Bt complications
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Bt complications

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Bt complications Bt complications Presentation Transcript

  • Nelia B. Perez RN, MSN
  • Complications, NursingInterventions and PreventiveMeasures of Blood TransfusionInfiltrationThrombophlebitisCirculatory OverloadAir EmbolismCatheter embolism infectionTransfusion Reaction
  • Infiltration – A substance (blood) that passes into the tissues and forms an accumulation of the blood to the skinManifestations: – Blanching of skin – Swelling, pain at site – Cool to touch – Decreased infusion rate
  • Nursing Interventions: – Discontinue IV – Restart in a new site – Apply warm compress to increase fluid absorptionPreventive Measures: – Check the IV site before starting the transfusion – Monitor the site during the transfusion – Inspect the site thoroughly. – Make sure that a main line is set before starting the transfusion.
  • Thrombophlebitis – Inflammation of a vein with formation of a thrombus / clotManifestations: – Redness, heat & swelling at site – Possible pain – Red line along course of vein
  • Nursing Interventions: – Discontinue IV – Restart in a new site – Apply warm compress to sitePreventive Measures: Measures – Check the site before transfusion – Monitor and inspect the site during and after the transfusion – Inquire and tell the patient to notify you if any sudden awkward feeling is felt – Check the integrity of the IV line and patency
  • Circulatory Overload – Too rapid infusion of the blood causing fluid volume overload to the patient  Manifestations: – Apprehension, shortness of breath – Coughing, frothy sputum, crackles – Engorged neck veins – Increased central venous pressure and jugular vein pressure – Increased blood pressure and pulse
  •  Nursing Interventions: – Stop the infusion / Slow down IV rate – Inform the doctor at once. – Monitor CVP through a separate line – Maintain the I.V. infusion with normal saline solution – Administer oxygen. – Elevate the patient’s head. Preventive Measures: – Always monitor the patient’s vital signs before, during and after blood transfusion – Transfuse blood slowly. – Don’t transfuse more than 2 units of blood in 4 hours. – Have oxygen readily available at the bedside of the patient.
  • Air Embolism – Obstruction of the circulation by air that has gained entrance to veins usually caused by empty IV lines and sets – Blood given under air pressure following severe blood lossManifestations: – Dyspnea, cyanosis, hypotension, tachycardia – Loss of consciousness – Wheezing, chest pain
  • Nursing Interventions: – Stop infusion immediately – Clamp tubing – Turn client to the left with his left down – Administer oxygen – Inform the doctorPreventive Measures: – Have a clamp accessible at the bedside – Check the patient and site and line every now and then – Monitor the time of the transfusion.
  • Catheter Embolism InfectionClogging of the catheter set causing obstruction of a blood vessel by a clot or particle that leads to development of infectionManifestations: – Fever, shills, flushing, tachycardia
  • Nursing Interventions: – Stop the transfusion at once. – Replace the whole set. – Inform the doctor. – Open the main line
  •  Preventive Measures: – Monitor patient’s vital signs. – Use a blood set with filter and check the patency of the whole set before transfusion. – Assess patient for occurrence of signs and symptoms of fever. – Inspect the blood before the transfusion. – Change the blood tubing and filter every 4 hours. – Infuse each unit of blood over 2 to 4 hours; terminate the infusion if the time period exceeds 4 hours. – Maintain sterile technique when administering blood products.
  • Transfusion ReactionIncludes Hemolytic, Allergic, Pyrogenic, Anaphylactic – Caused by ABO & Rh incompatibility, allergic antigenManifestations: – Fever, chills, headache, lumbar or sternal pain, palpitations, tachycardia, urticaria, laryngeal edema, bronchospasm, – Flushing, heat along vein
  •  Nursing Interventions: – Stop the IV at once. – Continue main IV – Inform the doctor – Give medicines as prescribed – Send blood and urine specimen for work-up Preventive Measures: – Have a thorough assessment of the patient before hand. Take note of the occurrence of any allergies. – Monitor patient’s vital signs. – Always check the line, site, and set for the validity and availability of the company…
  • Citrate Intoxication – Large amounts of citrated blood in patients with decreased liver function.Manifestations: – Neuromascular irritability – Bleeding due to decreased calcium – Cardiac arrhythmias – Hypotension – Muscle cramps – Nausea and vomiting – Seizures – Tingling in the fingers
  •  Nursing Interventions: – Monitor and treat hypocalcemia – Encourage patient to eat foods rich in calcium – Monitor how many blood bags already infused to the patient. – Monitor calcium and citrate level if with multiple transfusions Preventive Measures: – Remind the doctor about how many blood bags already infused to the patient – Avoid using citrated blood – Monitor liver function – Have calcium gluconate available in your unit.
  • WHAT TO DO IF TRANSFUSIONREACTION OCCURS…When they do occur, it is usually because of ABO incompatibility between patient and donor during transfusion of red cells.Ensure that the intended recipient is getting the intended unit at the time of transfusion.
  •  Acute Transfusion Reactions signs and symptoms will usually appear within the first 5- 15 minutes after the transfusion is started, but can happen anytime during the transfusion. Types of Acute Transfusion Reactions: – Acute hemolytic Transfusion Reaction – Febrile nonhemolytic Transfusion Reaction – Mild allergic (Urticarial) – Anapylactic – Transfusion Associated Circulatory Overload – Transfusion – Related Acute Lung Injury – Septic Transfusion Reaction
  •  Symptoms you might see during an acute transfusion reaction include: – Temperature increase of more than 1°C or 2°F – Bloody urine – Chills – Hypotension – Severe low back, flank, or chest pain – Low or absent urine output – Nausea and vomiting – Dyspnea, wheezing – Anxiety, "sense of impending doom" – Diaphoresis – Generalized bleeding, especially from punctures and surgical wounds.
