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Nursing management of a patient with blood transfusion
- 1. BSC (H)NURSING RAKCON Nursing MANAGEMENT Of A Patient WITH Blood TRANSFUSION
- 8. Rbc's Frozen rbc's Packed rbc's Platelets GRANULOCYTES
- 10. Selection of donor ■ Donorshouldbe freefromdiseasesuchasTB, cancer,jaundiceoranyother transmissibledisease. ■ Makesurethatthedonorhasnotdonatedbloodwithinprevious90days. ■ Physicallyactivebetweentheageof18to65yearswithanaverageheightandweight. ■ Donormusthavenormalvitalsigns. ■ Mustnothavebeenpregnantwiththelastsixmonth. ■ HBlevelmustbeabove12gm/dl. ■ Donarshouldbedisqualifiedwhohavehistoryofrecentdentalsurgery,majorsurgery, receiptofbloodorbloodcomponent,immunizationetc.
- 11. • Explaintheproceduretodonor. • Bloodshouldnotbecollectedemptystomach,should notbedehydrated. • Followingthedonationdonorshouldbeoffered sweeteneddrinkandaskedtotakerestatleastoneto twohourstopreventfaint. • Beforeleavingthedonormustbecheckedforany giddiness,colourchange,vitalsigns.
- 12. GENERAL INSTRUCTIONs ■ Bloodshouldbefreshed. ■ DonorshouldnothaveanyhistoryofJaundice,Cancer,Malaria,Hepatitis,TB, Cephalis,AIDS,oranytransmissibledisease. ■ Bloodshouldbetestedforbloodgrouping,crossmatching,AIDS,hepatitis. ■ Wholebloodshouldbestored2-6/1-6degreecentigrade. ■ Donorvitalsignsshouldbenormal. ■ Useanappropriatesterile,pyrogenfreetransfusionsetcontainingfilterand largeraggregateofleucocyteplatelet. ■ Use18Gneedlefortransfusion.
- 13. • RecordtheTPRchartoftherecipientbeforetofindanycomplication. • DonotaddanymedicationorusedsameIVcannulausedfordrugs. • Adjustrateofflowto5ml-10ml/minduringfirsthalfanhourof transfusionthen40-45drops/minorasperdoctor’sorder. • Checktheexpirationdateonbloodbagandobserveforanycolour change. • Avoidshakingthebag,ifneededthebloodmaybeallowtostandin roomtemperaturefor30minbeforeadministeringtothepatient. • Administernormalsalinebeforeandafterthebloodtransfusion.
- 14. Procedure (Assisting in procedure) Preparatory phase :- •Checktheordersforbloodtransfusion. •Takeconsentoftherecipient. •Askanyhistoryofallergytoprevioustransfusion. •Obtainbaselinedata-TPR,BPetc. •NoteHB,platelet,hematocrit(aspertransfusion). •Checkthethebloodproduct(checkby2 registerednurses),selfandother- serialnumber,bloodcomponent,bloodtype,RHfactor,expiry,screeningtest.
- 15. • Observeforcolour,RBCclumpingetc,any abnormality. • Offerbedpanoraskthepatienttogototoilet. • Keeppatientwarmwithblankets.
- 21. Procedure :- ■ Introduceyourself. ■ Verifyidentifythepatient. ■ Explaintheproceduretotheclient. ■ Takearticlestothebedside. ■ Instructtheclienttorepeatpromptlyforanycertainnausea,itching,rashes,dyspnea, oranyotherunusualsymptoms. ■ ChecktheIVsolution,infusionandsizeofIVcannulawhichisalreadythereonthe patient.IfitisnotappropriatethenanewIVcannulaneedtobeinserted. ■ StartanIVinfusionofNSsothattheinfusionsetisflushedbeforebloodtransfusion. ■ Seethatthecorrectbloodcomponentfortheclientisobtained(crosschecked).
- 22. • Preparethebloodbag. • Invertthebloodbandgentlyseveraltimestomixthethecellswiththeplasma(no roughhandlingasitcandamagecells. • Exposethepartonbloodbagbypullingbackthecover. • ClosethetheclampofBTset.InsertthespikeofBTsetintothebloodbag.Hang thebagonIVstand. • OpentheclampofBTset. • Regulatetheflow20dropsmininitiallyfor15minutesthen5-10mlminforhalf hour. • Observetheclientcloselyforanyadversereactionasmentioned. • Ifanyreactionoccursstopthebloodtransfusionimmediatelyandirrigatethe tubingwithNSandinformthedoc.
- 23. ■ Documentthedataabouttransfusionanditsreaction. ■ Recordvitals,typeofbloodunits,sizeofpuncture,sizeofmiddle,droprateetc. ■ Ifnoreactionoccurthenmonitorthepatientandestablishedrequiredflowrate (40-45dropsperminute). ■ Mostadultswilltolerateoneunitofbloodtransfusedover2hoursbutoneunit shouldbegivenwith3-4hrs. ■ Assessvitalsevery30minutesforfirstonehour. ■ Terminatethetransfusionandirritatewithnormalsaline. ■ Recordtheprocedure.
