Transcript Blood transfussions

Administration of Blood and
Blood Products
PN 3 November 2005
Donation and Deferrals
• http://www.pbs.org/wnet/redgold/index.htm
• www.bloodservices.ca
Transfusions
Typing and Cross Matching
• To determine if blood of donor is
compatible with blood or recipient
• If incompatible may result in “clumping” or
agglutination and hemolysis of recipients
blood cells. This may result in death.
• Typing determines blood type(A, B, AB, O)
• Cross match determines compatibility
Blood group A
If you belong to the blood group A, you
have A antigens on the surface of your
red blood cells and B antibodies in your
blood plasma.
Blood group B
If you belong to the blood group B,
you have B antigens on the surface
of your red blood cells and A
antibodies in your blood plasma.
Blood group AB
If you belong to the
blood group AB, you
have both A and B
antigens on the surface
of your red blood cells
and no A or B
antibodies at all in your
blood plasma
Blood group 0
If you belong to the blood
group 0 (null), you have
neither A or B antigens on the
surface of your red blood
cells but you have both A and
B antibodies in your blood
plasma
Agglutinin
• An antibody that causes a “clumping” of
specific antigens
• Type A have an A antigen, type B have a B
antigen, AB have both A and B antigens;
type O have neither A or B
• A types have agglutinin for B; B have
Agglutinin for A, AB have none and O has
A and B agglutinins
Rh Factor
• Inherited antigen in human blood
• There are 5 but we concern ourselves with
the one identified as “D”
• A person who is identified as having “D” is
called Rh positive
• Rh negative recipient must receive
negative blood
• If the receive positive blood future tx may
cause death
Types of Transfusions
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Whole Blood
Red blood cells
Platelets
Plasma
Cryoprecipitate
Pre-Transfusion
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Agency policy
Consent
Hx of previous transfusion
What symptoms do you want pt to report
Initiating the transfusion
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IV with large bore needle
Blood tubing primed with 0.9% NaCl
Blood filter
Baseline vital
Have pt. comfortable, i.e. go to bathroom
During the Transfusion
• Blood not initiated within 30 mins returned
to lab
• Infused no longer than 4 hours
• All info on pt and blood must be exactly
the same
• Check vital signs q5 mins x 3 and then
q15 mins x 4 then hourly
Transfusion Reactions
• Listen to the pts complaints
• Check vitals, observe the patient
Types of Reactions:
Hemolytic
Allergic
Febrile
Bacterial
Circ overload
Hemolytic
• Blood type or Rh incompatibility
• Destruction of cells and inflammatory
response
• Maybe immediate or at next transfusion
• Mild with fever and chills or life threatening
• Apprehension, HA, chest pain, low back
pain, Tachycardia, Tachypnea,
Hypotension, hemoglobinuria, impending
doom
Allergic
• Clients with a history of allergy
• Uticaria, itching, bronchospasm,
anaphylaxis.
• Occurs during and up to 24 hours after
• Sometimes given washed RBC to remove
WBC and plasma
Febrile
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Occurs after multiple transfusions
Develop anti WBC antibodies
Give WBC reduced blood (filter, washed)
S and S: chills, tachycardia, fever,
hypotension, tachypnea
Bacterial
• Contaminated blood transfusion
• Gram negative because these grow fast in
blood
• S and S: tachycardia, hypotension, fever,
chills, shock
• Onset is rapid
Circulatory Overload
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Blood infused to quickly
Whole blood or multiple infusions
Older adults are most at risk
S and S, hypertension, bounding pulse,
distended jugular veins, dyspnea,
restlessness, confusion.
• Manage and prevent by monitoring I & O;
infusing slowly, diuretics, chest
assessment!
Transfusion-Associated Graftversus-Host Disease
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Rare but life-threatening
Immune suppressed individuals
90% mortality rate
Thrombocytopenia, anorexia, nausea,
vomiting, chronin hep, wt loss, recurrent
infections.
• Occurs 1-2 weeks
Incidentals
• Blood warmers
• Pumps and pressure bags
• Dilutents and concurrent fluid and meds
RPN Responsibility
• Pick up blood from blood bank
• Prime blood tubing
• Confirm client identity with other Registered
Nurses (not another RPN)
• Independent double check of all ID
• Re-verify the MD order and concent
• Time the transfusion
• WATCH and ASSESS the patient
• Documentation
What not to Do
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