Administering Blood Transfusion Return Demonstration

Aki Notes BSN 2-YB-9

Blood Transfusion
− Replace blood components to restore the blood’s
ability to transport oxygen and carbon dioxide, clot,
fight infection, and keep extracellular fluid within the
intravascular compartment.
− Purposes: restore volume, restore oxygen-carrying
capacity, administer blood component.
− Managing blood transfusion therapies demand
knowledge of blood components and products

Blood Components
Component Synonyms Description
• Liquid component
− Rh factor is another way to group blood according to
(55%)
the presence or absence of the Rh antigen, which was
• Mixture of water,
discovered in 1940.
Plasma - sugar, fat, protein
− An Rh-negative patient should never be given Rh-
and salts
positive blood. The first time may not illicit negative
• Transport blood cells
effects, but after the Rh antibodies are formed,
throughout the body
subsequent transfusions could cause agglutination.
• Most abundant cell
(45%)
• Gives red color to the
blood
Red Blood RBC,
• Biconcave shape with
Cells Erythrocytes
flattened center
• Contains the
hemoglobin protein
that carries oxygen
• Comprise 1% of
blood volume
White WBC, • Protect body from
Blood Cells Leukocytes infection
• Types: neutrophil
and lymphocytes
• Fragments of cells
Platelets Thrombocytes • For coagulation
(clotting) process − There are eight different blood groupings based on Rh
factor, each either Rh-positive or Rh-negative
Blood Typing/Matching
− The four blood groups are A, B, AB, and O.
− The differences in each group are determined by the
presence of certain protein molecules known as − Cross matching is a procedure to check for antibodies
antigens (a foreign substance in the blood located on to different antigens after the blood group and Rh
red blood cells [RBCs]) and antibodies (a protein factor are known
manufactured in response to the presence of an − It’s the final step in testing for compatibility. The blood
antigen in the body located in blood plasma). from a donor is mixed in a test tube with the blood
− When the wrong type of blood is given to a patient, it from the recipient. If any clumping occurs, then the
clumps together—a potentially fatal process known as blood isn’t compatible and further testing will be
agglutination, an immunologic response that occurs needed.
when the cells of one type of blood interact with the − An autologous blood donation is one in which a person
antibodies of another type. donates blood for their own use prior to or during a

