BLOODTRANSFUSION PRESENTED BY: Carmina F. Gurrea, RN Clinical Instructor
OVERVIEW Blood Transfusion Components of the Blood Blood transfusion products Compatibility test Indications for blood transfusion Adverse effects of blood transfusion Nursing Responsibilities Steps in Administering Blood Transfusion products
What is Blood Transfusion? A Blood Transfusion is the introduction of whole blood or components of whole blood – such as plasma, serum, erythrocytes, or platelets – into the venous circulation.
What are the Components of the Blood?Human blood consists of about 22 percent solids and 78percent water. The components of human blood are: Plasma, in which the blood cells are suspended, including: Red blood cells (erythrocytes) - carry oxygen from the lungs to the rest of the body. White blood cells (leukocytes) - help fight infections and aid in the immune process. Types of white blood cells include: Lymphocytes MonocytesBlood Cellular Portions Eosinophils Basophils Neutrophils (granulocytes)
What are the Components of the Blood? Platelets (thrombocytes) - help in blood clotting. Fat globules Chemical substances, including: Carbohydrates Proteins Hormones Gases, including: Oxygen Carbon dioxide Nitrogen
BLOOD TRANSFUSION 1. Whole blood – provides bothPRODUCTS O2 carrying capacity and volume expansion. 2. Red Blood Cells – contains the oxygen carrying capacity (hemoglobin); for the treatment of anemia in normovolemic patients who require an increase in the oxygen capacity 3. Platelets – for the treatment of bleeding cause by thrombocytopenia
COMPATIBILITY The most important test include ABO blood typing, Rh typing, cross matching, TEST the direct anti globulin test, and the anti body screening test. The donor’s blood will also be screened for Hep B, syphillis, AIDS and the Cytomegalovirus Typing and cross matching establishes the compatibility between the donor and recipient , and minimize the risk of hemolytic reaction. Rh Blood group – compose of the Rh +, Rh - HLA “Human leukocyte antigens” these are mostly detected on lymphocytes w/c is necessary for immunity,these determines the degree of histocompatibility between the donor and recipient
ABO & Rh Grouping Antigen - any substance that causes the formation of antibodies to it. Antibody - proteins of the globulin class, most often gamma globulins, produced by lymphocytes and plasma cells in response to antigenic stimulation.
FOUR BLOOD TYPES 1. Group O- universal RBC donor 2. Group AB-universal red cell recipient because their serum contains no ABO antibodies. (patient can receive packed or washed RBC from A,B,or O donors 3. Group A – person has an anti – B in his serum 4. Group B – person has an anti – A in his serum
Compatibility Test Group O “Universal donor” lacks both A & B antigen , which can be transfused (as packed RBC’s) in limited amounts in emergency cases with little risk of agglutination. Group AB- has neither anti A or anti B antibodies,so he can receive A,B,O (packed RBC’s) making him a “Universal recipient”
Rh blood grouping IF the Rh (-) receives a Rh + ,Rh (D) positive immunization will occur resulting in RBC hemolysis
Indications for a blood transfusion 1. Blood loss due to trauma 2. Heart or other major surgery 3. Organ transplants 4. Bleeding disorders (hemophilia) 5. Anemia (sickle cell) 6. Leukemia 7. Disorders that destroy blood cells or bone marrow 8. RH incompatibility in newborn babies
Adverse reactions1. Febrile – fever & chills,which occurs within the 30 mins of transfusion Treatment - stop transfusion, antipyretics Prevention – pre transfusion antipyretic2. Allergic reaction (mild to moderate) – urticaria,joint pain,wheezing Treatment – Stop transfusion, antihistamine Prevention – pre transfusion antihistamine
Adverse reactions3. Hypervolemic – dyspnea, arrhythmias, hypertension Treatment – cardio pulmonary support Prevention – avoid rapid or excessive transfusion4. Bacterial sepsis – chills, fever, shock Treatment – stop transfusion, support blood pressure Prevention - care in blood collection & storage
Nursing Responsibilities 1. Confirm that there is a physician’s order and a signed consent from the client. 2. Have two nurses confirm that the client name and ID number, blood type, RH type, and product unit numbers are correct. Check also the expiration date. 3. Make sure the transfusion is started within 30 minutes of arrival at bedside. 4. Maintain asepsis. If possible wear gloves before performing venipuncture, transfusing blood, and when terminating blood and disposing of equipment.
