1. Prepared By: Miss. Sana’a AL-Sulami

2. Outlines: What is the blood transfusion. Purpose of blood transfusion. Assessment of the patient. Planning for blood transfusion. The Equipment and preparation for blood transfusion. Performance of blood transfusion. Termination of blood transfusion. What is the blood transfusion. Purpose of blood transfusion. Assessment of the patient. Planning for blood transfusion. The Equipment and preparation for blood transfusion. Performance of blood transfusion. Termination of blood transfusion.

3. Blood transfusion  It is administration of whole blood or any of the components of blood such as packed RBCs, Plasma, Platelets, via the intravenous route.  Blood Groups : Human blood is commonly classified into four main groups ( A, B, AB, O ).

4. Blood Typing & crossmatching:  To avoid transfusion incompatible red blood cells, both blood donor and recipient are typed and their blood crossmatched.  Blood Typing is done to determine the ABO blood group and Rh factor status.

5. Selections of blood donors:  Screening of blood donors is rigorous. Criteria have been established to protect the donor from possible ill effects of donation and to protect the recipient from exposure to diseases transmitted through the blood.

6. Cont,  Potential donors are eliminated by a history of hepatitis, HIV infection, heart disease, most cancers, severe asthma, bleeding disorders, or convulsions. Donation may be deferred for people with malaria or who have been exposed to malaria or hepatitis or in situation of pregnancy, surgery, anemia, high or low blood pressure.

7. Special precautions are necessary when administering blood. When a transfusion is ordered, obtain the blood from the blood bank just before starting the transfusion. Don’t store the blood in the refrigerator on the nursing unit, lack of the temperature control may damage the blood. Blood is administered through a # 18, 19 gauge intravenous needle.

8. A Y-type blood transfusion set with an in–line or add-on filter is used when administering blood. One arm of administering set connects to the blood ; normal saline ( 0.9 % NaCl ) is attached to the other arm of the Y-Type set. Saline is used to prime the set and flush the needle before administering blood. Blood transfusion should be completed within 4 hours of initiation.

9. T HE P URPOSES To restore blood volume after severe hemorrhage. To restore the capacity of the blood to carry oxygen To provide plasma factors, or platelet concentrates which prevent or treat bleeding.

10. Assessment: Clinical signs of reaction ( e.g, sudden chills, fever, nausea, itching, rash, low back pain, dyspnea ). Manifestations of hypervolemia. status of infusion site Any unusual symptoms. Clinical signs of reaction ( e.g, sudden chills, fever, nausea, itching, rash, low back pain, dyspnea ). Manifestations of hypervolemia. status of infusion site Any unusual symptoms.

11. Planning Verify physician order for transfusion. Verify the client consent and obtain baseline data before the transfusion. Verify that a signed consent form was obtained. Assess vital signs for baseline data. Determine any known allergies or previous adverse reaction to blood. Note the specific reasons for transfusion. Verify physician order for transfusion. Verify the client consent and obtain baseline data before the transfusion. Verify that a signed consent form was obtained. Assess vital signs for baseline data. Determine any known allergies or previous adverse reaction to blood. Note the specific reasons for transfusion.

12. Equipment Unit of whole blood, or packed RBCs. Blood administration set. 250 ml normal saline infusion. IV pole. Venipuncture set containing a # 18 or # 19 guage needle or catheter. Povidone – iodine solution or scrub pad. Alcohol swabs. Tape. Clean gloves.

13. Preparation Prepare the client:  Explain the procedure and it’s purpose to the client.  If the client has intravenous infusion, check whether the needle and solution are appropriate to administer blood.  If the client does not have an IV solution infusing, check agency policies.

14. 1. Obtain the correct blood component for the client. 1.Check the physician order with the requisition. 2.Check the requisition form and the blood bag label with laboratory technician or according to agency policy. 3.With another nurse compare the laboratory blood record with: A.The client’s name and identification number. B.The number on the blood bag label. C.The ABO group and Rh type on the blood bag label.

15. 2. Verify the client’s identify: 1.Ask the client’s full name. 2.Check the client’s arm band for name and ID number. Don’t administer the blood to client without an arm band. 3. Set up the infusion equipment: 1.Ensure that the blood filter inside the drip chamber is suitable for whole blood to be transfused. 2.Put on gloves, close all clamps on the Y-set. 3.Using twisting motion.

16. 4. Prime the tubing : 1.Open the upper clamp on the normal saline tubing and squeeze the drip chamber until it covers the filter and one-third of the drip chamber above the filter. 2.Tap the filter chamber to expel any residual air in the filter. 3.Remove the adapter cover at the tip of the blood administration set. 4.Open the main flow rate clamp, and close both clamps.

17. 5. Start the saline infusion. 6. Prepare the blood bag. 7. Establish the blood transfusion :  The blood will run into the saline filled drip chamber.  Readjust the flow rate with the main clamp. 8. Observe the client closely for the first 5 to 10 minutes. ◦ Run the blood slowly for the first 15 minutes at 20 drops per minutes. ◦ Note adverse reaction.

18. 9. Document relevant data. ◦ Record starting blood, including vital signs, type of blood, blood unit number, site of venipuncture, size of needle. 10. Monitor the client.

19. Terminate the transfusion: Don clean gloves. If no infusion is to follow, clamp the blood tubing and remove the needle. If the primary IV is to be continued, flush the maintenance line with saline solution. Disconnect the blood tubing system and reestablish the intravenous infusion using new tubing. Discard the administration set according to the agency practice.

20. Terminate the transfusion: Remove the gloves. Again monitor vital signs. Follow agency protocol for appropriate disposition of the blood bag. document relevant data. Evaluation: Changes in vital signs or health status. Presence of chills, nausea, vomiting or skin rash.