rle finals (4)

Cards (8)

  • Blood transfusion
    Introduction of whole blood or components of blood, such as plasma, serum, erythrocytes, or platelets, into the venous circulation
  • Purposes of blood transfusion
    • To restore/ increase circulating blood volume after surgery, trauma, child birth
    • To restore or increase the red blood cell level after severe and chronic anemias and to maintain blood hemoglobin levels such as in leukemia
    • To provide selected cellular components as replacement therapy such as clotting factors, platelets and albumin
  • Types of blood and blood products and indications for use
    • Whole blood (type A,B,AB or O, and Rh(+) or Rh(-) - To expand blood volume, to restore circulation and renal blood flow when plasma volume is decreased but the red cell mass is adequate, as in acute hemorrhage, acute dehydration or burns; to replace deficient coagulation factors in bleeding disorders
    • Packed red cells (high Hematocrit, since approximately 80% of the plasma is removed) - Used when blood volume is adequate but the red cell mass is inadequate, as in chronic anemia
    • Platelets - For patients with severe thrombocytopenia (reduced platelets;) Replaces platelets, for example in Dengue Hemorrhagic Fever
    • Albumin - To expand the blood volume rapidly when blood volume is reduced in shock or burns; also to increase level of albumin in patients withhypoalbuminemia
    • Prothrombin complex (for example, konyne, Proplex) contains factors VII, IX, and XI and prothrombin - Used for bleeding associated with deficiencies of those factors
    • Factors VIII fraction or (cryoprecipitate) - For hemophiliacs, Caution: May transmit infection, transfuse with a filter
    • Fibrinogen preparations - Used particularly for bleeding associated With congenital hypofibrinogenemia (a deficiency of fibrinogen, a necessary factor for blood coagulation)
  • There is no margin for error when administering blood products because adverse reactions can be considerable and life-threatening
  • Special considerations for blood transfusion
    • Blood transfusion must be matched to the patient's blood type (A,B,O,AB), Rh group and other factors
    • A blood product infusion should begin within 30 minutes of leaving the blood bank
    • A blood warmer may be used if the patient is in critical condition or it patient is feeling chilly before infusion
    • Blood transfusion should be checked every 15-30 minutes to ensure that it is running on time
    • Blood components that are still hanging after 4O without refrigeration must be discontinued
    • In the post infusion period, the patient's urine is observed for signs of hematuria, indicating a transfusion reaction
    • If a transfusion reaction occurs, stop the blood, start the saline, stay with the patient and immediately notify the physician. If shortness of breath occurs, start low flow oxygen (1-2 L/min.) per agency protocol. Return the blood component bag to the blood bank or laboratory with the transfusion reaction form
  • Acute transfusion reactions
    • Acute hemolytic - Infusion of ABO incompatible whole blood, RBCs or components containing 10 ml or more of RBCs. Antibodies in the patient's plasma attach to antigens on transfused RBCs causing RBC destruction
    • Febrile, nonhemolytic (most common) - Sensitization to donor white blood cells; platelet or plasma proteins
    • Mild allergic - Sensitivity to foreign plasma proteins
    • Anaphylactic - Infusion of IgA proteins to IgA deficient recipient who has developed IgA antibody
    • Circulatory overload - Fluid administered faster than the circulation can accommodate
    • Sepsis - Transfusion of contaminated blood components
  • Equipment for blood transfusion
    • Blood transfusion set (g. 19-22 needle)
    • Ordered 0.9% (NSS) 1L
    • Sterile dry CB (2 pcs.)
    • Plaster
    • Cross matching result
    • Working gloves
    • Ordered blood component
    • Sterile OS(1pc.)
  • Procedures and rationales for blood transfusion
    1. Check the doctor's order and Ensure that the consent form (if required) is signed - Verifies doctor's prescription for blood transfusion and patient's consent
    2. See that the patient has a patent g. 18-19 cannula in place - A needle smaller than g.19 may break up red cells
    3. Obtain the blood product from the laboratory and initiate transfusion within 30 minutes. In the Laboratory check the following: type of blood product, Client's name, ward and room number, Cross-matching compatibility, Donors blood group, Expiration date and time on blood bag, presence of blood clot - Prevent bacterial growth and destruction of RBC
    4. Wash hands and assemble equipment with another nurse - Deters spread of microorganisms and saves time
    5. Verify and record the blood product and identify the client with another nurse - For safety 2 nurses must verify the order and match the numbers on the blood component with those of the crossmatching slip. Provides for a double-check, to decrease the risk of error. The blood component must not be transfused after the expiration date. If the unit contains clots, it should be returned to the blood bank or laboratory
    6. Don working gloves - Reduces risk of contact with blood borne pathogens
    7. Close the clamp of the tube and insert the spike in the port of the blood bag. Invert the blood bag, press the filter chamber, open the clamp and prime. Close the clamp