rle finals (5)

• Blood transfusion

  Infusion of the whole blood or a blood component into a patient's venous circulation
• Blood transfusion is a life-saving medical procedure ordered by the doctor
• Blood transfusion therapy

  Introduction of whole blood or components of blood, such as plasma, serum, erythrocytes, or platelets, into the venous circulation
• Blood transfusion can be life-saving in some situations, such as massive blood loss due to trauma, or can be used to replace blood lost during surgery
• Blood transfusion may also be used to treat severe anemia or thrombocytopenia caused by a blood disease
• Normal saline solution

  Used to maintain blood volume during surgery
• Only compatible IV fluid during blood transfusion is 0.9% saline solution (plain NSS)
• Pancytopenia

  Low platelet, white blood cell, and red blood cell count
• Risks of blood transfusions

  • HIV virus
  • Hepatitis B
  • Hepatitis C
• All of the above are blood-borne diseases
• Prior to blood transfusions

  Proper cross-matching of the donor's blood and the blood of the recipient (to assure compatibility)
• Equipment needed for blood transfusion

  • Blood group
  • Fresh whole blood
  • Packed RBC
  • Platelet concentrates and apheresis
  • Fresh frozen plasma (FFP)
  • Cryoprecipitate
  • Granulocyte concentrates
  • Human Albumin
• Packed RBC (PRBC) and FWB transfusion

  • IV solution used: Normal saline solution
  • Time to run: 4 hours
  • Expiration: 30 days
  • Administered: Piggy back or Side drip
• PISO cations

  • Potassium inside, sodium outside
  • Possibility of hyperkalemia
• PICO anions

  • Phosphate inside, calcium outside
  • Another electrolyte imbalance
• Platelet concentrate and platelet apheresis

  • Purpose: Treat thrombocytopenia
  • Platelet concentrate: 30-50cc = 6 units from multiple donors
  • Platelet apheresis: 200-400cc = 1 unit from 1 donor (preferred by doctor)
  • Time to run: 1 hour
  • Needs to be agitated (use of agitator)
  • Stored at room temperature, cannot be frozen
  • Expiration: 5 days
• Fresh frozen plasma (FFP)

  • Purpose: Treat bleeding
  • Time to run: 30 mins
  • Needs to be consumed
  • Thaw before administering for 45 minutes
  • Expiration: 1 year
• Equipment for blood transfusion

  • Blood administration set (with an in-line filter)
  • 0.9% NaCl (Plain NSS)
  • IV pole
  • IV catheter (gauge 19 or larger)
  • Disposable gloves
  • Tape
• Pre-assessment before blood transfusion

  1. Obtain baseline vital signs, lung sounds, and urinary output

  2. Review recent laboratory values

  3. Ask about previous transfusion reactions

  4. Inspect IV insertion site and check the type of solution
• Performing blood transfusion

  1. Determine whether patient knows reason for transfusion

  2. Explain to patient what will happen, check for signed consent, advise patient to report any chills, itching, rash, or unusual symptoms

  3. Give premedications if ordered (acetaminophen to prevent febrile nonhemolytic reaction, diphenhydramine for allergic reactions)

  4. Hang container of 0.9% normal saline with blood administration set, initiate infusion

  5. Start IV with gauge 18 or 19, run normal saline at KVO

  6. Obtain the blood product

  7. Complete identification and checks (serial number, blood component, blood type, Rh factor, expiration date, screening tests)

  8. Take baseline vital signs

  9. Start infusion of blood (thaw first), prime in-line filter with blood, start administration slowly (25-50ml for the first 15 minutes), stay with the patient for the first 5-15 minutes of transfusion, check vital signs every 15 minutes for 1 hour

  10. Observe patient for flushing, dyspnea, itching, hives, rash

  11. Consume blood within 4 hours

  12. Assess frequently for transfusion reactions
• Transfusion reaction

  Reaction of the body to a transfusion of blood that is not compatible with its own blood
• Signs and symptoms of transfusion reaction

  • Anxiety
  • Flushing
  • Tachycardia
  • Hypotension
  • Chest pain
  • Back pain
  • Dyspnea
  • Fever
  • Chills
  • Jaundice
• If a transfusion reaction is suspected

  Stop blood transfusion and run 0.9% normal saline, notify the doctor and the blood bank
• When transfusion is complete

  Clamp off blood and infuse 0.9% normal saline, record administration of blood and patient's reaction
• Positive outcome of blood transfusion is exhibiting signs and symptoms of fluid balance (normal BP), improved cardiac output, and enhanced peripheral tissue perfusion
• Transfusion reaction

  Any adverse event which occurs because of a blood transfusion, can be an allergic reaction, a transfusion-related infection, hemolysis related to an incompatible blood type, or an alteration of the immune system
• The risk of a transfusion reaction must always be balanced against the anticipated benefit of a blood transfusion
• Types of transfusion reactions

  • Febrile non-hemolytic transfusion reaction
  • Viral infection
  • Bacterial infection
  • Acute hemolytic reaction
  • Anaphylactic reaction
  • Transfusion-associated acute lung injury (TRALI)
  • Volume overload
  • Iron overload
  • Transfusion-associated graft-vs-host disease (GVHD)
• Febrile non-hemolytic transfusion reaction

  Most common adverse reaction, causes fever and dyspnea 1 to 6 hours after receiving the transfusion, clinically benign with no lasting side effects
• Viral infection

  Risk is low in developed countries due to careful screening of donors and blood supply, but transmission has been documented rarely
• Bacterial infection

  Blood products can provide a medium for bacterial growth, highest risk with platelet transfusion
• Acute hemolytic reaction

  Medical emergency resulting from rapid destruction of donor red blood cells by host antibodies, often caused by clerical error, can lead to acute renal failure
• Anaphylactic reaction

  Severe allergic reaction, most common in people with selective IgA deficiency, requires prompt treatment and can be life-threatening
• Transfusion-associated acute lung injury (TRALI)

  Syndrome of acute respiratory distress, often with fever, noncardiogenic pulmonary edema, and hypotension, most patients recover fully within 96 hours
• Volume overload

  Can occur in patients with impaired cardiac function, leading to edema, dyspnea, and orthopnea
• Iron overload

  Can occur in patients receiving numerous red blood cell transfusions, can damage the liver, heart, kidneys, and pancreas
• Transfusion-associated graft-vs-host disease (GVHD)

  Immune attack by transfused cells against the recipient, occurs only in severely immunosuppressed patients, almost uniformly fatal
• Treatment of transfusion reactions

  Stop the transfusion immediately (saving the remaining blood and IV tubing for testing) and provide supportive care to the patient, more specific treatments depend on the nature and cause of the reaction