blood admin

target hemoglobin lvl for RBC transfusion

PRBCs for

• Hgb < 7 g/dl in all hemodynamically stable adults

• Hgb < 8 mg/dL in all pt with preexisting cardiovascular disease or those undergoing orthopedic and cardiac surgery

• active bleeding (hemorrhage) that cannot be controlled

• active bleeding associated w/shock

expected rise in hgb after 1 unit of PRBCs

increase hemoglobin by g/dL and hematocrit by 3%

type

to identify a person’s ABO and Rh blood type

screen

identifies additional antibodies in the pt blood that may react w/antigens in the donor blood

• ex: duffy, kidd, diego, cartwright, lutheran, etc…

crossmatch

donor blood is combined w/patients plasma to check for agglugination

step 1 blood admin

• nurse verifies that informed consent has been obtained for blood product

• its prescribers responsibility to obtain informed consent from the patient

• prescriber explains risks, benefits, alternatives

step 2 blood admin

nurse reviews the pt transfusion hx to determine if pt has had previous transfusion reactions

step 3 blood admin

establish IV access

• blood components can be admin into 23 gauge IV

• if rapid admin needed, it should be 18 gauge or 16 gauge

step 4 blood admin

request blood product from the blood bank

• SHOULD BE ADMIN WITHIN 30 MIN OF RECEIVING otherwise must be sent back

step 5 blood admin

gather supplies needed to admin blood products

• blood admin tubing w/170 micron filter (Y-type tubing)

• bag w/0.9% sodium chloride solution

• IV infusion pump

• equipment to obtain vitals

• PPE

• alcohol pads

• 0.9% sodium chloride flush syringe

• biohazard bag

step 6 blood admin

inspect the blood component

step 7 blood admin

complete the blood component verification process

• performed by RN administering the blood and another person considered qualified by the agency

• donor info, recipient info

step7a blood admin

verify that the blood component received from the blood bank is the component that was ordered by the prescriber

match the pt to the blood component: verify that the info on the tag attached to the blood bag matches w/pt ID band

leukocyte depleted blood products (leukocyte reduced or leukocyte poor)

• reducing WBCs decreases risk of non hemolytic transfusion reactions

• reduces risk for transmission of viral infections

• leuko-reduction is usually performed by the blood supplier or performed before admin w/leuko reduction filter

irradiated blood products

used to prevent transfusion associated graft versus host disease in HIGH RISK pt

why are platelets administered?

to control or prevent bleeding in pt with thrombocytopenia or platelet dysfunction

platelets by apheresis

• donors blood passed through an apheresis machine that separates platelets from the other blood components

• platelets are collected

• remaining blood products returned to donor

allogeneic blood

collected from a donor OTHER than the pt

autologous blood

collected from the pt weeks before a planned invasive procedure (ex: surgery)

step 7b blood admin

verify that the info on the tag matches the info on the blood component label

• donor info, recipient info

• barcoding!

step 8 blood admin

explain procedure to pt and family

step 9 blood admin

obtain vitals BEFORE TRANSFUSION INITIATED

prime blood admin tubing w/0.9% sodium chloride (if using Y tubing)

• close clamps

• spike saline bag

• open clamp below saline

• completely prime 170 micron filter

step 10 blood admin

aseptically attach saline primed blood tubing to pt IV cannula and infuse saline at TKO rate (to keep open, slow IV fluid infusion rate that is just enough to maintain IV lines patency, keeping from becoming clotted or blocked)

• flush w/saline before attaching blood tubing to assure IV cath is in vein

step 11 blood admin

spike blood component w/other Y connection and infuse the blood

1. close clamp

2. spike blood product

3. open clamp

document time transfusion was started

at what rate should the blood be infused during the first 15 min of transfusion?

2 mL/min

at what rate will the nurse set the infusion pump?

120 mL/hr

step 12 blood admin

remain w/the pt during the first 10-15 min of the transfusion to observe for s/s of a transfusion reaction

transfusion reaction symptoms

• temp rise greater than or equal to 1.8 F or 1C

• chills

• skin manifestations: hives, rash, flushing, pruritus, angioedema

• resp symptoms: dyspnea, wheezing, crackles, congested cough, cyanosis, SPO2 less than 90%

• restlessness and anxiety

• unexpected fall in BP

• unexpected bradycardia or tachycardia

• pain in back or chest

• nausea or vomiting

• hematuria

step 13 blood admin

take vitals 10 min after initiating transfusion

how often should vitals be monitored during transfusion?

• within 30 min before transfusion

• 10-15 min after initiating

• every 30-60 min during transfusion

• when transfusion is completed

allergic reaction

cause: recipients immune system overreacts to foreign proteins in the donated blood

manifestations: flushing, hives, pruritus, anaphylactic reaction (rare) manifests as dyspnea, wheezing, anxiety, hypotension without fever

prevention: admin autologous blood products, premediate w/acetaminophen, diphendydramine (benadryl) and corticosteroids, admin WASHED RBCs or washed platelets

febrile non-hemolytic transfusion reaction

cause: caused by recipients antibodies directed AGAINST donor’s leukocytes, platelets, or plasma proteins

clinical manifestations: fever (rise in temp greater than 1 C), chills, flushed skin, anxiety, headache during OR up to 24 hrs after transfusion

prevention: admin leukocyte reduced blood products to patients w/history of this type of transfusion reaction, premediate w/acetaminophen and diphendydramine (benadryl)

transfusion associated circulatory overload (TACO)

cause: blood product is administered faster than the circulatory system can accommodate. pulmonary edema develops due to volume excess or circulatory overload

clinical manifestation: dyspnea, orthopnea, crackles in lungs, distended jugular veins

prevention: admin blood product at an appropriate flow rate based on pt size, age, and clinical condition

transfusion related acute lung injury (TRIAL)

cause: antibodies in the donors blood react w/the neutrophils in the recipients pulmonary microvasculature, causing damage to the pulmonary endothelium

clinical manifestation: dyspnea, severe hypoxemia, frothy sputum, hypotension, and fever that develops within 6 hours of initiation of a transfusion, chest x-ray that shows pulmonary infiltrates

treatment: supplemental O2, administer corticosteroids

prevention: admin leukocyte reduced blood products, screen donors for relevant antibodies

sepsis reaction

causes: infectious agent in donors blood, inadequate cleansing of donors skin at the time of blood collecting or improper storage or processing in blood bank

manifestations: sudden chills, fever, tachycardia, shock

prevention: collect, process, and store blood products according to CDC, FDA, and AABB standards, aseptically infuse blood products within 4 hrs

acute hemolytic transfusion reaction

cause: donor blood is destroyed (hemolyzed) by recipients antibodies, usually caused by ABO blood group incompatibility

clinical manifestations: fever, chills, hypotension, flushing, wheezing, anxiety, red-colored urine, low back pain, can result in renal failure

prevention: proper labeling of pt pretransfusion type and crossmatch blood samples, proper id of pt and blood components at time of transfusion

fresh frozen plasma

indications: clotting factor deficiencies, elevated INR, liver disease, warfarin reversal

expected outcome: improved coagulation and reduced bleeding

safe admin: ABO compatible plasma, infuse promptly after thawing, monitor for fluid overload/reactions

cryoprecipitate

indications: low fibrinogen, DIC, hemophilia, massive transfusion

expected outcomes: improved clot formation and fibrinogen lvls

safe admin: thaw before use, infuse soon after preparation, monitor for reactions