Blood Transfusions 2024.pptx

Blood and Blood Products Dr. Sue Cagir DNP, MS,RN, CNE Student Learning Outcomes Identify therapies for blood disorders, including nursing implications for the administration of blood components Describe different transfusion reactions, and the appropriate nursing intervention...

Blood and Blood Products Dr. Sue Cagir DNP, MS,RN, CNE Student Learning Outcomes Identify therapies for blood disorders, including nursing implications for the administration of blood components Describe different transfusion reactions, and the appropriate nursing interventions Types of Blood Products Whole Blood – Rarely Used –Traumatic Event – large blood loss Packed Red Blood Cells – most commonly used- low hemoglobin, hematocrit – Anemias, Replace Blood Loss after Surgery- administer over 2-4 hours Platelets – Low Platelet Count (Normal Platelet Count 150,000 – 450,000 platelets per microliter of blood) – At risk for bleeding – Administer Platelets over 15-20 minutes Fresh Frozen Plasma (FFP) - Replaces coagulation (clotting) factors – used to prevent or for active bleeding – Disease States – Administer over 30-60 minutes Types of Blood Products Cryoprecipitate - used to replace clotting factors especially factor VIII and fibrinogen Used to prevent or control bleeding in patients with genetic disorders lacking clotting factors. This includes patients with serious but rare hereditary conditions such as Hemophilia A (who lack factor VIII) and von Willebrand disease (who lack von Willebrand factor). 1 unit over 15-20 minutes Granulocytes –Rarely Used. To bring up the WBCs in a severely neutropenic patient Rh Factor Rh factor refers to the presence or absence of a certain antigen on your red blood cells. The presence of the antigen – Rh positive The absence of the antigen – Rh negative If a Rh-negative person encounters Rh-positive blood, the body will produce antibodies that attack the foreign red blood cells from the Rh- positive blood – sensitization Sensitization is irreversible If the female becomes pregnant with a Rh+ fetus – serious consequences can occur for the pregnancy outcomes Rhophylac can help Rh- pregnant females prevent sensitization Leukocyte Reduced RBC Same RBC mass as whole blood but with 80% of the plasma removed and 70% of the leukocytes removed – leukoreduction (LR) Assists with allergic reactions from the donor’s WBC count Must be used with a special leukocyte-filtered tubing Albumin Not a blood product – used with blood products Expands circulating blood volume by exerting oncotic pressure Pulls fluid from the extracellular fluid into the vascular system (veins) Increases Blood Pressure and Urine Output much more rapidly than Isotonic IV fluids Monitor Protein Level Monitor Lung Sounds for fluid overload  Blood Typing (Type and Crossmatch) Blood typing is the process of determining the blood type and Rh factor of a sample of blood. Very Specific Blood Tube Cross-matching involves finding the best donor sample for a patient prior to blood transfusion. Blood Type (A,B,AB or O) are identified Rh factor is determined Rh+ or Rh – O negative is considered the universal donor because it does not contain antigens All must match identically before transfusing to the patient This will prevent a transfusion reaction Key Identifiers that MUST be checked prior to administering blood products Patient name The best way to prevent a Date of Birth transfusion reaction is proper identification Medical Record Number Two licenses personal – ABO Blood Group usually nurses check the patient Rh Compatibility When the type and cross Expiration Date blood is drawn AND before Blood Unit ID transfusion Nursing Interventions Blood Transfusion Obtain a signed consent (back of the operating room consent) Assess client’s lungs Vital signs 30 minutes before start of transfusion Insert an IV Catheter –18 - 20 gauge – start an infusion of 0.9 NS at KVO until blood is ready to be administered Blood must be administered through a filtered tubing Check patients for allergies A RN must stay with client for the first 15 minutes - take vital signs Infuse the blood slowly to start, monitoring for a reaction Complete infusion of product within 4 hours (prevent infection) Post Transfusion Blood Pressure Symptoms of Blood Transfusion Reaction