- 25. Pre procedure :- • Confirmthatthetransfusionhasbeenprescribed. • Checkthatpatientsbloodhasbeentypedandcrossmatched. • Verifythatpatienthassignedawrittenconsent. • Explaintheproceduretothepatient.Instructpatientaboutsignsandsymptomsof transfusionreaction(itching,swelling,shortnessofbreath,fever,chills). • Takepatientstemperature,pulse,respirationandbloodpressuretoestablishabaseline andauscultatelungs,assessforjugularvenousdistentiontoserveasabaselinefor comparisonduringtransfusion. • Usehandhygieneandweargloves.Inaccordancewithstandardprecaution. • Usea16or18gaugeorlargerneedleforinsertioninalargevein.Usebloodtransfusionset thatcontainabloodfiltertoscreenoutfibrinclotsandotherparticulatematter.Donot ventthebloodcontainer.
- 26. Procedure :- ■ ObtainthePRBCsfromthebloodbankaftertheintravenouslineisstarted (institutionpolicymaylimitreleasetoonly1unitatatime). ■ Doublecheckthelabelswithanothernursephysiciantomakesurethatthe ABObloodgroupsandRHtypeagreewiththecompatibilityrecord.Checkto seethatthenumberandtypeonthedonorbloodlabelandonthepatient’s medicalrecordarecorrect.Checkthepatientidentificationbyaskingthe patient’snameandcheckingtheidentificationwristband. ■ Checkthebloodforgasbubblesandanyunusualcolourorcloudiness(gas bubblesmayindicatebacterialgrowth.Abnormalcolourorcloudmaybea signofhemolysis).
- 30. Transfusion of platelets or fresh frozen plasma (FFP)
- 31. Pre procedure :- ■ Confirmthatthetransfusionhasbeenprescribed. ■ Verifythatpatienthassignedwrittenconsent. ■ Explaintheproceduretothepatient.Insteadpatientinsignandsymptomsofof transfusionreaction (itching,swelling,shortnessofbreath,fever,chills). ■ Takepatientstemperature,pulse,respirationandbulbbloodpressuretoestablisha baselineandauscultatelungsassessforjugularvenousdistentiontoserveasabaselinefor comparisonduringtransfusion. ■ Usehandhygieneandwearglovesinaccordancewithstandardprecaution. ■ Usea18or16togaugeorlargerneedleforplacementinalargeveinifpossible.Use appropriatetubingperinstitutionpolicy(plateletsoftenrequiredifferenttubingfromthat
- 32. Procedure :- ■ ObtaintheplateletsorFFPfromthebloodbank(onlyaftertheintravenouslineis started). ■ DoublecheckthelabelswithanurseorphysiciantomakesurethatABOgroupmatches thecompatibilityrecord(notusuallynecessaryforplatelets,hereonlyifcompatible plateletsareordered).checktoseethatthenumberandtypeonthedonorbloodlabeland onthepatientschartarecorrect.checkthepatientidentificationbyaskingthepatient’s nameandcheckingtheidentificationwristband. ■ Checkthebloodproductforanyunusualcolourorclumps(excessiverednessindicates contaminationwithlargeramountofredbloodcells). ■ MakesureplateletsorFFPunitsareadministeredimmediatelyaftertheyareobtained.
- 33. ■ InfuseeachunitofFFPover30-60minutesperpatientcantoleranceinfuseeach unitofplateletsasfastaspatientcantoleratetodiminishedplateletclumping duringadministration.Observethepatientcarefullyforadverseeffectincluding circulatoryoverload.Decreaserateofinfusionifnecessary. ■ Observethepatientcloselythroughoutthetranslationforanysignofadverse reactionincludingrestlessness,nausea,vomiting,torsoorbackpain,flushing, hematuria,feverorchills.Shouldanyadversereactionoccurstopinfusion immediatelynotifyphysicianandfollowtheagenciestransfusionreaction standard. ■ Monitorvitalsignsatendoftransmission. ■ Flushlinewithsalineaftertransfusiontoremovebloodcomponentfromtubing.
- 36. 1.Hemolytic reaction Itiscausedbyinfusionofincompatiblebloodproducts. AssessFor:- ■ Backpain. ■ Feverandchills. ■ Feelingoffullness. ■ Flushing.
- 39. 2.Febrile , non - heamolytic Itiscausedbyhypersensitivitydonor,plasmaprotein, platelets,whitecells. Assessfor:- ■ FeverAndChills ■ Flushing ■ Headache ■ Anxiety
- 41. 3.Allergic reactions :- Itiscausedbysensitivitytoplasmaproteinofdonor.Which reactswithrecipientantigen. Assess for :- ■ Flushing ■ Rashes ■ Laryngealedema ■ Dyspnea
- 43. 4. Circulatory overload Itiscausedbyadministration ofbloodvolumeatagreaterratethanthecirculatory systemcanaccommodate. Assessfor:- ■ RiseInVenousPressure ■ Dyspnea ■ Cough ■ DistendedNeckVein ■ Hypertension
- 45. 5. Septic reaction :- Itiscausedbythetransfusionofbloodorbloodcomponents. Assessfor:- ■ FeverAndChills ■ Vomiting ■ Hypertension
- 47. Planning and Implementation ■ Meticulouslyverifyingpatientidentificationbeginningwithtypeandcrossmatchsample collectionandlabelingtodoublecheckbloodproductandpatientidentificationpriorto translation. ■ Inspectingthebloodproductforanygasbubbles,clotting,orabnormalcolourbefore administration. ■ Beginningtransfusionslowly(1-2mlmin)andobservingthepatientcloselyparticularly duringthefirst15minutes(severereactionsusuallymanifestwithin15minuteafterthe startoftransfusion. ■ Transfusingbloodwithin4hoursandchangingbloodtubingevery4hourstominimize theriskofbacterialgrowthatwarmroomtemperature.