BLOOD TRANSFUSION RETDEM 1

Aki Notes Administering Blood Transfusion Return Demonstration BSN 2-YB-9

scheduled surgery. When the blood is given back, it is Packed Red Blood Cells (PRBC)
called an autologous blood transfusion. − Collected from whole blood by either centrifugation or
− An allogeneic blood transfusion, in which blood from sedimentation, after drawing off about 250 ml of
another from a person is used. plasma and platelets from the donor unit
− PRBCs have a hematocrit between 70% and 80%
The Blood Products (vicious)
− For each unit of PRBCs transfused, the average 70 kg
adult’s hemoglobin will generally increase by 1 g/dl;
hematocrit will usually rise by 2% to 3%
− Generally administered as blood replacement during
surgery
Nursing Considerations
• Preparation - prime the tubing and filter with 0.9%
sodium chloride before hanging; filters are for
maximum of 4hrs only
• Typing- Universal (due to plasma removal), however,
Rh- positive PRBCs should be given only to patients
known to be Rh-positive; Rh-negative PRBCs should be
given to patients who are known to be Rh-negative or
Whole Blood who have an unknown Rh status
− Rarely ordered, used and administered • Time considerations – PRBCs and filters are for
− Contains cells (red blood cells [RBCs], white blood cells maximum of 4hrs only
[WBCs], and platelets), plasma (plasma proteins, • Administration - Because of its viscosity, PRBCs can
antibodies, water, and waste), and electrolytes. be difficult to administer through a small catheter
− blood volume expander and a source of proteins that within the 4- hour time limit. Many hospitals have a
promote coagulation. policy that PRBCs must be infused through at least a
− Indicated for patients who need rapid, massive 20-gauge peripheral I.V. catheter.
replacement of lost blood (usually more than 25% of • Cautions – Do not administer in the same line with
their blood volume) and who have symptoms of most other infusions due to risk of hemolysis. The only
hypoxia, or patients who need an exchange exceptions are 0.9% sodium chloride, 5% albumin,
transfusion plasma protein fraction, or compatible plasma.
Nursing Considerations Modified PRBCs are similar to PRBCs
• Preparation - prime the tubing and filter with 0.9% − PRBCs washed in 0.9% sodium chloride and is
sodium chloride before hanging; filters are for intended for neonatal or intrauterine transfusion or
maximum of 4hrs only when patients have had recurrent or severe allergic
• Typing - type specific, and it must be ABO- and Rh- reactions to plasma proteins.
compatible to prevent serious transfusion reactions − Leukocyte-filtered PRBCs are given to patients
• Time considerations – whole blood and filters are who’ve had repeated febrile reactions to transfusions.
for maximum of 4hrs only
• Gradual and full – infuse 25ml slowly over 15 Platelet Products
minutes while monitoring the patient to check for − Available in two (2) preparations:
adverse reactions • random-donor concentrates made from single
• Infusion – depends on patient condition. Healthy units of whole blood, and
adults with chronic anemia can safely be given RBCs • single-donor concentrates obtained from
at a rate of 3 to 4 ml/kg/hour. Careful with patients plasmapheresis of a single donor.
with cardiovascular compromise - can’t tolerate rates − Platelet products also contain plasma (especially factor
of more than 1 ml/kg/hour. III, necessary for coagulation), some RBCs, and some
• Cautions – Do not administer in the same line with WBCs (leukocytes).
most other infusions due to risk of hemolysis. The only − Platelets are transfused to control or prevent bleeding
exceptions are 0.9% sodium chloride, 5% albumin, associated with deficiencies in platelet number or
plasma protein fraction, or compatible plasma. function and to aid in the coagulation process.
− Each unit of platelet concentrate should increase the
average adult patient’s platelet count by about 5,000
platelets/microliter.
BLOOD TRANSFUSION RETDEM 2
Aki Notes Administering Blood Transfusion Return Demonstration BSN 2-YB-9

− Patients with immune thrombocytopenic purpura • Typing - It must be ABO compatible, but Rh antibody
shouldn’t receive platelet infusions, unless life- status is irrelevant
threatening bleeding occurs.
Transfusion Reactions
Nursing Considerations
− Acute hemolytic transfusion reactions (AHTR) can
• Time considerations - Platelets should be infused cause serious, potentially fatal consequences
either within 4 hours of being removed from the
− Common causes: ABO incompatibility between patient
refrigerator due to the risk of bacterial contamination.
and donor during transfusion of red blood cells. Most
• Special filters - platelets should be administered cases of ABO incompatibility result from clerical error
through a standard 170- to 260-micron filter. Avoid
at some point in the transfusion process.
filters that were used to filter whole blood or PRBCs;
− Signs and symptoms of AHTR usually appear 5 to 15
red cell debris already accumulated in the filter might
minutes after the transfusion begins, but they can
trap the platelets. Instead, use a new filter.
develop anytime during the transfusion:
• Typing - For most adults, platelet concentrates don’t
• Febrile – chills, fever, headache, flushing,
require ABO crossmatching before infusion. But
tachycardia,↑anxiety
patients who’ve had numerous platelet transfusions
• Allergic – Mild: hives, pruritus, facial flushing;
may become resistant to pooled donor platelets and
Severe: SOB, branchospasms, ↑anxiety
may respond better to donor- matched platelets from
• Hemolytic – low back pain, hypotension,
a single donor.
tachycardia, fever and chills, chest pain,
• Age - Infants and small children must receive either
tachypnea, hemoglobinuria
ABO compatible or reduced-volume ABO incompatible
− Should any of these symptoms occur, immediately
platelets. The number of red cells in platelets isn’t high
discontinue the transfusion, hang 0.9% sodium
enough to cause an incompatibility reaction. But there
chloride to maintain vascular access (be sure to use
are enough red cells for an Rh-negative child to
new tubing), and call for assistance.
develop Rh antibodies if he receives Rh positive blood
− REACTION: Rash, Elevated Tem, Ache, Chills, Increase
products.
RR, Oliguria, Nausea

