reaction, there are specific steps that are to be taken

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2011. objectives identify various blood products available for transfusion identify possible blood...

Documents

blood filter

blood types

blood components

blood compatibility

needs blood

blood facts

blood product transfusion

surface of red blood