BLOOD TRANSFUSION NUR 317

TRANSFUSION Infusion of blood products for the purpose of restoring circulating volume.

May be whole Blood or blood components Platelets Plasma PRBC Albumin

Administering Blood Products Leukocyte-free PRBC: Most WBCs removed to reduce risk of reaction Whole blood: Most common blood product given in the hospital Used to treat shock, low blood volumes, low hematocrit and hemoglobin, hemorrhage Packed RBCs: Separated from plasma Used to treat anemia, and reduce risk of volume overload

Administering Blood Products Fresh frozen plasma (FFP): Used to restore plasma volume, treat some bleeding problems separated from whole blood by a centrifuge process Platelets Maintain normal coagulability of blood Used to treat some bleeding disorders, and to compensate when marrow can not produce enough

Blood Supply Safety Once blood has been received from the donor it is immediately tested for blood type and infectious diseases

Type and Crossmatch Blood undergoes “type and crossmatch”: Typing to determine ABO and Rh factor Crossmatching to determine compatibility between donor and recipient blood

ANTIGEN: is a substance that prompts the generation of antibodiesantibodies ANTIBODY: are proteins that are found in blood and are used to identify and neutralize foreign objects, such as bacteria and virusesproteinsbloodbacteriaviruses

4 types A B AB O

Blood Typing The Rh factor is made up of numerous complex antigens When it is present, the person is Rh positive (Rh+); if not present, the person is Rh negative (Rh–)

Blood Typing An Rh positive person may receive either – or + blood An Rh negative person must receive only Rh– blood If an Rh– person receives Rh+ blood, antibodies will form If another transfusion of Rh+ blood is given, the antibodies will agglutinate with the Rh antigens of the blood being transfused

Blood compatibilities

Blood typing for transfusion Universal donor= O- Does not contain A, B, or Rh antigens Universal recipients= AB+ Blood contains A, B, and RH antigens Usually blood banks exactly match the pt blood

Blood Screening Prior to be being released for patient use testing for: Hepatitis C Human immunodeficiency virus (HIV)

Infusion Therapy Risks Risk factors: Disease transmission Hepatitis B Hepatitis C Hepatitis A HIV Syphillis Bacterial contamination Acute or delayed transfusion reactions Allergic reactions Mismatched ABO Incompatible Death Circulatory overload

Infusion Therapy Hazards Some risks specific to massive transfusion (replacement of > one blood volume in 24 hours): Hypothermia Hemodilution Platelet dysfunction Electrolyte problems

ADMINISTRATION PROCESS ASSESS Transfusion history Previous transfusions, allergies and reactions Type of transfusion reaction, manifestations, and treatment

Interventions Once the blood has been taken from the blood bank, it must be administered within 30 minutes The nurse must ensure: Positive patient identification Appropriateness of blood component Blood product inspection Verification of donor – recipient compatibility Verification of product expiration date

administration of blood 18 or 20 gauge IV canula blood needs to be checked by 2 licensed nurses. Check expiration date, name, medical record number, type of blood, blood band id, pt age Check vitals prior to administration **blood must be initiated with in 30 minutes of arrival from bank to floor Use blood tube for administration Monitor for blood reactions Monitor vitals continuously during administration

Circulatory overload: Dyspnea Tachycardia Cough frothy sputum Cyanosis increased BP that drops suddenly distended neck veins crackles

Y-type blood tubing