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UNIT 8:BLOOD TRANSFUSION

UNIT 8:BLOOD TRANSFUSION. OBJECTIVE 1. DISCUSS TREATMENT WITH BLOOD COMPONENTS. TRANSFUSION. Infusion of blood products for the purpose of restoring circulating volume. Increases the blood’s oxygen carrying capacity Reverses tissue hypoxia. Statistics. 14 million units collected

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UNIT 8:BLOOD TRANSFUSION

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  1. UNIT 8:BLOOD TRANSFUSION

  2. OBJECTIVE 1 • DISCUSS TREATMENT WITH BLOOD COMPONENTS

  3. TRANSFUSION • Infusion of blood products for the purpose of restoring circulating volume. • Increases the blood’s oxygen carrying capacity • Reverses tissue hypoxia

  4. Statistics • 14 million units collected • 12 million administered • 60% eligible to donate, only 5% do

  5. May be whole or components • Platelets • Plasma • PRBC • Albumin

  6. Administering Blood Products • Whole blood: • Most common blood product given in the hospital • Used to treat shock, low blood volumes, low hematocrit and hemoglobin, hemorrhage • Packed RBCs: • Separated from plasma • Used to treat anemia, and reduce risk of volume overload • FROM MY NURSING LAB

  7. Administering Blood Products Leukocyte-poor RBCs: • Most WBCs removed to reduce risk of reaction • FROM MY NURSING LAB

  8. Administering Blood Products • Fresh frozen plasma (FFP): separated from whole blood by a centrifuge process • Used to restore plasma volume, treat some bleeding problems • Platelets • Maintain normal coagulability of blood • Used to treat some bleeding disorders, and to compensate when marrow can not produce enough • FROM MY NURSING LAB

  9. Donation Guidelines • Per the American Red Cross, donor must: • Be healthy • Be at least 17 y/o (16 y/o if allowed by state law) • Weigh at least 110 pounds • Not have donated blood in the last 8 weeks • FROM MY NURSING LAB

  10. Donation Guidelines • Individuals with the following are not permitted to donate blood: • Fever • High blood pressure • Very high or very low pulse rate (with the exception of highly conditioned athletes) • Irregular heartbeat • FROM MY NURSING LAB

  11. Donation Procedures • Donation procedures use standard precautions for both donor and phlebotomist • Donor is asked to remain in a recumbent position until s/he feels ready to sit up. Blood banks typically offer donors both food and fluids • FROM MY NURSING LAB

  12. Donation Procedures • Donors are asked to: • Leave the dressing in place • Avoid heavy lifting for several hours • Increase fluid intake for 2 days • Avoid alcoholic beverages for 3 hours • Avoid smoking for 1 hour • Eat healthy meals for 2 weeks • FROM MY NURSING LAB

  13. Complications of Donating • Excessive bleed at donor site • Anginal chest pain • Can occur with those with CAD • Seizure • (rare but can occur with those with epilepsy) • Fainting : most common • Hypotension • Syncope

  14. Blood Supply Safety • The FDA is responsible for ensuring the safety of the blood supply in the United States • Once blood has been received from the donor it is immediately tested for blood type and infectious diseases • FROM MY NURSING LAB

  15. Type and Crossmatch • Blood undergoes “type and crossmatch”: • Typing to determine ABO and Rh factor • Crossmatching to determine compatibility between donor and recipient blood • FROM MY NURSING LAB

  16. http://science.discovery.com/videos/100-greatest-discoveries-shorts-the-beginning-of-blood.htmlhttp://science.discovery.com/videos/100-greatest-discoveries-shorts-the-beginning-of-blood.html

  17. ANTIGEN: is a substance that prompts the generation of antibodies and can cause an immune response • ANTIBODY: are gamma globulinproteinsthat are found in blood or other bodily fluids of vertebrates, and are used by the immune system to identify and neutralize foreign objects, such as bacteria and viruses

  18. 4 types • A • B • AB • O

  19. Blood Typing • Most people have two related inherited antigens – A and B – that form the basis for the ABO blood typing • Individuals with A antigen have type A blood • Individuals with B antigen have type B blood • Individuals with both A and B have type AB blood • Individuals with neither antigen have type O blood • FROM MY NURSING LAB

  20. Blood Typing • Antibodies with each blood type: • Blood type A: Has B antibodies • Blood type B: Has A antibodies • Blood type AB: Has no antibodies • Blood type O: Has both antibodies • FROM MY NURSING LAB

  21. Blood Typing • The Rh factor is made up of numerous complex antigens • When it is present, the person is Rh positive (Rh+); if not present, the person is Rh negative (Rh–) • FROM MY NURSING LAB

  22. Blood Typing • An Rh positive person may receive either – or + blood • An Rh negative person must receive only Rh– blood • If an Rh– person receives Rh+ blood, antibodies will form • If another transfusion of Rh+ blood is given, the antibodies will agglutinate with the Rh antigens of the blood being transfused • FROM MY NURSING LAB

  23. Blood compatibilities

  24. Blood typing for transfusion • Universal donor= O- • Does not contain A, B, or Rh antigens • Universal recipients= AB+ • Blood contains A, B, and RH antigens • Usually blood banks exactly match the pt blood

