Patient Care: IVs and Blood Transfusions

Patient Care - IVs and Blood Transfusions

• TPN Orders: Verify the order with MAR (medication administration record), expiration date, and compare to the order.
• Metabolic Disturbances: Check lab values before administering medications if a patient has a metabolic problem.
• Blood Transfusion Reasons for Refusal: Jehovah's Witness is a common reason.
• Autologous Blood Transfusions: Patient's own blood is used instead of donated blood.
• Blood Transfusion Tubing: Y-tubing is used for blood transfusions.
• Blood Transfusion Reaction Time: Reactions can occur within 15 minutes; stop infusion, disconnect, and assess the patient.
• Pre-Transfusion Checks: Vital signs are obtained before a blood transfusion.
• Central Line Administration: TPN solutions should be administered through a central line.
• Universal Blood Type: Type O is the universal blood type.
• Blood Administration Time Limit: Blood must be administered within 4 hours of being removed from storage.
• TPN Monitoring: Blood sugar must be checked at least every 6 hours.
• Blood Transfusion Post-Procedure Lab Work: Hemoglobin is a key lab check after packed red blood cell transfusions.
• Compatible Fluid for Blood Transfusions: Normal saline is compatible with blood products.
• Universal Blood Recipient: Type AB is the universal receiver.
• Y-tubing Use: A Y-tubing can only be used once with blood transfusions.
• Peripheral IV Antibiotics and Central Lines: Antibiotics should be administered via a central line if intended for central use, or a peripheral IV is acceptable if used in the peripheral compartment.
• Verifying Patient Orders: Verify the prescribed product and rate with the physician's order.
• Blood Expiration Time: If a call light is triggered before administering blood and the timeframe is exceeded, return the blood to the blood bank.
• Contraindicated Lipid Use: Pancreatitis patients should not receive lipids.
• Adverse Blood Reaction Symptoms: Swelling, itching, flank pain, fever, chills, and rashes may indicate a reaction.
• Central Line Dressing Change Frequency: Central lines should be changed every 5-7 days.
• Venipuncture Tourniquet Release Timing: Release the tourniquet after the last blood sample is collected.
• Blood Product Storage Requirements: A documented order is required for the blood and for the correct type of product.
• TPN Duration: TPN infusions are typically administered for a time-frame of 24 hours.
• Assessment of Blood Transfusion/TPN Effects: Ensure that protein levels are monitored when assessing the effectiveness of TPN treatment. A good sign that the TPN is working is that protein levels are appropriate.

Other Patient Care Considerations

• Consent: Obtain consent before administering any procedure or treatment to a patient.
• Gauze Dressing Duration: Gauze dressings should stay in place for 1-2 days.
• Lab Supplies: Gloves, alcohol, cotton balls or gauze, and a tourniquet are required when obtaining patient samples.
• IV Insertion Site: Distal, non-dominant sites are the preferred insertion points.
• Gauze Saturation: Change saturated gauze dressings.
• IV Flush Location: Use central lines for flushing IV sites.
• Assessment Findings (Crackles): Crackles upon auscultation signify fluid overload.
• TPN Documentation: Document the time, patient's vital signs, volume of blood/TPN, and any additives.
• TPN Candidates: Trauma and burn patients are candidates for TPN treatment.
• Blood Typing Verification: Document any verification of blood types, including donor and blood bank types, to avoid errors.