Blood Administration

• Packed Red Blood Cells (PRBCs):

  • Indications: low RBC count
  • Expected outcomes: Increased RBC count and decreased symptoms of anemia
  • Procedure:
  • Assess patient
  • Prepare and gather the equipment necessary
  • Identify the patient
  • Obtain consent
  • Get IV access
  • Get the blood bag
  • Check compatibility
  • Begin transfusion slow to monitor for reaction
  • Document
  • Dispose
• Fresh Frozen Plasma (FFP):

  • Indications: Lacking clotting factors or dysfunctional/deficient clotting factors
  • Expected outcomes: Correct the coagulopathy and replenish the clotting factors to help with bleeding
  • Procedure:
  • Patient assessment 
  • Verify order
  • Obtain consent
  • Identify patient
  • Prepare and gather equipment
  • Get the FFP bag
  • Check compatibility
  • Get IV access
  • Start transfusion and monitor for adverse reactions
  • Document and dispose
• Platelets:

  • Indications: When thrombocytopenia (low platelet count) is present or there is a platelet dysfunction
  • Expected outcomes: Prevent and treat the bleeding and resolve the platelet dysfunction if there is any
  • Procedure:
  • Patient assessment 
  • Verify order
  • Obtain consent
  • Identify patient
  • Prepare and gather equipment
  • Get the platelet bag
  • Check compatibility
  • Get IV access
  • Start transfusion and monitor for adverse reactions
  • Document and dispose
• Cryoprecipitate:

  • Indications: Low fibrinogen deficiency or lack of clotting factors
  • Expected outcomes: Replenished fibrinogen and other clotting factors to treat and prevent more bleeding
  • Procedure: 
  • Patient assessment 
  • Verify order
  • Obtain consent
  • Identify patient
  • Prepare and gather equipment
  • Get the cryoprecipitate bag
  • Check compatibility
  • Get IV access
  • Start transfusion and monitor for adverse reactions
  • Document and dispose
• Blood Typing, Screening, and Crossmatching eliminates blood incompatibilities

  • TRUE
• Blood Typing: identifies a person's ABO and Rh blood type
• Blood Screening: Identifies additional antibodies in the patient's blood that may react with antigens in the donor blood

  • examples of common antigens: duffy, kidd, diego, cartwright, lutheran
• Blood Cross matching: Donor blood is combined with patient's plasma to check for agglutination
• Possible Transfusion Reaction Symptoms: watch for these

  • Temp rise greater than or equal to 1.8 F or 1 C
  • Chills 
  • Skin manifestations: hives, rash, flushing, pruritus, angioedema 
  • Respiratory symptoms: dyspnea, wheezing, crackles, congested cough, cyanosis, SPO2 <90%
  • Restlessness and anxiety 
  • Unexpected fall in blood pressure 
  • Unexpected bradycardia or tachycardia 
  • Pain in back or chest 
  • Nausea or vomiting
  • Hematuria
• Vital Signs should be monitored:

  • Within 30 minutes before transfusion
  • 10-15 minutes after initiating the transfusion
  • Every 30-60 minutes during the transfusion
  • When the transfusion is completed
• Types of Blood Transfusion Reactions:

  • Allergic reaction
  • Febrile Non-hemolytic Transfusion Reaction
  • Transfusion Associated Circulatory Overload (TACO)
  • Transfusion Related Acute Lung Injury (TRAILI)
  • Sepsis Reaction
  • Acute Hemolytic Transfusion Reaction
• Allergic Reaction:

  • Manifestations: flushing, hives, pruritus, dyspnea, wheezing, anxiety, hypotension without fever
  • PREVENT: administer autologous blood products, premeditated with acetaminophen, diphenhydramine (Benadryl) and corticosteroids, administer washed RBCs or washed platelets
• Febrile Non-hemolytic Transfusion Reaction

  • Manifestations: Fever (rise in temp 1 C), chills, flushed skin, anxiety during or up to 24 hours after transfusion
  • PREVENT: administer leukocyte-reduced blood products to patients with a history of this type of transfusion reaction, premeditated with acetaminophen and diphenhydramine
• Transfusion Associated Circulatory Overload (TACO)

  • Manifestations: dyspnea, orthopnea, crackles in lungs, distended jugular veins
  • PREVENT: administer blood product at an appropriate flow rate based on patient’s size, age and clinical condition
• Transfusion Related Acute Lung Injury (TRAILI)

  • Manifestations: dyspnea, severe hypoxemia, frothy sputum, hypotension, and fever that develops within 6hrs of transfusion
  • PREVENT: administer leukocyte-reduced blood products
• Sepsis Reaction

  • Manifestations: sudden chills, fever, tachycardia, shock 
  • PREVENT: collect, process and store blood products according to CDC, FDA, and AABB standards 
  • Aseptically infuse blood products within 4 hours
• Acute Hemolytic Transfusion Reaction

  • Manifestations: fever, chills, hypotension, wheezing, anxiety, red-colored urine, low back pain (can sometimes result in renal failure) 
  • PREVENT: proper labeling of patients pretransfusion type and crossmatch blood samples, proper identification of patient and blood components at the time of transfusion
• Blood Transfusion: Step one

  • The nurse verifies that informed consent has been obtained for the blood product

  1. It is the prescriber’s responsibility to obtain informed consent from the patient
  2. The prescriber explains risk, benefits, and alternatives
• Blood Transfusion: Step two

  • The nurse reviews the patient’s transfusion history to determine if the patient has had previous transfusion reactions
• Blood Transfusion: Step three

  • Establish IV access
  • make sure that it is the correct gauge
• Step four

  • Request the blood product from the blood bank
• Step Five

  • Gather supplies needed to administer blood product:
  • Blood administration tubing with a 170 micron filter
  • A bag of 0.9% sodium chloride solution
  • IV infusion pump
  • Equipment to obtain vital signs
  • PPE
  • Alcohol pads
  • 0.9% sodium chloride flush syringe
  • Biohazard
• Step 6

  • Inspect the blood component
• Step Seven

  • Complete the blood component verification process
  • Performed by the RN administering the blood product and another person considered qualified by the agency
  • Verify that the blood component received from the blood bank is the component that was ordered by the prescriber
• Step Eight

  • Explain procedure to the patient and family
• Step nine

  • Obtain vital signs before the transfusion is initiated
  • Prime the blood administration tubing with 0.9% sodium chloride (if using Y tubing)
• Step Ten

  • Aseptically attach saline primed blod tubing to patient’s IV cannula and infuse saline at TKO rate
• Step Eleven

  • Spike blood component with the other Y connection and infuse blood
• Step Twelve

  • Remain with patient during the first 10-15 minutes of the transfusion to observe for S/S of a transfusion reaction
  • Possible Symptoms:
  • Temperature rise greater than or equal to 1.8 F or 1 C
  • Chills
  • Hives, rash, flushing, pruritus, angioedema
  • Dyspnea, wheezing, crackles, congested cough, cyanosis, SPO2 less than 90%
  • Restlessness and anxiety
  • Unexpected fall in BP
  • Unexpected bradycardia or tachycardia
  • Pain in back or chest
  • Nausea or vomiting
  • Hematuria
• Step Thirteen

  • Take vital signs 10 minutes after initiating the transfusion