Transfusion Therapy


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Transfusion Therapy

  1. 1. Transfusion Therapy<br />Jolene Bethune, RN, MSN<br />
  2. 2. Objectives<br />
  3. 3. Provide overview of transfusion therapy.<br />Describe pre-transfusion responsibilities.<br />Describe transfusion responsibilities.<br />
  4. 4. Describe post-transfusion responsibilities.<br />Describe types of transfusions.<br />Describe transfusion reactions.<br />Describe autologous transfusions.<br />
  5. 5. Overview<br />
  6. 6. Any blood component may be removed from a donor and transfused into a recipient. <br />
  7. 7. Most of the blood supply in the US is donated by provided by volunteers, donated at a site that is convenient to their work or home. <br />
  8. 8. Blood components may be transfused individually or collectively depending, with varying degrees of benefit to the recipient. <br />
  9. 9. Pre-transfusion Responsibilities<br />
  10. 10. Pre-transfusion Responsibilities<br />Assess laboratory values.<br />
  11. 11. Verify the medical prescription.<br />
  12. 12. Assess the client’s vital signs, urine output, skin color and history of transfusion reactions.<br />
  13. 13. Obtain venous access. Use a central catheter or at least a 20-gauge needle, if possible.<br />
  14. 14. Obtain blood products from a blood bank; transfuse immediately.<br />
  15. 15. With another registered nurse, verify the patient by name and number, check blood compatibility and note expiration time.<br />
  16. 16. Administer the blood product using the appropriate filtered tubing.<br />
  17. 17. If the blood product needs to be diluted, use only normal saline solution<br />
  18. 18. Remain with the patient during the first 15-30 minutes of the infusion.<br />
  19. 19. Infuse the blood product at the prescribed rate.<br />
  20. 20. Monitor vital signs.<br />
  21. 21. Types of Transfusions<br />
  22. 22. Packed Red Blood Cells<br />Given to replace cells lost due to trauma, surgery or conditions that destroy RBCs or impair RBC maturation.<br />Supplied in 250ml bags.<br />Most common blood component given.<br />
  23. 23. Packed Red Blood Cells<br />Given to patients who with HGB < 8g/dL or who are hypoxemic.<br />Actually a transplant of tissue.<br />Infuse with special tubing.<br />Requires ABO compatibility.<br />
  24. 24. Platelets<br />Given to patients with PLT counts < 10,000mm3 or who have thrombocytopenia and have active bleeding or are scheduled for an invasive procedure.<br />Packed in bags of 300ml from pooled donors or 200ml from a single donor.<br />Infused over 15-30-minute period.<br />Infuse with special tubing.<br />
  25. 25. Fresh Frozen Plasma<br />Contains clotting factors and can be used for patients with clotting disorders.<br />Used for patients who are actively bleeding with a PT/PTT greater than 1.5 times normal rate.<br />Requires ABO compatibility.<br />Comes in 200ml bags.<br />Infuse over 30-60 minutes.<br />Use regular Y set or filtered tubing.<br />
  26. 26. Cryoprecipitate<br />Derived from plasma.<br />For clients with clotting factor disorders.<br />Contains clotting factors VIII and XIII, von Willebrand’s factor and fibrinogen.<br />For clients with fibrinogen level <100mg/dL.<br />Infuse @ 10-15mL/unit; usually given by IV push within 3 minutes.<br />Should be ABO compatible.<br />
  27. 27. Granulocytes (WBC)<br />For clients with infections.<br />Suspended in 400ml plasma.<br />Infuse in 45-60 minutes.<br />Take VS q15min throughout the transfusion.<br />
  28. 28. Transfusion Reactions<br />
  29. 29. Febrile – caused by anti-WBC antibodies<br />Chills<br />Tachycardia<br />Fever<br />
  30. 30. Hypotension<br />Tachypnea<br />WBC filters used to trap WBCs ad prevent their infusion<br />
  31. 31. Hemolytic<br />Caused by RH incompatibility<br />Reaction may be mild, with fever/chills or life-threatening, with DIC<br />
  32. 32. Symptoms include:<br />Apprehension<br />Headache<br />Chest pain<br />
  33. 33. Low back pain<br />Tachycardia<br />Tachypnea<br />Hypotension<br />Hemoglobinuria<br />A sense of impending doom<br />
  34. 34. Allergic<br />Urticaria<br />Itching<br />Bronchospasm<br />
  35. 35. Anaphylaxis<br />Prevented by giving leukocyte-reduced or washed RBCs in which the WBCs and plasma have been removed.<br />
  36. 36. Bacterial<br />Results from contaminated blood products.<br />Tachycardia<br />Hypotension<br />
  37. 37. Fever<br />Chills<br />Shock<br />
  38. 38. Circulatory Overload<br />Occurs when blood is given too quickly<br />Dyspnea<br />Restlessness<br />Confusion<br />
  39. 39. Hypertension<br />Bounding pulse<br />Distended jugular veins<br />Monitor I/O, infuse blood products slowly and giving diuretics<br />
  40. 40. Transfusion-associated graft-versus-host disease (TA-GVHD).<br />Donor T-cells attack host tissues.<br />Symptoms occur within 1-2 weeks<br />Thrombocytopenia<br />
  41. 41. Anorexia<br />Nausea<br />Vomiting<br />
  42. 42. Chronic hepatitis<br />Weight loss<br />Recurrent infection<br />
  43. 43. Autologous Blood Transfusions<br />Collection/infusion of client’s own blood<br />
  44. 44. Four types:<br />Preoperative autologous blood donation<br />Acute normovolemic hemodilution<br />Intra-operative autologous transfusion<br />Postoperative blood salvage<br />
  45. 45. Preoperative autologous blood donation<br />Collecting whole blood from the client, dividing it into components and storing it for later use<br />Can be collected weekly as long as client’s H&H are within safe range<br />Can be stored up to 40 days; up to 10 years for rare blood types.<br />
  46. 46. Acute normovolemic hemodilution<br />Withdrawal of client’s RBCs and volume replacement just before a procedure<br />Goal is to decrease RBC loss during surgery<br />Blood is stored at room temperature for up to 6hrs and reinfused after surgery.<br />Not for anemic clients or those with poor kidney function.<br />
  47. 47. Intra-operative autologous transfusion & Post operative blood salvage<br />Recovery/reinfusion of client’s own blood from operative field or bleeding wound.<br />Special devices collect, filter, drain blood into transfusion bag<br />Used for trauma or surgical patients with severe blood loss<br />Blood must be reinfused within 6 hours.<br />
  48. 48. Reference<br />Ignatavicius, D. D., & Workman, M. L. (2010). Medical-surgical nursing: patient-centered collaborative care(6 ed.). Philadelphia, PA: W. B. Saunders Company.<br />