Blood administration


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Blood administration

  1. 1. Blood AdministrationDetermine patient’s allergies and previous transfusion reactionsCheck that consent is signed and on the chartBlood consent will last for the duration of the patient’shospitalizationInstruct patient of signs and symptoms of a blood transfusionreactionThe pink copy of the blood record or a copy of the order must betaken to the lab to obtain blood
  2. 2. Blood Administration (continued)Blood administration record is a triplicate form 1. Pink Copy: take to lab to obtain blood 2. Yellow copy (carbon): return to lab completed 3. White copy (original): place on chart under nurse’s notes {green} tabVital signs are taken:  Baseline [RN]  15 minutes (from start of blood) [RN]  30 minutes (from start of blood) [LPN or CSA]  1, 2, and 3 hours (from start of blood) [LPN or CSA]  Post transfusion [LPN or CSA]  The “start of blood” is the time the blood hits the vein
  3. 3. Blood Administration (continued) Vital signs are taken q15 minutes during platelet administration Clear pump before and after any blood administration Document INTAKE in CPSI under appropriate box Change blood tubing after two units or 4 hours – whichever comes first (maximum of 2 units per administration set)
  4. 4. Blood Administration (continued)Check crossmatch record with two nurses at bedside. This is aNPSG  ABO group & RH type  Name & DOB  Blood band number (at the bedside)  Donor number/group/type  Expiration date  Check the order  Check that permit is signed/on chartAdminister all blood products immediately (begin transfusionin less than 30 minutes after obtaining from blood bank)
  5. 5. Blood Administration (continued) Never add ANY meds to blood products Infuse each unit over <4 hours Baseline vitals – before spiking blood 18 GA needle preferred (may use 20 GA if necessary) Prime/flush blood tubing with 0.9% Normal Saline only Use blood administration set – micro filter in- line Severe reactions most likely to occur during the first 15 minutes and first 100 ml
  6. 6. Blood Administration (continued) It takes at least 30 ml to cause a blood reaction Blood is to be started at 120 ml/hr allowing 30 ml to infuse while the nurse is at the bedside – change rate after first 15 minutes if needed Transfuse a unit of packed red blood cells in about two hours not exceeding 4 hours. Slower transfusions are for those patients more susceptible to fluid overload The RN stays with the patient for first 15 minutes of each unit Most reactions are to additives, not blood It is not necessary to document the information from the blood transfusion sheet (V/S, education) in CPSI Documentation of the start of the blood, volume infused, and any reaction however, should be charted in CPSI
  7. 7. Blood Administration (continued)Dispose of completed blood bag in biohazard (red) trashReturn completed blood bag to lab only if reaction suspectedIf using a blood warmer (only if indicated)• Set up prior to obtaining blood from blood bank• Document blood warmer temperature before, during, and after transfusion• Do not use extension tubing below the warmer• Clamp to IV pole less than 42 inches above the floor
  8. 8. Blood Administration (continued)Do NOT warm unless risk of hypothermic response and thenonly by specific blood warming equipmentIn accordance with physician orders, a blood warmer may beindicated in the following circumstances:  Massive volume infusions  Infusion rate greater than 300 ml/hr  Exchange transfusion of newborn  When cold agglutinin is present  More than two blood units given consecutively  When a patient’s body temperature is 35-38 C  When blood is administered via a central line
  9. 9. Blood Administration (continued)Types of reactions: • Fever, defined as equal to or more than 1 C or 2 F above baseline with or without chills • Shaking chills (rigors) with or without fever • Pain at infusion site or in chest, abdomen, flanks, back, or joints • Blood pressure changes, usually acute either hypertension or hypotension • Respiratory distress, including dyspnea, tachypnea, or hypoxemia • Skin changes, including flushing, urticaria, and localized or general edema Continued on next page…
  10. 10. Blood Administration (continued) Types of reactions (continued) • Nausea with or without vomiting • Acute onset of sepsis including fever, severe chills, hypotension, and high output cardiac failure • Anaphylaxis • Any of the above signs occurring within 6 hours of transfusion should also be treated as a possible transfusion reaction • Patient death, only when accompanied by signs or symptoms of a blood transfusion reaction, is reason to initiate the transfusion reaction process
  11. 11. Blood Administration (continued)If any of the previously mentioned symptoms are noted a bloodtransfusion reaction is suspected and the following steps must betaken immediately: Stop blood Connect saline with new tubing to infuse at KVO Initiation of a Suspected Transfusion Reaction Form Clerical check: Patient’s ID bracelet with Lab Transfusion copy form Notify patient’s physician immediately  She/he may want to continue the transfusion after administration of antipyretics and/or antihistamines  Transfusion reaction form must be filled out even if the transfusion is resumed
  12. 12. Blood Administration (continued) Notify lab immediately to draw post reaction specimen (Even if MD orders transfusion continued) Immediately collect a urine specimen Return the blood bag complete with tubing to laboratory Order “SUSPECTED TRANSFUSION RCN I” in CPSIIf a patient refuses a transfusion, they sign a “Refusalof Blood and Release from Consequences”  The nurse then notifies the physician and anesthesia if the patient is pre-operative
  13. 13. South Campus Upon receipt of order for blood products, WCMC – South lab technicians draw patient specimens and deliver to WCMC – North campus lab for crossmatch Upon completion of crossmatch, appropriate blood products are packaged in a blood transport container with ice. EXCEPTION – plateletpheresis is delivered at room temperature in a special box designed for platelets only A temperature monitoring device is attached to the blood product and a temperature monitoring form is initiated by the blood band and placed in the transport container to be completed by lab or the nursing supervisor on the south campus
  14. 14. South Campus (continued) Following initial temperature check upon receipt to WCMC – South, blood products are to remain in the transport container unless being removed for the purpose of administration Blood products are either used or returned within 24 hours to the North Campus. Any unused blood products are promptly returned to the North Campus Registered Nursing Associates obtain and administer blood products to patients on the South Campus according to the same procedure previously described