  •  Should any of these symptoms occur, discontinue the unit immediately, hang normal saline (on a new tubing) to maintain vascular access, and call for assistance. Closely monitor the patient’s vital signs and symptoms. Notify the physician and obtain further orders to address the patient’s symptoms. Recheck the patient’s identifying information against the transfusion record and blood bag. All bags, tubings, filters, and paperwork should be retained and forwarded per hospital policy.
  • Importance of Giving Health Education to Patients and FamilyIt can establish rapport to you and the patient and family.Tension will be lessen on their part and anxiety will be alleviated.To enlighten them the real concept of blood transfusion therapy.It serves as a channel and communication between you and your patient.
  • The client’s major concern is likely to be the safety of the transfusion, specifically the risk of contracting AIDS.Provide accurate information for the client, and begin efforts to ensure a safe and effective transfusion before the blood or component is collected.
  • DOCUMENTING BLOODTRANSFUSIONS Date and time the transfusion was started and completed Name of the health care professional who verified the information of the patient and the blood Catheter type and gauge Total amount of the transfusion Patient’s vital signs before and after the transfusion
  •  Infusion device used Flow rate and if blood warming was used Vital signs obtain prior to, during, and after the transfusion Name of the component, unit number Evidence of possible transfusion reaction. – Document interventions done and to whom you notified. Patient’s outcome.
  • Date Time12/12/0 2:00 D = Patient reports nausea and chills8 pm = Cyanosis of the lips noted at 1:50 pm, with PRBCs transfusing A = Infusion stopped. Approximately 100 mL infused. = Tubing changed of 1,000 mL of D5NSS infusing at KVO rate in right arm. = Notified Dr. X. = BP:170/90, Pulse Rate: 104, Respiratory Rate: 25, Temperature: 36.0°C. = Blood sample taken from PRBCs. Urine specimen also sent out to lab for urinalysis. = Gave patient diphenhydramine 50mg via IV as prescribed by the doctor. = Two blankets placed on patient. R = Patient reports he’s getting warmer and less nauseated. = BP: 148/80; Pulse Rate: 80; Respiratory Rate: 20; Temperature: 36.8°C. = Patient no longer complaining of nausea or chills. ---------------------------------------------------------------- Ram M. Mar, R.N.
  • TWELVE SIMPLE STEPS NECESSARY IN CARING FOR A PATIENT RECEIVING BLOOD TRANSFUSIONSTEP 1: OBTAIN PATIENT’S TRANSFUSION HISTORYSTEP 2: SELECT A LARGE GAUGE NEEDLE OR CATHETERSTEP 3: CONSIDER THE TUBING & FILTER’S PORE SIZESTEP 4: FOLLOW PROTOCOL TO OBTAIN THE BLOOD PRODUCT ACCORDING TO HOSPITAL POLICYSTEP 5: IDENTIFY THE BLOOD PRODUCT & THE PATIENTSTEP 6: OBTAIN BASELINE VITAL SIGNS & RECORD
  • STEP 7: USE 0.9% NORMAL SALINE FOR THE STARTER SOLUTIONSTEP 8: START THE TRANSFUSION SLOWLYSTEP 9: MAINTAIN THE PRESCRIBED TRANSFUSION RATESTEP 10: MONITOR PATIENT’S V/S & DOCUMENTSTEP 11: OBSERVE FOR ANY ADVERSE REACTIONSTEP 12: COMPLETE THE NECESSARY PAPERWORK
  • Computations of flow and drip ratesCalculation of IV Flow Rates Calculation of cc/hr is essential in most IV therapy. Volume = cc/hr # of hrs E.g. 1 L over 8 hrs = 125 cc/hr 50 cc over 20 minutes = 150 cc/hr
  • Calculation of gtt/min (Long Method)STEPS : 1. Need to know cc/hr to calculate 2. Gtt factor = gtt / ml gtt factors : macrodrip 10, 15, 20 gtts/ml microdrip 60 gtt/mlEXAMPLE : LONG METHOD Doctors Order : Run 1L D5W over 8 hours Microdrip - 1000 ml ÷ 8 hours = 125 cc/hr 125 cc x 60 gtt/ml = 125 gtt/ml 60 min 1 10 gtt/ml set 125cc x 10 gtt/ml = 20 – 21 gtt/min 60 min 1 15 gtt/ml set 125cc x 15 gtt/ml = 31 gtt/min 60 min 1 20 gtt/ml set 125 cc x 20 gtt/ml = 41 – 42 gtt/min 60 min 1
  • SHORT METHOD cc / hr ÷ 6 for 10 gtt / min cc / hr ÷ 4 for 15 gtt / min cc / hr ÷ 3 for 20 gtt / min cc / hr = gtt / min for microdrip set
  • 10 Rights in Safe Drug Administration • Right DRUG • Right PATIENT • Right DOSE • Right ROUTE • Right TIME • Right DOCUMENTATION • Right PATIENT’S HISTORY • Right DRUG ALLERGIES • Right DRUG-DRUG, DRUG-FOOD INTERACTION • Right HEALTH EDUCATION