Lec 4: Blood administration

what are the blood components

• RBC

• plasma

• platelets

• cryoprecipitate aka cyro

how are RBO groups determined

type of antigen present on RBC

what antigens attack a type O carrier? (what blood can they not recieve)

A or B blood

who is the universal PLASMA donor

type AB

• only can recieve AB plasma

who is the universal PLASMA receiver

O = can receive any plasma

O and A blood compatibility pic

B blood compatibility pic

what are the indications for packed red blood cells (PRBCs)

• use for chronic symptomatic anemia (have fatigue, impeding daily life, SOB)

• restoration of blood volume

how much does PRBCs raise blood volume by

raises Hgb 1 g/dL and Hct 3%

• typical volume of bag is approx 250 mL

• tx when hgb is 70

PRBCS & Key Admin Guidelines (gauge)

• catheter size= 22-14 gauge with 20-18 gauge appropriate for general populations

  • larger = greater chance of cells bursting/lyse

• use only 0.9% NaCl as primer

• use 170-μm filter

• administer within 4 hrs (usually 2 hrs)

do we always have to give plasma as the same type as the patient?

yes unless not available, use any ABO group

what are the indications for platelets

• control bleeding in platelet deficiency

• thrombocytopenia

• hemorrhage with platelet count <50,000

• surgery with platelet count <100,000

• nonbleeding pt with rapidly dropping platelets <15,000

Platelets & Key Admin Guidelines

• admin= 1 unit (30-50 mL) over 5 to 10 mins

• use Y set iv line

• ABO compatible

• 1 unit raises platelet count 5 to 10,000

• usually administer 6 to 8 units at one time

Indications: for FFP

• procoagulant deficiencies

• disseminated intravascular coagulation (DIC)

• massive transfusions in trauma

how is plasma usually stored

frozen than thawed for use

plasma characteristics

• liquid portion of blood

• does not contain RBCs/platelets

FFP characteristics

• prepared from whole blood separating and freezing plasma within 8 hrs of collection

• FFP may be stored up to 1 year

• does not provide platelets

• typical volume is 200 - 250 mL

what material is high in concentration with cyroprecipitate

fibrinogen

• use same ABO type as pt for 1st choice, usually only A and B available on unit

what doe blood products require before admin?

informed consent

Blood products: aka plasma protein products list, dont memorize

• Albumin, 5 or 25%

  • comes in glass bottle, needs a vented IV set

• Factor VII Concentrate

• Factor VIII Concentrate

• Factor IX Concentrate

• Antithrombin III (ATIII) Concentrate

• Intravenous Immune Globulin Immunoglobulins (e.g. Rh Immune Globulin (RhIG)

• Hepatitis B Immune Globulin (HBIG)

• Varicella Zoster Immune Globulin (VZIG)

• Prothrombin Complex Concentrates (PCCs)

what must we assess with the pt before preparing to admin blood products

• VS baseline

• assessment of lungs and kidneys

• lab values

• pt history of transfusions

why do we care about a patients history of transfusions

• the more transfusions = higher likelihood of adverse event from time to create antibodies

• 1st transfusion = be extra careful in 15-30 min

what are the steps to administrating a blood product

• confirm informed written (signed) consent has been obtained

• confirm pt is wearing a transfusion service Identification number (TSIN) when required

• check the order

• gather required equipment

• obtain and verify blood component or product

• have a 2nd HCP verify pt identity and blood component or product

• pre-transfusion assessment

• tell pt to report any side effects where possible and admin the blood component or product

• monitor the transfusion as required

• report any adverse reaction

• complete the required documentation

what must be confirmed for informed consent to be valid

• must be obtained for transfusion

• must be documented in pts chart

• consent obtained by the most responsible health care provider (MRHP)

what happens if the pt is not able to give consent and its an emergency?

2 physicians will independently decide the need

How long does consent last for? when should we get new consent?

no specific timeframe, new consent if…

• pt condition has changed

• pt knowledge has changed

• refusal to adhere

what is the Transfusion Service Identification Number (TSIN) used for

used to determine blood group, screens for antibodies

Adult TSIN Band pic

Neonatal/Small Child TSIN Band

what must be in the order for a blood infusion

does an order exist = must have pt name, DOB, ULI number, date, allergies

• type and amount of blood component to be infused

• rate and duration of infusion

• any special requirements for that infusion

• sequence of infusion

• any pre/post transfusion meds or lab testing

• recipients ID and indication for transfusion

• route of admin

what equipment is needed for a blood transfusion

gloves, NS, tubing with 170 mc filter, one line goes to blood other goes to NS

• prime with NS first than clamp, spike blood bag

how does Obtaining Blood Component From Blood Bank work

sign for blood, checking: carried out by 2 people = blood bank person + health professional

• name, identification number of pt

• transfusion donor number

• expiration date of component

• ABO and Rh compatibility

• transfusion tag

how many units can we pick up from the blood bank at a time

pick up only one unit at a time

• needs specialized fridges

Transfusion Tag RBCs

attached to blood components (red cells, plasma, platelets)

what checks must we do prior to or at the bedside before giving blood products

• pt id on transfusion order matches pt id on blood bag

• blood bag consistent with order

• blood bag product number matches product number on tag

• blood bag not expired

• no abnormalities exist ex leaks

what checks must we do prior to or at the bedside before giving blood products for the blood components