- 48. ■ Preventinginfectionsdiseasetransmissionthroughcarefuldonorscreeningfor performingpretestavailabletoidentifyselectedinfectiousagent. ■ PreventingGVHdiseasebyensuringirradiationofbloodproductscontaininga viableWBC(i.ewholeblood,platelets,packedRBC,andgranulocyte)before transfusionirradiationaltersabilityofdonorlymphocytestoengraft anddivide. ■ Preventinghypothermiabywarmingbloodunitto37degreeCelsiusbefore transfusion. ■ Removingleukocytesandplateletsaggregatesfromdonorbloodbyinstallinga microaggregatefilter(20-40micromsize)inthebloodlinetoremovethese aggregatesduringtransfusion.
- 51. 1.) Risk of ineffective breathing pattern relatedto increasedcardiac output. Goals:After2hourofnursinginterventiontheclientwillestablishaneffectivebreathingpattern. NursingInterventions:- ■ Monitorvitalsigns ■ Assessrespiratoryrate,rhythmanddepth. ■ Assessforpainordiscomfort. ■ Maintaincalmattitudewhiledealingwithclient. ■ Encouragepositionofcomfort. ■ Administeroxygenatlowestconcentrationorasprescribed. Evaluation:Goalmeetafter2hoursofnursinginterventiontheclientwasabletoestablishaneffectivebreathing pattern.
- 53. 2.) Risk for Fluid volume excess related to blood transfusion. Goals:After4-8hoursofnursinginterventionpatientwilldemonstratebehaviortomonitorfluidstatusandreduce recurrence offluidexcess. ■ Nursingintervention: ■ Establishreport ■ Monitorandrecordvitalsigns ■ Assesspossibleriskfactors ■ Assesspatientappetite ■ Noteamountrateoffluidintakefromallsource Evaluation:After4-8hoursofnursinginterventionpatienthavedemonstratedbehaviortomonitorfluidstatusand reducerecurrenceoffluidexcess.
- 55. 3.) Risk for impaired sikn integrity related to pruritus or itching. ■ Goals:After6-8hoursofnursinginterventiontheclientwillhavereducedthefurtherimpairment ofskinintegrity. ■ Nursingintervention: ■ Assesstheaffectedsite ■ Keeptheareacleananddry ■ Changedresssingasoftenasnecessary ■ PleasepatientinlawsemiFowlerposition ■ Monitorpuncturesites Evaluation:After6-8hoursofnursinginterventiontheclienthavereducriskoffurtherimpairmentof skinintegrity.
- 56. Hypothermia
- 57. 4.) Risk for hypothermia related to blood transfusion ■ Goals:patientmaintainsacorebodytemperatureabove36degreeC ■ Nursingintervention: ■ Assessforprecipitatingsituationandriskfactors. ■ Noteandmonitorpatient’stemperature. ■ Regulatetheenvironmenttemperature. ■ Keepthepatientandlinensdry. ■ Giveextraclothing. ■ Givewarmfluids. ■ Evaluations:thepatientbodytemperaturereturnstonormal.
- 59. 5.) Risk for infection related to aseptic techniques. ■ Goals:Patientsremainfreeofinfectionasevidencedbynormalvitalsigns,absenceofsignsandsymptomsof infection. ■ Nursinginterventions: ■ Assess forthepresence,existenceofhistoryofriskfactors. ■ Maintainorteachasepsisfor peripheralIVcareandhandling. ■ Washhandsbeforecontactwithpatients. ■ Encourageintakeofprotein-richandcalorie-richfoods. ■ Encouragemorefluidsintake. ■ Placethepatientinprotectiveisolationifthepatientisatveryhighrisk. ■ Evalvations:afternusinginterventionsthepatienthasreducedriskofinfections.
- 60. Research Article
- 61. Blood transfusion practice among health care personnel in nepal Bloodtransfusionhaswellprovenclinicalbenefitinthetreatmentofanemiawhereit helpsbyimprovingoxygendeliverytotissues.Thetrendofbloodtransfusionis increasingglobally,whichhasrisenfrom85millionunitsoftransfusionin2012to112.5 millionofdonationsin2016.AccordingtoWorldHealthOrganizationglobaldata basesystem(WHO-GDBS)report,2016,atotalof255,178bloodproductswereissued andtransfusedinNepal,ofwhich149,635werewholebloodand51,487wereredblood cells(RBCs).