  25. products • PRBCs: 250-300ml/unit infuse over 2-4 hours • Platelets: 80-60ml/pack: usually 4-6 packs are pooled for transfusion infuse as quickly as the pt tolerates • FFP: 180-270ml/unit infuse in less than 4 hours • Cryoprecipitate:10-15ml/bag; usually 10 bags are pooled for transfusion infuse in less than 4 hours (contains factor 1 and 8)

  26. Blood Screening • Prior to be being released for patient use • NAT blood screening detects minute amounts of the RNA and DNA of specific viruses • NAT testing has been FDA-approved for: • Hepatitis C • Human immunodeficiency virus (HIV) • West Nile virus • FROM MY NURSING LAB

  27. OBJECTIVE 2 • DEMONSTRATE SAFE NURSING INTERVENTIONS IN BLOOD TRANSFUSIONS

  28. PT EDUCATION • EXPLAIN RISKS AND BENEFITS • WHAT TO EXPECT • WHAT SIGNS/SYMPTOMS TO LOOK FOR • Discuss possible alternatives if unable to accept donation • What Religion will not accept transfusions? • JEHOVIAH WITNESS

  29. Other Alternatives • Volume Builders • Crystalloids • Artificial Crystalloids • Dextran for example • May cause bleed problems or allergic reactions • THEY ONLY REPLACE VOLUME • DONATIONS • Autologous • Predonation by the client themselves • Client will donate blood 1 unit/week for 3-4 weeks taking FE and/or EPO

  30. Infusion Therapy Risks • Risk factors: • Disease transmission • Hepatitis B 1:140,000 • Hepatitis C 1: 225,000 • Hepatitis A 1:1 million • HIV 1: 1.5 million • Syphillis 1: 1 million • Bacterial contamination • Acute or delayed transfusion reactions • Mismatched ABO 1: 35,000 • Incompatible Death Rate 1:600,000 • Circulatory overload

  31. Infusion Therapy Risks • Risk factors: • Disease transmission • Bacterial contamination • Acute or delayed transfusion reactions • Circulatory overload • FROM MY NURSING LAB

  32. Infusion Therapy Risks • Each unit of blood currently undergoes tests for nine diseases • Bacterial contamination is very rare, but may occur at any point • Refrigeration helps prevent bacterial growth • Transfusion reactions • Allergic reactions, incompatibilities, anaphylactic response to plasma proteins • FROM MY NURSING LAB

  33. Infusion Therapy Hazards • Some risks specific to massive transfusion (replacement of > one blood volume in 24 hours): • Hypothermia • Hemodilution • Platelet dysfunction • Electrolyte problems • BUT WHICH ONES??? • Calcium toxicity: LOW • Iron overload • http://www.youtube.com/watch?v=ctg44Z_4Z6M • FROM MY NURSING LAB

  34. Infusion Therapy Risks • Noninfectious Serious Hazards • Mistransfusion and ABO/Rh incompatibility • Cardiopulmonary toxicity/circulatory overload • Transfusion-related graft-vs.-host disease • Transfusion-related acute lung injury • Metabolic derangements in pediatric and massive transfusion • Undertransfusion • FROM MY NURSING LAB

  35. ADMINISTRATION PROCESS • ASSESS Transfusion history • Previous transfusions, allergies and reactions • Type of transfusion reaction, manifestations, and treatment • GET SET OF BASELINE VITALS

  36. Interventions • Once the blood has been taken from the blood bank, it must be administered within 30 minutes • The nurse must ensure: • Positive patient identification • Appropriateness of blood component • Blood product inspection • Verification of donor – recipient compatibility • Verification of product expiration date 

  37. adminstration on blood • Pt needs 18 or 20 gauge IV needle so cells are not lysed (destroyed) • Prior to administration, blood needs to be checked by 2 licensed nurses. Check the expiration date, name, medical record number, type of blood, blood band id, pt birthday • Check vitals prior to administration • **blood must be initiated with in 30 minutes of arrival from lab to floor • Use blood tubing for administration • Monitor for blood reactions • Monitor vitals continuously during administration

  38. Figure 23.1 Y-type blood tubing. From My Nursing Lab

  39. Figure 23.2 Sample blood administration record fromMy Nursing Lab

  40. OBJECTIVE 3 • ASSESS TRANSFUSION REACTIONS AND SAFE INTERVENTIONS

  41. Chart 23-6 (continued)Transfusion Reactions from My Nursing Lab

  42. RX continued • Circulatory overload:dyspnea, tachycardia, cough, frothy sputum, cyanosis, increased BP that drops suddenly, distended neck veins, crackles • High risk are elderly and those with history of CHF • cardio system is unable to manage the additional fluid load • Occurs anytime during transfusion and up to several hours after completion • Occurs if infusing too rapidly or too much quantity • Tx: stop infusion, call for help, be prepared for code, be prepared to administer oxygen and Lasix

  43. The END

  44. CRITICAL THINKING • You as the nurse are administering a PRBCs to a client. Baseline vitals are HR72 RR16 BP125/78 and 99.2F. After 1 hour when you take the vitals you find 100.8F and 90/50 for the BP. What might the client be experiencing? • A. Septicemia • B. Iron Overload • C. Circulatory Overload • D. Delayed Transfusion Reaction

  45. Answer • Septicemia

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