• ABO (+ Rh) on blood bag label match tag

• ABO (+ Rh) is compatible with pts ABO and Rh

• compatibility status of unit

• any special requirements ex washed, irrigated

what checks must we confirm at the bedside before giving blood products

• pts id

• pts id matches transfusion tag

• transfusion service id number matches tsin on the band

what are the steps to assessment after giving blood on the pt

• pre transfusion vitals

• stay at pt bedside for 1st 5 min

• be immediately available (pt in sight) for 1st 10-15 min

• vital signs during transfusion after 15 min, than q1h

• post transfusion monitoring VS, and monitor for 15 min

if a pt has had a previous or 1st time rxn to blood transfusion, how long do we monitor them for post transfusion

if pt has had previous rxn = 60, before or 1st time =30

• monitor for 30-60 min

do we do vitals before blood admin

yes always

what allergy signs should we look out for when transfusing blood

stop infusion if =

• hives

• difficulty breathing

• pain at site

• back pain

• feeling diff than usual

how to administer PRBCs

ensure clamps are locked

1. prime line with NS

2. hang blood = take bag and hold in hand, take line without NS, remove protective covering over port, insert spike slowly by twisting a quarter turn DONT PUT ON POLE

3. ensure NS turned off, clamp locked, open up blood bag clamp

4. infuse slowly - follow 15 min rule = start the transfusion at 50 ml/h for the first 15 min (12.5ml of blood)

5. stay for 15 min to monitor, than set rate to prescribed rate, max infusion time is 4 hrs

how much time do we have to start the infusion after picking up the blood from the blood bank

within 30 mins

• if you went over 4 hrs you have to stop infusion and return the blood

how to discontinue an infusion steps

• flush line to ensure all blood is cleared from line

• take pts VS

• documentation tag = one stays on pt chart, one goes to blood bank

• bag and tubing are discarded in biohazard container

• if another unit is to be transfused, keep vein open (KVO) by infusing NS

how often do we change the equipment/lines for blood transfusion

changed q8h at least

• changed whenever you switch from one product to another = brand new line

Transfusion Tag Mounting Record pic

once transfusion complete, place sticker on to mounting record

what are the most common symptoms of transfusion reactions

= stop infusion, keep line open with NS, notify doctor if..

• fever

• chills

• dyspnea

• lightheadedness

• urticaria

• itching

• flank pain

what emergency equipment is required to be on hand when giving blood

• pre primed line of NS aka rxn line (if rxn occurs, discontinue that line and attach to this backup line)

• oxygen = nasal cannula or mask

• medications

what are the emergency medications?

• epinephrine= adult or pediatric 1 mg/ml, neonate 0.1 mg/ml

• diphenhydramine= 50 mg/ml injectable

• hydrocortisone, injectable

Acute rxns: acute hemolytic transfusion rxns S&S

• discomfort/anxiety

• dyspnea

• fever/chills

• facial flushing

• severe pain

• shock (rapid pulse, low BP, clammy skin, N/V)

what to do if acute hemolytic transfusion rxns

• stop transfusion

• begin supportive tx = maintain a good BP by using IV fluids, Lasix (renal blood flow)

• try to promote urine output of 100 mls/hr for 24 hrs

how do acute hemolytic transfusion rxns happen

from giving wrong blood to wrong pt

• can lead to DIC, death

Acute rxns: febrile rxn S&S

aka a fever

• increase in baseline by 1C

• pt shows fever + chills

how do febrile rxns happen

caused by reaction to antibodies

how do we tx febrile rxns

• stop blood

• notify physician

• tx with antipyretic med

• use leukocyte filter

acute rxns: allergic reactions characteristics

• cause = antibody formation

• s&s = hives, itching, resp distress

• tx = stop transfusion, notify doctor, prepare for histamines

what is the most common complication of blood transfusions

infection

complications: transfusion related acute lung injury S&S

• resp distress

• hypoxia

• pulmonary edema (crackles)

• hypotension

• fever

what to do if transfusion related acute lung injury aka tx

• oxygen support

• mechanical ventilation = ICU

complications: transfusion related circulatory overload cause

from high osmolarity draws fluid into intravascular space = overload

• look at kidney fx

transfusion related circulatory overload S&S and tx

• S&S = HF, dyspnea, crackles

• stop transfusion, consider lasix

complications: citrate toxicity cause and S&S

citrate = anticoagulation of choice from blood clotting in bag

• rapid admin of blood = hypoglycemia and hypomagensia

complications: transfusion associated graft - versus - host disease cause

lymphocytes from blood components attack recipients tissues  (bone marrow, GI tract)

• recognition hard from nonspecificity

• fatal

complications: delayed hemolytic transfusion rxn description + S&S

• present asymptomatically

• can happen 4 weeks after transfusion

• higher risk if they had other blood product transfusions before

• S&S = slight fever