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Blood transfusion
 

Blood transfusion

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c/o Arellano University lecture medium

c/o Arellano University lecture medium

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    Blood transfusion Blood transfusion Presentation Transcript

    • Simon John L. Crisostomo, RN
    •  Packed RBC  Replaces erythrocyte and resolution of anemia, usually a unit of packed RBC’s are supplied in 250 ml unit bag  Each unit increases the hemoglobin by 1 g/dl and hct by 2-3% which will change in 4-6 hours after completion of blood transfusion Whole Blood  Rarelyused, used to resolve Hypovolemic shock from Hemorrhage  Each unit normally contain 500ml
    •  Platelets  Used to treat Thrombocytopenia and Platelet dysfunction  Cross-matching is not required but may done, bags contains 50-70 ml per unit to 200-400 ml per unit  Administered immediately on receipt from blood bank and may be given rapidly over 15 to 30 minutes
    •  Fresh Frozen Plasma  Provides Clotting factors or Volume expansion; NO PLATELETS  Infused within 6 hours, Rh and ABO compatibility test required  About 200-250 ml per unit  PT and PTT is a done post transfusion for resolution of Coagulation defects or Hypovolemia
    •  Albumin  Prepared in plasma and can stored for 5 year  Treat Hypovolemic shock or Hypoalbunemia Cryoprecipitate  Are prepared from Fresh Frozen Plasma and can be stored for 1 year  Used to replace clotting factors, especially Factor VIII and Fibrinogen
    • Introduction of wholeblood plasma, serumerythrocyte or platelets intothe venous circulation.
    •  1. To increase the circulating blood volume as in shock due to hemorrhage. 2. To increase red cell volume of hemoglobin content of the blood as in anemia. 3. To increase WBC content of the blood as in agranulocytosis and leukopenia. 4. To increase the quantity of protein malnutrition, excessive loss of protein from burns or vesicular skin diseases.
    •  1. IV tray 2. Compatible BT test 3. IV catheter/needle g 18/19 4. Plaster 5. Tourniquet 6. Blood product 7. Plain NSS 8. IV stand 9. Gloves
    •  1. Verify doctor’s order -To avoid mistakes. and make a treatment card. 2. Explain procedure to - Encourage client’s coo- client. peration and decrease anxiety. 3. Request blood/blood component from hospi- tal blood bank to include blood typing and cross matching.
    •  4. Warm blood at - To prevent unto- room temperature ward blood reac- by wrapping the tion. blood bag with a towel. Blood should be transfused not more than 20 mins. from the time it arrives from the blood bank.
    •  5. Have the doctor and To prevent any problem in relation a nurse countercheck to transfusion. the compatible blood to be transfused. a) name and identifica- tion number b) client’s blood group and Rh type c) donor’s blood group and Rh type d) crossmatch compati- bility e) blood unit and serial component f) expiration date of blood product
    •  6. Get the base- - To compare any line vital signs be- change in vital fore transfusion. signs before and during BT. 7. Give pre-med - To prevent minor 30 mins.before allergic reactions. transfusion.
    •  8. Wash hands and - To preventcontami- don gloves. nation of microor- ganisms. 9. Prepare equipments - To facilitate inter- needed. vention.
    •  Clients blood sample are drawn and labelled at the bedside when drawn, the client is asked to state his or her name, which compared with the name of the client’s identification band or bracelet. The recipient’s ABO and Rh type are identified An Antibody screen is done to determine the presence of antibodies other than anti- A and Anti-B
    •  Cross-matching is done in which donor RBC are combined with recipient’s serum and Coomb’s serum; Crossmatching is compatible if NO RBC Coagulation occurs The Universal RBC donor is O negative, The Universal recipient is AB positive
    •  Infusion controllers and Pumps  Usedto administer blood products if they are designed to function with opaque soln’ Special manual Pressure Cuff  Maybe used to increase the flow rate but should not exceed 300 mmHg
    •  To prevent HYPOTHERMIA and adverse reactions when several units of blood being administered Do not warm blood products in the microwave or in hot water
    •  Avoid large vol. of refrigerated blood infused rapidly which can cause cardiac dysrhythmias No other soln’ other than NSS should be added to blood components Medications are NEVER added to blood components or piggy backed into a blood transfusion Infusions (1 Unit) shout NOT exceed 4 hours to avoid Septicemia
    •  Blood administration set should be changed every 4-6 hours Always check the blood bag for the expiration date Inspect the blood bag for leaks, abnormal color clots and bubbles Blood must be administered as soon as possible (within 20-30 mins.) from receiving from the blood bank Never refrigerate blood, if blood is administered within 20-30 mins. Return it to the blood bank
    •  Blood is infused as quickly as the clients condition allows Components containing few RBC and Platelets may be infused rapidly but caution must be taken to avoid circulatory overload The nurse should measure the vital signs and assess the lung sounds before the transfusion and again after the 1st 15 mins and every hour until 1 hour after the transfusion is completed
    •  Blood will be released from the Blood Bank only by recognized personnel The Name and the identification number of the intended recipient must be provided to the blood bank and a documented permanent record of this information must be maintained Blood should be transported from the blood bank to only one client at a time to prevent blood delivery to the wrong patient
    •  The most critical phase of the transfusion is Confirming product compatibility and verifying clients identity Two registered nurses are needed to check the physician’s order, the clients identity, and the client’s identification band or bracelet and number, verifying that the name and number are identical to those on the blood component bag
