Blood components dosage_and_their_administration fkh1


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  • Excluded student nurses, student ODP’s and medical students
  • Temp, pulse and BP Still need to improve on transfusion observations – results of the National Comparative audit still show that we fail to complete end of transfusion observations. Important to have all observations as it gives a full overall picture that all is well Recent night transfusion and IV component audits showed poor observation compliance. Repeat obs at the end of transfusion and 15 mins after commencement of each new unit Note an unconscious patient should have regular pulse and temp Sometimes frusemide is given prior to infusions to reduce the risk of circulatory overload especially in the cardiovascular impaired Empty blood bag is retained on unit/ward for 24hrs after transfusion
  • Check that IV access has been established, any delay may result in wastage of the blood component. Step 1: Check the blood component has been prescribed. Check the prescription form and/ or fluid balance chart to ensure that the component has been prescribed and if the patient has any special requirements e.g., irradiated blood, and if they require any concomitant drugs prescribed, e.g., a diuretic. Step 2: Undertake baseline observations. Ensure that the patient’s temperature, pulse and blood pressure are recorded before the blood component is administered. Step 3: C heck the component before approaching the patient. Undertake a visual inspection of the blood component for signs of discolouration, leaking, clots etc and check the expiry date and time.
  • If you are interrupted - STOP , and start the checking procedure again It is vital that you positively identify the patient Step 1: This can best be achieved by asking the patient to tell you their NAME and DOB. This information must be checked against the patient’s wristband for accuracy. In the unconscious patient (or in paediatric practice) it is imperative to verify the patient identification details with a second member of staff. * In unidentified patients in the A/E department the unique identification number should be used at all times during the transfusion process *
  • If you are interrupted - STOP , and start the checking procedure again Step 2: Check the patient’s first name, surname, DOB and hospital number on the compatibility/traceability label attached to the blood bag against the patient’s ID wristband for accuracy. * IF THERE ARE ANY DISCREPANCIES - DO NOT PROCEED - CONTACT YOUR HTL *
  • If you are interrupted - STOP , and start the checking procedure again Step 3: Check that the blood group and the donation number on the compatibility/traceability label attached to the blood bag are identical to the blood group and donation number on the blood component. A different but suitable blood group which is compatible with the patient may have been issued. If you are unsure about the suitability of the component check with the HTL before transfusing. *IF THERE ARE ANY DISCREPANCIES - DO NOT PROCEED - CONTACT YOUR HT L*
  • What is an adverse incident? Refer staff to the Transfusion policy for information on what to do
  • Recap on safe administration
  • Blood components dosage_and_their_administration fkh1

    1. 1. Blood ComponentsDosage And Their Administration Fadi Khaizaran Dallaa General Hospital LD/BB Chief Technicians Nov 2012
    2. 2. History of Transfusions Blood transfused in humans since mid-1600’s 1828 – First successful transfusion 1900 – Landsteiner described ABO groups 1916 – First use of blood storage 1939 – Levine described the Rh factor
    3. 3. Transfusion Overview Integralpart of medical treatment Most often used in Hematology/Oncology, but other specialties as well (surgery, ICU, etc) Objectives  Blood components  Indications for transfusion  Safe delivery  Complications
    4. 4. Blood Components Prepared from Whole blood collection or apheresis Whole blood is separated by differential centrifugation  Red Blood Cells (RBC’s)  Platelets  Plasma  Cryoprecipitate  Others Others include Plasma proteins—IVIg, Coagulation Factors, albumin, Anti-D, Growth Factors, Colloid volume expanders Apheresis may also used to collect blood components
    5. 5. Differential Centrifugation First Centrifugation Closed SystemWhole Blood Satellite Satellite Bag Main Bag Bag 2 1 First Platelet-rich RBC’s Plasma
    6. 6. Differential Centrifugation Second CentrifugationRBC’s Platelet-rich Plasma Second Platelet Plasma RBC’s Concentrate
    7. 7. Whole Blood Storage  4° for up to 35 days Indications  Massive Blood Loss/Trauma/Exchange Transfusion Considerations  Use filter as platelets and coagulation factors will not be active after 3-5 days  Donor and recipient must be ABO identical
    8. 8. RBC Concentrate Storage  4° for up to 42 days, can be frozen Indications  Many indications—ie anemia, hypoxia, etc. Considerations  Recipient must not have antibodies to donor RBC’s (note: patients can develop antibodies over time)  Usual dose 10 cc/kg (will increase Hgb by 2.5 gm/dl)  Usually transfuse over 2-4 hours (slower for chronic anemia
    9. 9. Platelets Storage  Up to 5 days at 20-24° Indications  Thrombocytopenia, Plt <15,000  Bleeding and Plt <50,000  Invasive procedure and Plt <50,000 Considerations  Contain Leukocytes and cytokines  1 unit/10 kg of body weight increases Plt count by 50,000  Donor and Recipient must be ABO identical
