MedSurge Exam 3

Donor requirements

Must be at least 17, weigh at least 110 lbs, males that have not had sex with others males in 3 months, must wait 56 days between donations, oral temperature cannot exceed 99.5, systolic 90-180/diastolic 50-100, hemoglobin at least 12.5

People ineligible to donate 

Anyone who has used needles to take drugs or any unprescribed substance in 3 months, men that have had sex with other men in 3 months, anyone with a positive HIV test, anyone who has taken Tegison for psoriasis

Autologous blood donation

When a person donates their own blood to be stored and used for transfusions in the future

Autologous blood donation guidelines

Donations can be made every 3 days as long as hemoglobin is in a safe range, donations should begin 5 weeks prior to transfusion, donations should end 3 days before transfusion

Blood salvage

Suctioning blood from the body cavities or joint spaces during surgery

How long can RBCs be refrigerated for

42 days

How long can RBCs be frozen for

10 years

Antigens 

Substances that cause the formation of antibodies by recognizing substances as self or foreign; A, B, AB

Rh factor

Antigenic substance in the RBCs of most people; + or -; Rh positive can receive Rh negative and positive, Rh negative can only receive negative

Antibody

Protein substance developed in the body in response to the presence of an antigen

Aggluntinin

Antibody that causes a clumping of specific antigens

Indications for PRBCs

Symptomatic anemia, acute and chronic blood loss

Indications for FFP

Deficiency of plasma coagulation factors, massive transfusion in trauma, emergency reversal of PT/INR

Indications for granulocytes

Neutropenia with infection

Verification of blood

Recheck physician order, compare ABO group and Rh type on the chart to the bag, check with another licensed person, do not hang blood you didn’t personally check

Obtaining blood from blood bank

Double check with the person who issues blood, inspect color, for leaks, cloudiness, clots or air, check expiration date and time

What is the only fluid you can hang with blood 

0.9% normal saline

How long can you transfuse blood for

No more than 4 hours

What should the starting infusion rate be for blood

2ml/min for the first 15 minutes, then up to prescribed order 

Needle for blood transfusions

20 gauge is golden standard, 18 gauge or large for rapid transfusion, 22 gauge if unable to gain access with large gauge, 23 gauge for peds

Blood warmers

Decreases the risk of dysrhythmias and cardiac arrest, important when administering several units of blood, should be 38 degrees C or 100.4 degrees F, never hold water under tap water, microwaves or immerse in water bath

Steps to give blood 

Confirm transfusion order, check that blood has been typed and crossmatched, informed consent, explain procedure, obtain baseline vitals, hang hygiene, start IV, obtain PRBCs from blood bank, double check labels with another licensed person, check for any abnormalities in blood bag, start within 30 minutes of receiving the bag, start transfusion at 2ml/min for the first 15 minutes, monitor for 15 minutes then obtain vital signs and compare to baseline, change blood tubing every 2 units, do not exceed 4 hours of administration time 

Febrile reaction

Occurs when the donor’s WBCs produce cytokines

S/S of febrile reaction

Sudden chills and fever (rise in temperature greater than 1 degree C or 1.8 degrees F, headache, flushing, anxiety, muscle pain

Management of febrile reaction

Antipyretics as prescribed, do not restart transfusion

Acute hemolytic reaction

Occurs when there’s RBC damage before transfusion due to heat or imbalance of the cells'; dangerous and life threatening

S/S of acute hemolytic reaction

Chills, fever, lower back pain, flushing, tachycardia, hypotension, bleeding, ARF, shock, cardiac arrest

Management of acute hemolytic reaction

Treat shock if present, draw blood samples slowly, send urine specimen to lab, maintain BP with IV colloid solution, give diuretics as prescribed, do not restart transfusion

Allergic reaction

Occurs when the blood is hypersensitive to protein in the donor’s blood

S/S of allergic reaction

Flushing, itching, urticaria

Management of allergic reaction

Antihistamine as prescribed, if symptoms are mild transfusion can be restarted slowly, if severe do not restart

S/S of anaphylactic reaction

Anxiety, urticaria, wheezing, cyanosis, shock and possible cardiac arrest

Transfusion Associated Circulatory Overload TACO

Occurs when there is too much blood in the body

TACO S/S

Cough, dyspnea, pulmonary congestion, headache, hypertension, tachycardia, distended neck veins

Management of TACO

Place in upright position, administer diuretics oxygen and morphine as prescribed

Bacterial contamination

Occurs when the blood is contaminated with bacteria

S/S of bacterial contamination

Rapid onset of chills, high fever, vomiting, diarrhea hypotension, shock 

Management of bacterial contamination

Obtain blood culture and send bag with remaining blood to transfusion service for further study, treat septicemia as directed (antibiotics, IV fluids, vasopressors, steroids)

Transfusion related acute lung injury TRALI

Damage to the lungs that occurs when the body reacts to the donor’s antibodies

TRALI S/S

Abrupt onset of dyspnea, hypoxia, hypoxemia, hypotension, and pulmonary edema 

Management of TRALI

Oxygen, ventilator

Delayed hemolytic reaction

Occurs when an antigen gets reintroduced to the blood

S/S of delayed hemolytic reaction

Fever, mild jaundice, decreased Hct

Indications for whole blood

Treatment of massive blood loss

Indications for PRBCs

Anemia

Indications for FFP

Increase clotting factors

Indications for platelets

Control or prevent bleeding

Non tunneled central venous catheter

Inserted directly into vein, short term, inserted by physician, 1-5 lumens, 7-10 inches, accounts for majority for CRBSI

Non tunneled catheter insertion steps

Informed consent, supine position, surgical scrub and sterile attire, sterile drape the patient from head to toe, prep skin with chlorhexidine gluconate solution and allow time to dry, cover with moisture permeable sterile dressing, placement via xray before use

Peripherally inserted central catheter PICC

Long catheter inserted into the vein, 1-3 lumens, 18-29 inches, month-year dwell time, lower rate of infection

Tunneled central venous access device

Long term use (months or years), made of silicone, inserted into vein and tunneled back through the skin, lower rate of infection

Implantable port

Inserted via surgery, most common in anterior chest, single or double lumen, lowest risk of infection

CLABSI

Central line associated bloodstream infection

CRBSI

Catheter related bloodstream infection

Which vein has the lowest risk of infection

Subclavian 

Long term venous devices

Tunneled, port, PICC

Short term venous devices

Non-tunneled

How often should sterile dressings be changed

Every 7 days or PRN

How often should gauze dressings be changed

2 days or PRN

Flushing central lines

Never use syringe smaller than 10ccs, only NS, use start/stop technique, flush with 10ccs NS before and after use 

Dead space technique

Technique used to obtain blood specimens; Withdrawal until blood enters the syringe, discard blood, draw specimen

Intraluminal occlusion

Thrombus, which can occur due to stagnant blood

Extraluminal occlusion

Fibrin sheath or Pinch off syndrome 

Discontinuation of central line

Turn off any current transfusions, position supine, non sterile gloves used, remove old dressing, clean site 70% isopropyl alcohol, remove sutures if present, place sterile gauze over entry site and apply light pressure, apply pressure for at least 2 minutes, apply dressing

When should you change the tubing for TPN

24-72 hours or policy

Local infection s/s

Red, heat, drainage, tenderness

Septic infection s/s

Fever, increased BP, mental status changes, increased HR

Hyperglycemia s/s

Polyuria, confusion, lethargy, dehydration

Hypoglycemia s/s

Diaphoresis, tachycardia, tremors, mental status changes

When should TPN be administered

Must be out of the refrigerator 1 hour before hanging