    •  At the bedside, the nurse ask the client to state his or her name, the nurse compares he name with the name on the identification band or bracelet The nurse checks the blood bag tag, label, blood requisition form to ensure that ABO and Rh type are compatible If the nurse notes any unconsistencies when verifying client identity and compatibility, the nurse notifies the blood bank immediately
    •  Assess for any cultural or religious beliefs regarding blood transfusion (Jehovah’s witness) Ensure that an Informed consent is signed Determine any previous reaction to blood transfusion
    •  Check the clients VS, assess renal, circulatory and respiratory status and the client’s ability to tolerate intravenously administered fluids If the client’s temperature is elevated, notify the physician before beginning the transfusion, a fever may be a cause for delaying the transfusion in addition to masking a possible symptoms of an acute transfusion reaction
    •  Maintain standard, transmission based, and other precautions as necessary Insert an IV line and infused normal saline; maintain the infusion at KVO An 18 or 19 gauge IV needle will be needed to achieved maximum flow rate of blood products and prevent damage to RBC; if a smaller gauge needle must be used, RBC must be diluted with normal saline
    •  Always check the bag for the volume of the blood component Blood products should be infused through administration set designed specifically for blood; use a Y tubing or straight tubing blood administration set that contains a filte designed to trap fibrin clots and other debris that accumulate during blood storage Premedicate the client with Acetaminophen or Diphenylhydramine as prescribed if the client has a history of adverse reactions 30 minutes before the transfusion is started if orallly or immediately before transfusion if IV administered
    •  Instruct the client to report anything unusual immediately Determine the rate of infusion by physician order Begin the transfusion slowly under close supervision; if NO reaction is noted within the 1st 15 mins. The flow can be increased to the prescribed rate During the transfusion, monitor the client for signs and symptoms of transfusion reaction, the 1st 15 mins of the transfusion are the most critical, and the nurse must stay with the client
    •  If a major compatibility exist or a severe allergic reaction occurs, the reaction is usually evident within the 1st 50 ml of the transfusion Document the clients tolerance to the administration of the blood products Monitor appropriate laboratory values and document the effectiveness of treatment related to the specific type of blood products
    •  If a transfusion reaction occurs, stop the transfusion, the change in IV tubing down to the IV site, keep the IV line open with normal saline, notify the physician and blood bank and return blood bag and tubing in the blood bank Do not leave the client alone and monitor the client for nay life life threatening symptoms Obtain appropriate: laboratory samples, such as blood and urine samples (free hemoglobin indicates the RBC cell are hemolyzed)
    •  Signs: chills and diaphoresis, muscle aches, back pain, or chest pain, rashes, hives, itching swelling, rapid thready pulse, dyspnea, cough, wheezing or rales, pallor, cyanosis, apprehension, tingling and numbness, headache, nauses, vomiting, abdominal cramping and diarrhea Unsconscious client: weak pulse, fever, tachycardia or bradycardia, hypotension, visible hemoglobinuria, oliguria or anuria Delayed Transfusion reaction: occurring days to years after a transfusion
    •  Nursing Interventions:  Stop the transfusion  Keep the intravenous line open with 0.9% normal saline  Notify the physician and the blood bank  Remain with the client, observing signs and symptoms and monitoring vital signs as often as every 5 minutes  Prepare to administer Emergency medications such as antihistamines, vasopressors, fluids, corticosteroids as prescribed  Obtain urine specimen for laboratory studies  Return blood bag, tubing attached labels, transfusion record to the blood bank
    •  Signs: Cough, dyspnea, chest pain, and rales, headache, hypertension and tachycardia and a bounding pulse, distended neck veins Nursing Interventions:  Slow the rate of Infusion  Place the client in an Upright position, with the feet in a dependent position  Notify the physician  Administer O2 diuretics, morphine, SO4 as prescribed  Monitor for dysrythmias  Phlebotomy also may be a method of prescribed treatment in a severe case
    •  Signs: Rapid onset of chills and a high fever Nursing Interventions:  Notifythe physician  Obtain blood cultures and cultures in the blood bag  Administer O2, IV fluids, antibiotics, vasopressors and corticosteroids as ordered
    •  Signs: Vomiting, diarrhea, hypotension, altered hematological values Nursing Interventions:  Deferoxamine (Desferal) administered IV or SubQ, removes accumulated iron via the kidneys  Urine turns red as iron is excreted aa administration of deferoxamine; treatment is discontinued when serum iron level return to normal
    •  Signs: A disease commonly transmitted is Hepatitis C which is manifested by anorexia, nausea, vomiting, dark urine, and jaundice; the symptoms usually occur within 4-6 weeks after the transfusion Other infectious agents transmitted include Hepatitis B virus, HIV, HHV6, Epstein-Barr Virus, Human T-cell Leukemia, Cytomegalovirus and Malaria Nursing Intervention:  Donor screening  Antibody testing of donors for HIV
    •  Description: Citrate is transfused, blood binds with Calcium and is exercised Nursing Intervention  Assess serum Calcium before and after the transfusion  Monitor for signs of Hypocalcemia  Slow the transfusion  Notify physician if signs og Hypocalcemia occurs
    •  Description: Stored blood liberates K+ through Hemodialysis Nursing Intervention:  The older blood the greater risk of hyperkalemia; therefore patient at risk such as those with renal insufficiency or renal failure, should receive fresh blood  Assess the date on the blood and the serum potassium level before and after the transfusion and notify the physicians if signs of Hyperkalemia occur