Erythema (rash), Hives Temperature increase greater than or equal to 1 degree Centigrade or 1.8 degree Fahrenheit above baseline Hypotension- Blood Pressure Changes from baseline Chills Headache Tachycardia Usually occur within the first 15 minute of infusion Transfusion Reaction -Blood Administration – Nursing Interventions If a reaction occurs perform the following interventions Stop blood immediately and take vital signs Infuse 0.9 sodium chloride only (with new tubing) Complete Vital Signs and a Physical Assessment then notify the provider Follow facility policy - send urine sample, CBC and bilirubin to determine hemolysis. Return blood bag and tubing to laboratory for analysis Complications: Transfusion Reactions Type of Transfusion Symptoms Reaction Acute Hemolytic Chills, Fever, Low Back Pain, Tachycardia, Hypotension – Reaction Usually occurs in the first 15 minutes (50 mL) of the transfusion, but it can be delayed. Nursing Actions: Stop Blood, New Tubing NS to KVO, Urine and CBC- return blood and blood tubing Febrile nonhemolytic Most common (sudden chills) Fever: increase in temperature reaction, fever, greater than 1 ℃ from baseline Additional Intervention: headache acetaminophen for fever with order Anaphylactic Reactions Anxiety, urticaria, wheezing, shock , cardiac arrest. Additional Interventions: CPR is needed, Epinephrine Ready for IM or IV injection Mild Allergic Reactions A patient that has a history of allergic reactions to blood (flushing, itching, transfusion or has undergone a stem cell transplant may urticaria) receive washed (leukocyte-poor) RBC to prevent this reaction. Additional Nursing Interventions: If no respiratory compromise, antihistamines may be prescribed, and transfusion rerestarted slowly (pending on hospital policy)  Complications: Transfusion Reactions Type of Symptoms Transfusion Reaction Circulatory Cough, Shortness of Breath, Crackles, Hypertension, Tachycardia, Distended Overload Neck Veins Older Adults are at risk. Additional Nursing Interventions: Stop Transfusion, Place client in a sitting position with legs down, Notify the healthcare provider. Administer diuretics and oxygen as orders, monitor the intake and output. Prior to transfusion assess kidney, respiratory and cardiovascular function for risk of overload Sepsis Rapid onset of chills and fever, vomiting, diarrhea hypotension, shock. Additional Nursing Interventions; Prevention. Ensure refrigeration, inspect blood for gas bubbles discoloration, or cloudiness (bacterial infection) – return to the blood bank if seen. Transfusion must be complete in four hours. If suspects obtain blood cultures treat sepsis with antibiotics, IV fluids, vasopressors, and steroids Hyperkalemia Bradycardia, hypotension, irregular heartbeat, paresthesia of extremities, due to lysis of muscle twitching, potassium level 5.0 mEq/L or greater – Cause Small IV gauge - blood cells break up the cells Transfusion Rare and occurring 1 to 2 weeks following transfusion. Manifestations: nausea, Autologous Blood Transfusion Several weeks prior to elective surgery the client donates blood which can be used for that client after or during surgery Weekly blood collection can be done if client has normal laboratory values Iron supplements are prescribed Fresh blood can be saved for up to 40 days, or blood can be frozen for up to 10 years before use for a client who has a rare blood type Prevents some blood reactions, but still at risk for circulatory overload and sepsis NCLEX RN A nurse is caring for a hospitalized client who has an activated partial thromboplastin time (aPTT) greater than 1.5 times the expected reference range. Which of the following blood products should the nurse prepare to transfuse A. Whole Blood B. Platelets C. Fresh Frozen Plasma D. Packed red blood cells NCLEX RN A nurse is assessing a client during transfusion of a unit of whole blood. The client develops a cough, shortness of breath, elevated blood pressure, and distended neck veins. The nurse should anticipate a prescription for which of the following medications? A. Epinephrine B. Lorazepam C. Furosemide D. Diphenhydramine References ATI Nursing Education. (2016). Blood and Blood Product. In Content Mastery Series Review Module RN Pharmacology for Nursing (7.0 ed., pp. 207–212). essay.