Nursing Responsibilities 5. Use appropriate blood administration set 6. Mix the blood cells with plasma gently to maintain their integrity 7. Assess the client closely for transfusion reactions.
Nursing Responsibilities 8. If any reaction occurs a. Stop infusion immediately b. Notify the physician c. Maintain patency of the IV with normal saline d. Send the blood to the laboratory e. Monitor vital signs frequently f. Send a urine specimen to the laboratory if hemolytic reaction is suspected
Steps/Checklist 1. Verify the doctor’s order and make a treatment card according to hospital policy. 2. Observe the 10 rights when preparing and administering any blood or blood components 3. Explain the procedure/rationale for giving blood transfusion to patient and significant others and secure consent. Get patient’s history regarding previous transfusion 4. Explain the importance of the policy on Voluntary Blood Donation (RA 7719 – National Blood Service Act of 1994)
Steps/Checklist 5. Request prescribed blood/ blood components from blood bank to to include blood typing and cross- matching and blood result of transmissible disease 6. Using a clean lined tray, get compatible blood from hospital blood bank. 7. Wrap blood bag with clean towel and keep it at room temperature. 8. Have a doctor and a nurse assess patient’s condition. Counter check the available blood to be transfused against the cross-matching sheet. The ABO grouping and Rh serial no. of each blood unit and expiry date with the blood bag label and other laboratory blood exams as required before transfusion (Hgb and Hct)
Steps/Checklist 9. Get the baseline vital signs (BP, RR, & temperature) before transfusion. Refer to MD accordingly. 10. Give pre med 30 min before transfusion as prescribed. 11. Do hand hygiene before and after procedure 12. Prepare equipment needed for BT (IV Injection tray compatible BT set, IV catheter/ needle G19, plaster, tourniquet, blood/ blood components to transfused, plain NSS 500cc, IV set, needle gauge 18 (only if needed), IV hook, gloves, sterile 2x2 gauze or transparent dressing, etc.
Steps/Checklist 13. If main IVF is with dextrose 5%, initiate and IV line with appropriate IV catheter with plain NSS on another site, anchor catheter properly and regulate IV drops. 14. Open compatible blood set aseptically and close roller clamp. Spike blood bag carefully, fill the drip chamber at least half full, prime tubing and remove air bubbles (if any), use needle G18 or G19 for side drip (for adults) or G22 for pedia (if blood is given through the Y injection port, the gauge of the needle is disregarded)
Steps/Checklist 15. Disinfect the Y-injection port of IV tubing (Plain NSS and insert the needle from the BT administration set and secure with adhesive tape. 16. Close roller clamp of IV fluid of plain NSS and regulate to KVO while transfusion is going on. 17. Transfuse the blood via the injection port and regulate at 10- 15gtts/min. initially for 15mins and then at the prescribed rate (usually based on the patient’s condition.) 18. Monitor the patient within the first 5 – 10 mins of transfusion and refer immediately to the MD for any adverse reactions.
Steps/Checklist 19. Observe/ assess patient on an on-going basis for any untoward signs & symptoms such as flushed skin, chills, elevated temperature, itchiness, urticaria, dyspnea. If any of these symptoms occur, stop transfusion, open the IV line with plain NSS and regulate accordingly and report to the doctor immediately. 20. Swirl the bag gently from time to time to mix the solid with the plasma N.B. one BT set should be used for 1-2 units of blood. 21. When blood is consumed, close the roller clamp of BT and disconnect from IV lines then regulate the IVF of plain NSS as prescribed. 22. Continue to observe and monitor patient post transfusion for delayed reaction could still occur.
Steps/Checklist 23. Re – check Hgb and Hct, bleeding time, serial platelet count within specified hourse as prescribed and/ or per institution policy. 24. Discard blood bag and BT set and sharps according to Health Care Waste Management (DOH/ DENR) 25. Fill out adverse reaction sheet as per institutional policy. 26. Remind the doctor about the administration of calcium gluconate if patient has several units of blood transfusion (3-5 more units of blood)