Effective Hemodynamic Management in Blood Administration

1. Blood Administration Hemodynamic Management

2. Blood Therapy • Indications • Significant hypovolemia due to acute blood loss • Symptomatic anemia • Decreasing hemoglobin • Decreasing hematocrit • To increase oxygen carrying ability • Decreased clotting factors Hemodynamic Management

3. Type and Screen • Indications • Sudden blood loss • Anemia • Pre-surgical work-up • Procedure • Phlebotomy • Spin and separate • Test for antibodies Hemodynamic Management

4. Cross Match • Indications • Specific blood for specific patient • Procedure • Incubate donor cells with recipient serum • Coomb’s test Hemodynamic Management

5. Types of Blood Products • Common • Whole blood • Packed red blood cells • Fresh frozen plasma • Platelets • Less common • Albumin • Cryoprecipitate Hemodynamic Management

6. Blood Types Blood Types Antigens Antibodies A A Anti-B B B Anti-A AB A, B None O None Anti-A, Anti-B Hemodynamic Management

7. Blood Administration • Type O ........... universal donor • Type AB .....… universal recipient Hemodynamic Management

8. Rh Factor • Rh positive • Possess D antigen • Rh negative • Possess no D antigen • Rh negative patients may develop antibodies to D antigens with exposures to Rh positive blood Hemodynamic Management

9. Blood Administration • Equipment needed • Physicians order • Blood typed and cross matched • Venous access (18ga or larger) • Filtered administration set • 0.9% NS • Thermometer Hemodynamic Management

10. Transfusion Procedure • Preparation of patient • Confirm order for blood • Check patient for • Right patient • Right blood product • Right type • Assess baseline vital signs • Ensure suitable venous access Hemodynamic Management

11. Transfusion Procedure • Preparation of blood • Check blood for • Right patient • Right blood product • Right type • Expiration date • Maintain temperature of blood Hemodynamic Management

12. Transfusion Precautions • Do not mix blood with • D5W - causes hemolysis • LR - causes clotting • Medications - may react Hemodynamic Management

13. Transfusion Procedure • Procedure • Flush tubing with 0.9% NS • Cover the administration filter with blood • Connect blood to tubing • Piggyback onto IV line of 0.9% NS • Start transfusion slowly • Monitor for adverse reaction Hemodynamic Management

14. Transfusion Rate • Procedure • Initially @ rate of 1 ml/min • Evaluate for hemolytic reaction • Monitor vital signs q 15 minutes • After 30 minutes, adjust flow rate • Evaluate for hemolytic reaction • Monitor vital signs q 30 minutes Hemodynamic Management

15. Transfusion Rate • Whole blood • 2-3 hours • No more than 4 hours • Packed red blood cells • 2-3 hours • No more than 4 hours • Fresh frozen plasma • Less than 2 hours Hemodynamic Management

16. Transfusion Reaction • Signs and symptoms • Fever - 2 degrees or more • Hives, itching or skin symptoms • Swelling, soreness or hematoma at IV site • Tachycardia • Respiratory distress • Hypotension • Anaphylaxis • Nausea, vomiting • Blood in urine All Signs of Shock Hemodynamic Management

17. Transfusion Reaction • Treatment • STOP the transfusion! • Maintain IV access with 0.9% NS • Save the remaining blood product • Administer oxygen PRN Hemodynamic Management

18. Transfusion Reaction • Treatment • Medications • Benadryl • Epinephrine • Tylenol • Lasix • Notify physician • Treat for signs and symptoms of shock Hemodynamic Management

19. Documentation • Record • Baseline vital signs • Time transfusion started • Transfusion flow rate • Patient’s response and ongoing vital signs • Time transfusion ended • Pertinent observations and clinical manifestations Hemodynamic Management

20. Blood Administration Conclusion Hemodynamic Management