    10. 10. Plasma and FFP Contents—Coagulation Factors (1 unit/ml) Storage  FFP--12 months at –18 degrees or colder Indications  Coagulation Factor deficiency, fibrinogen replacement, DIC, liver disease, exchange transfusion, massive transfusion Considerations  Plasma should be recipient RBC ABO compatible  In children, should also be Rh compatible  Account for time to thaw  Usual dose is 20 cc/kg to raise coagulation factors approx 20%
    11. 11. Cryoprecipitate Description  Precipitate formed/collected when FFP is thawed at 4° Storage  After collection, refrozen and stored up to 1 year at -18° Indication  Fibrinogen deficiency or dysfibrinogenemia  vonWillebrands Disease  Factor VIII or XIII deficiency  DIC (not used alone) Considerations  ABO compatible preferred (but not limiting)  Usual dose is 1 unit/5-10 kg of recipient body weight
    12. 12. Granulocyte Transfusions Prepared at the time for immediate transfusion (no storage available) Indications – severe neutropenia assoc with infection that has failed antibiotic therapy, and recovery of BM is expected Donor is given G-CSF and steroids or Hetastarch Complications  Severe allergic reactions  Can irradiate granulocytes for GVHD prevention
    13. 13. Leukocyte Reduction Filters Used for prevention of transfusion reactions Filter used with RBC’s, Platelets, FFP, Cryoprecipitate Other plasma proteins (albumin, colloid expanders, factors, etc.) do not need filters— NEVER use filters with stem cell/bone marrow infusions May reduce RBC’s by 5-10% Does not prevent Graft Verses Host Disease (GVHD)
    14. 14. RBC Transfusions Preparations Type  Typing of RBC’s for ABO and Rh are determined for both donor and recipient Screen  Screen RBC’s for atypical antibodies  Approx 1-2% of patients have antibodies Crossmatch  Donor cells and recipient serum are mixed and evaluated for agglutination
    15. 15. RBC Transfusions Administration Dose  Usual dose of 10 cc/kg infused over 2-4 hours  Maximum dose 15-20 cc/kg can be given to hemodynamically stable patient Procedure  May need Premedication (Tylenol and/or Benadryl)  Filter use—routinely leukodepleted  Monitoring—VS q 15 minutes, clinical status  Do NOT mix with medications Complications  Rapid infusion may result in Pulmonary edema  Transfusion Reaction
    16. 16. Platelet Transfusions Preparations ABO antigens are present on platelets  ABO compatible platelets are ideal  This is not limiting if Platelets indicated and type specific not available Rh antigens are not present on platelets  Note: a few RBC’s in Platelet unit may sensitize the Rh- patient
    17. 17. Platelet Transfusions Administration Dose  May be given as single units or as apheresis units  Usual dose is approx 4 units/m 2—in children using 1-2 apheresis units is ideal  1 apheresis unit contains 6-8 Plt units (packs) from a single donor Procedure  Should be administered over 20-40 minutes  Filter use  Premedicate if hx of Transfusion Reaction Complications—Transfusion Reaction
    18. 18. Time Limits for InfusionBlood/ Start infusion Complete infusionblood productWhole blood/ within 30 min. of within 4 hourred cells removing pack (less in high from ambient temperature) refrigeratorPlatelet immediately within 20 minconcentratesFFP within 30 min within 20 min 18
    19. 19.  Is the product clearly prescribed? Are any drugs required before or during transfusion? i.e. antibiotics Is the rate of transfusion appropriate? Does the patients condition require medical review prior to transfusion All patients having a blood transfusion MUST have a NAMEBAND containing all of their
    20. 20. 1st checkersRegistered Nurse/ Midwife, Doctor2nd CheckersAny of the above &Qualified Theatre Practitioneror qualified nurse
    21. 21. Base line observations – Temperature, pulse and blood pressureFurther observations (as above) at 15 minutesA set of observations at the end of transfusionMore frequently if the patient is unwell, unobservable, unconscious or a child.
    22. 22. Ensure the venflon is secure, patent and there are no signs of inflammationGive the patient the call bellPatients should remain in a clinical area for the duration of the TransfusionReview the patients fluid balance and medication.
    23. 23. Pre-administration ProcedureStep 1: Check the blood component has been prescribedStep 2: Undertake baseline observations Step 3: Undertake visual inspection LEAKS DISCOLOURATION CLUMPING EXPIRY DATE If there is ANY discrepancy - DO NOT transfuse
    24. 24. Step 1: Ask the patient to tell you their: Full Name + Date of Birth Check this information against the patient’s ID wristband Be extra vigilant when checking the identity of the unconscious / compromised patient
    25. 25. Administration ProcedureStep 2: Check the patient’s – First name – Surname – Date of birth – Hospital numberon the compatibility/traceability label againstthe patient’s ID wristband
    26. 26. Administration ProcedureStep 3: Check the compatibility/traceability label with theblood bag label Any discrepancies DO NOT TRANSFUSE !
    27. 27. Blood Component Bedside Check Procedure SURNAME FIRST NAME(s) HOSPITAL NUMBER D.O.B.BLOOD GROUP (Patient and Unit) DONOR NUMBER EXPIRY DATE Special Requirements  
    28. 28.  Stop the Transfusion and seek Medical Input and inform the Transfusion Laboratory staff Check the Blood component matches the patient details Replace the unit and giving set with Normal Saline 0.9% Send the discontinued unit with giving set attached back to transfusion capped off at the end with a white venflon cap – and any previous transfused bags sealed with the blue plugs all in biohazard bags Documentation (complete the checklist) Complete a Trust Incident form