BLOOD ADMINISTRATION

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BLOOD ADMINISTRATION

• NRS 108
• ESSEC COUNTY COLLEGE
• Majuvy L. Sulse MSN, RN,CCRN

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Objectives Use safe accurate techniques and
apply the nursing process when caring for clients
who are receiving blood and blood products.
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Definition of terms

• Antigen-substance that elicits an immune
  response mostly proteins (can also be
  lipoproteins, polysaccharides and nucleic acids.
• Antibody-substances produced by the plasma (300
  molecules/sec) secreted into the blood other
  extracellular fluids
• Agglutination-a clumping like antibody action
  that results from an antibody molecules having at
  least two antigen binding sites

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Definition of terms contd

• Lysis-cell membrane destruction, occurs because
  of antibody binding to membrane- bound antigens
  of some invaders.
• Blood transfusion- are actual transplantation of
  tissue from one person to another. Donor and
  recipient must be checked for compatibility to
  prevent lethal reactions.

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Blood Transfusion contd

• Compatibility is determined by 2 different types
  of antigen systems (Cell surface proteins) ABO
  system antigen the Rh antigen (membrane surface
  of the RBCs)
• RBC antigens are inherited and maybe one of the
  following A antigen (type A blood) B antigen
  (type B blood) Both A B antigen (type AB
  blood) No antigen (type O blood)

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Compatibility Chart for Red Blood Cell
Transfusion

• Recipient
• ___________________________________
• Donor_______A______B______ AB_____0_
• A X X
• B X X
• AB X
• O X X X X

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Rh Compatibility

• An Rh negative person is born without the antigen
  and does not form antibodies unless he or she is
  spefically sensitized to it. Sensitization can
  occur with RBC transfusions from an Rh positive
  person or exposure during pregnancy and birth.
• An Rh positive person can receive an RBC
  transfusion from an Rh negative donor
• Rh negative people MUST NEVER receive Rh positive
  blood.

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Blood Product Components Indications for Usage

• Red Blood Cell (RBC)- administered to
• replace erythrocytes lost from trauma
• Erythrocytes lost from surgical intervention
• clinical conditions that result in destruction or
  abnormal maturation of RBCs
• Hgb less than 6 g/dL or 6-10 g/dL if clinical
  symptoms are present.

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Blood Product Components Indications for
Usage-contd

• Platelet Transfusions are administered
• Platelet counts below 20,000 mm3
• Thrombocytopenic patients actively bleeding or
  going for an invasive procedure

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Blood Product Components Indications for
Usage-contd

• Cryoprecipitate-
• product derived from plasma. Clotting factors
  (Vlll, Xlll), fibronectin, and fibrinogen are
  precipitated from pooled plasma.
• Clients with fibrinogen level less than 100 mg/dL
  or clotting factor disorder at a volume of 10-15
  ml/unit usually IV push within 3 minutes

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Blood Components continued

• Plasma
• Replaces blood volume.
• Used for clients with clotting disorders.
• Actively bleeding with PT or PTT greater than
  1.5 times than normal.
• ABO compatibility is required for transfusion of
  plasma products.
• FFP volume is about 200 cc is given as rapidly as
  the pt. can tolerate while the clotting factors
  are viable generally over a 30-60 minute period.
  Use a regular Y set or straight filtered tubing.

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Nurses responsibilities when Initiating,
Maintaining terminating A Blood transfusion
Therapy1. Assess lab values2. Verify medical
order3. Send blood specimen for type
cross-matching4. Obtain blood consent from
client or next of kin if unable/incompetent to
sign5. Assess VS, urine output, skin color, and
history of transfusion reactions
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• 6. Obtain venous access- large bore needle g.19
• 7.Obtain blood product from the blood bank
• 8. With another RN, verify clients name,
  number, blood compatibility and note expiration
  time.
• 9. Administer blood using appropriate filtered
  tubing as soon as possible
• 10 Use only normal saline for priming the tubing
  or for dilution

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Nurses responsibilities when Initiating,
Maintaining terminating A Blood transfusion
Therapy

• 11.Infuse slowly at about 2 ml/min during the 1st
  15 minutes then adjust at ordered rate
• 12.Remain with the client for the first 15-30
  minutes of infusion
• 13. Take VS and record as per facilitys policy
• 14.Upon completion of transfusion, discontinue
  infusion dispose of bag tubing properly.
• 15. Document.

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Transfusion Reactions

• An adverse reaction to blood transfusion therapy
  ranging from mild to life threatening condition.
  If this occurs
• Stop the transfusion
• Maintain a patent IV line with Normal saline
• Notify the healthcare provider blood bank
• Recheck identifying tags numbers
• Monitor VS and urine output

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Transfusion Reactions

• Treat symptoms per physicians order
• Save blood bag and tubing and send to blood bank
  for exam
• Complete transfusion reaction reports
• Collect required blood and urine specimen at
  intervals per hospital policy to evaluate for
  hemolysis
• Document on transfusion reaction form and patient
  chart

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Acute Transfusion Reactions

• Acute Hemolytic Reaction-
• Cause by ABO or Rh incompatibility
• Clinical signs
• Mild reaction with fever and chills or life
  threatening like DIC circulatory collapse
• Apprehension
• Headache
• Chest pain
• low back pain
• Tachycardia/tachypnea
• Hypotension
• Hemoglobinuria

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Acute Reactions contd.

• Febrile Reactions
• Caused by leukocyte incompatibility
• Prevented by using leukocyte filter tubing
• Clinical signs
• Sensation of cold
• Tachycardia
• Fever
• Hypotension
• Tachypnea

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Acute Reactions contd

• Allergic reactions
• Results from sensitivity to plasma proteins of
  the donor or history of allergy
• Antihistamines ( Epinephrine/corticosteroids) are
  used to prevent reaction
• Washed RBCs are given for those with history of
  allergy
• Signs
• Urticaria
• Itching
• Bronchospasm or anaphylactic reactions

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Acute Reactions contd

• Circulatory overload
• Occurs when blood product is administered too
  quickly
• Cardiac or renal insufficiency and older
  population at risk
• Signs
• Hypertension
• Bounding pulse
• Distended jugular veins
• Dyspnea
• Restlessness
• confusion

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Acute Reactions contd

• Bacterial transfusions reactions (Sepsis)
• Blood products infected from improper handling
  and storage
• May cause bacteremia or septic shock
• Massive transfusion reactions-due to large volume
  of transfusions and can cause
• Hypothermia
• Cardiac arrythmias
• Citrate toxicity
• Hypocalcemia
• Hyperkalemia

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Delayed transfusion Reactions

• Delayed hemolytic reactions
• Hep B
• Hep C
• HIV
• Iron overload
• Graft versus host disease