Transcript Blood Administration - Austin Community College

Blood Administration
Austin Community College
Charlene Morris
Types of
Blood Components
• CURRENTLY USED
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Packed RBC’s
Frozen RBC’s
Platelets
Fresh Frozen Plasma
Albumin
Cryoprecipitates &
commercial
concentrates
• NO LONGER USED
– Whole blood
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:
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Incompatibility reactions
Circulatory overload
Febrile reactions
Infection transmission
Increased hospital stay
Increased cost of care
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
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
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
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
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
Albumin: Plasma derivative
(Plasma protein fraction is similar product)
• As a volume expander…
– Used for patients 3rd spacing and are
hypovolemic, liver patients
– Hyperosmolar solution acts by moving
water from extravascular to intravascular
space
– Outcome: adequate blood pressure and
volume
Blood components cont.
• Plasma
– Contains clotting
factors & protein
– Used only for
clotting problems
• Risks
– Vascular overload
– Hypersensitivity
reaction
– Hemolytic
reactions
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
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
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
RBC & Plasma
Transfusions
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.
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
• Compare all labels second time
• Check vital signs and record
• 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
• Use appropriate filters
 For
intraoperatively
salvaged washed blood.
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Reduces leukocytes
Decreases fat globules
Reduces microaggregates
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
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
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!!
• 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
Transfusion
Reactions
• Anaphylactic
• Allergic or
Hypersensitivity
• Hemolytic
• Febrile
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?
Allergic Reactions - 1%
can occur during or after
transfusion
• Mild
– Urticaria
– Itching
• Severe
– Wheezing
– Dyspnea
– Bronchospasm
Anaphylactic Reactions
• Can occur very quickly, with only a
small amount of transfusion – usually
within 50 mls
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Hypotension, SOB, Tachycardia
Shock
Loss of consciousness
Facial edema
Dizziness
Chest tightness, abdominal cramping
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.
Hemolytic Reactions
Key Indicators:
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Apprehension
Headache
Chest pain
Tachycardia
Urticaria
N/V
Fever/chills
Burning at IV site
Low back pain
Hypotension
• Acute-usually occurs after
50 ml. infused
Lemone – after 100 to 200 ml infused
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
Nursing actions if reaction
occurs
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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
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.
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?
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
Pump Settings
• 2 cc X 15 min. =
30cc
• 30 cc = X cc
15 min. 60 min.
Run pump at 120 for
first 15 min.
 What
• 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
is the rate if you started at 80cc/15 min.?
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?
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?
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?
Rh – mother
with
Rh + baby
What med is used?
Major Surgeries Performed in
the Inpatient Setting
Emergency Surgery
• Transplants
• Ruptured aneurysm
• Life-threatening trauma
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?
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?
Autologous transfusion
 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.
Autologous transfusion
Who can have Autologous transfusion?

Patients less than 65 years old.

Patients without serious medical conditions like
serious heart and lung diseases.
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Patient’s with hemoglobin level of at least 11g / dl
before each donation
 Autologous
transfusion
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.
Directed donation of blood
 Sticker
"Directed Donation" affixed directly
on the unit.
 Note: Directed donations units may also be
collected by facilities other than yours.
 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.
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
 Cont.
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.
THE END!