Fresh Frozen Plasma (FFP)

Blood Transfusion & Reactions
− contains all the normal components of blood plasma,
PRE-BT
including clotting factors and 200 to 400 mg of
Before Transfusion: Preparations [R.I.P.E]
fibrinogen. FFP is removed from whole blood and
− Review - medical history and pertinent lab values.
frozen, generally within 8 hours of collection.
Find out previous transfusions and any adverse
− FFP may benefit actively bleeding patients with
reactions.
documented clotting deficiencies, such as from
− Informed consent – educate the patient about the
congenital deficiency, liver disease, anticoagulation
benefits, risks, and alternatives to blood transfusion.
with warfarin (Coumadin), or massive transfusion with
Reassurance that transfusion is generally a safe and
red cells and crystalloid/colloid solutions.
simple procedure
− Each unit of FFP transfused will increase the level of
− Perform – physical assessment; check the patient’s
any clotting factor by 2% to 3% in the average adult.
vital signs and assess for skin rashes, shortness of
− FFP transfusion is rarely indicated if prothrombin time
breath, wheezing, pain, chills, itching, or nausea.
(PT) and partial thromboplastin time (PTT) are less
− Evaluate – chart, blood or component ordered and
than 1.5 times normal.
the corresponding transfusion record from the blood
− Because FFP is an isotonic volume expander, patients
bank. Check the following:
receiving more than one unit must be monitored for
• Labels - expiration date, ABO/Rh label, unit
signs of overload.
number, the component label, and any special
Nursing Considerations processes (such as irradiation or leukocyte
• Thawing - FFP should be used as soon as possible depleted)
after it’s been thawed, and always within 24 hours of • Integrity - Press lightly on the unit and invert it to
thawing. A hanging unit must be infused within 6 hours ensure that all bag segments and seams are free
due to the risk of bacterial contamination. from leaks and that port covers are in place
• Filters -Use a standard filter (170 to 260 microns) in • Appearance - uniformity of color between bag
the tubing when filtering FFP. Because FFP isn’t as segments and the main part of the bag
viscous as whole blood or PRBCs, a blood component
recipient set is often used

BLOOD TRANSFUSION RETDEM 3

Aki Notes Administering Blood Transfusion Return Demonstration BSN 2-YB-9

INTRA-BT  Unit and hospital number

During Transfusion [A.R.M.]  Expiration date and time on blood bag.
− Assess – patency of vascular access  Type of blood product compared with written order.
 Presence of clots in blood
− Record - Record the patient’s temperature, pulse,
respirations, and blood pressure. 8) Wash hands and put on gloves.
− Monitor - vital signs 15 minutes after starting the 9) Open blood administration kit and close roller clamps.
transfusion and as needed, based on the patient’s 10) For Y-tubing set.
 Spike the normal saline bag and prime the tubing
condition, until the transfusion is complete. If the
between the saline bag and the filter.
patient experiences symptoms of a transfusion
 Squeeze the sides of drip chamber and allow filter to
reaction, immediately discontinue the transfusion and partially fill.
call for help  Open lower roller clamp and prime tubing to the hub.
POST-BT  Close lower clamp.
After Transfusion  Invert blood bag once or twice. Spike blood bag, open
− If no complications occur, document the transfusion in clamps and fill tubing completely, covering the filter with
the patient chart. Note on the chart the date, time, blood. (start slowly) approximately 20 drops/minute in
type of infusion, the patient’s vital signs, and how the first 15-30 minutes. If no signs of transfusion reaction,
procedure is tolerated. increase rate to ordered rate.
 Close lower clamp.
Sample Charting: 4/30/19 8:30 am 1 unit of PRBC
11) For single tubing set.
(#65234) hung to be infused over 3 hours. IV site in L  Spike blood unit using filter tubing.
forearm with 19 g angiocath. VS taken and recorded.  Squeeze drip chamber and the filter filled with blood.
Informed to contact nurse if begins to experience any  Piggyback a saline into the blood administration tubing.
discomfort during transfusion. Stated he would use the call  Secure all connections with tape.
lights. 12) Attach tubing to venous catheter aseptically and open
clamps on blood tubing. Infuse the blood product at
Retdem – Administering Blood transfusion the ordered rate.
1) Verify the written order for the transfusion  Hemolytic Reaction – Incompatibility between client’s
 Verify blood product matches physician order blood and the donor’s blood
 Compare ‘Blood Transfusion Record’ to patient’s – Chills, fever, Headache, backache, Dyspnea,
wristband. Cyanosis, Chest pain, Tachycardia, Hypotension
 Have pt. state their name & date of birth. Verify match. – Nursing intervention:
 Compare and verify (‘Blood Transfusion Record’ to • STOP transfusion
requisition/ tag attached to the unit of blood) • KVO with PNSS (keep vein open)
2) Greet and identify the patient. • Send remaining blood, a sample of client blood
 Client's Identification ( Name on Band or Bracelet ) and urine sample to the laboratory.
 Recipient ABO type & Rh type Identify • Notify the physician
 An antibody screen :- Presence of Antibody • Monitor VS
 Universal Blood Donor — O • Monitor I &O.
 Universal Blood Recipient — AB  Febrile Reaction – Sensitivity of the client’s blood to WBC,
3) Explain the procedure. Start IV line if necessary. platelets or plasma protein
4) Have the client sign the consent forms. – Fever, Chills, Warm, flushed skin, Headache,
5) Obtain baseline vital signs. Anxiety, Muscle pain
6) Obtain the blood product from the blood bank within – Nursing Intervention:
30 minutes of initiation. • STOP transfusion
 Check expiration date. • Give antipyretics
 Check blood label against blood unit for client’s name • Notify the physician
and identification band number. • KVO with PNSS
 Check the blood group (ABO) and type (Rh), blood unit  Allergic Reaction
number. – Mild – Sensitivity to infused plasma proteins,
 Check blood unit for bubbles, cloudiness or dark color Flushing, Itching, Urticaria, Brochial wheezing
 if any of these signs is present, return blood unit to
laboratory and process a written report of actions
– Nursing interventions
• STOP transfusion
according to agency protocol.
• Notify the physician
7) Verify the blood product and the client with another
• Administer antihistamine as ordered
nurse.
 Client’s name, blood group, RH type.
– Severe – Antibody-antigen reaction, Dyspnea,
Chest pain, Circulatory collapse, Cardiac arrest
 Cross match compatibility.

BLOOD TRANSFUSION RETDEM 4

Aki Notes Administering Blood Transfusion Return Demonstration BSN 2-YB-9

– Nursing interventions
• STOP transfusion
• KVO with PNSS
• Notify the physician immediately
• Monitor VS
• Administer CPR as needed
• Administer medication / oxygen as needed
 Circulatory Overload – Blood administered faster than
the circulation can accommodate
– Cough, Dyspnea, Crackles, Distended neck veins,
Tachycardia, Hypertension
– Nursing interventions
• STOP or SLOW the transfusion
• Place the client upright, with feet dependent
• Administer diuretics and oxygen as needed
• Notify physician
 Sepsis – Contaminated blood administration
– High fever, chills, Vomiting, Diarrhea, Hypotension
– Nursing interventions
• STOP transfusion
• Send remaining blood to laboratory Notify the
physician
• Obtain a blood specimen from the client for
culture
• Administer IV fluids and antibiotics
• KVO with PNSS
13) Remain with client for the first 15-30 minutes,
monitoring vital signs frequently according to
institutional policy.
14) After blood has infused, flush the tubing with normal
saline.
 Complete the transfusion within 3- 4 hours.
15) Wash hands and documentation
 transfusion time
 blood product
 volume of blood
 vital signs
 any abnormal reaction

Wala ding demo vid ito kaya search search nlng sa

youtube. Yung lecture dito galing kay Sir Dino, ung prof
natin sa funda nonn. Hehe good luck puh

BLOOD TRANSFUSION RETDEM 5