Potential complications of blood transfusions, VAC, atelectasis

What to do in case of a severe blood transfusion reaction?

1. DC blood

2. remove blood tubing, hang NS

3. Give O2 if SOB

4. Take VS every 5 mins

5. Visually inspect urine for blood

What to do in case of a mild blood transfusion reaction?

• give benadryl/acetaminophen

• infusion will be continued

What is an acute hemolytic reaction? how much blood is needed to see it?

• RBC hemolysis d/t blood incompatibility

• only takes 5ml

what are the s/s of acute hemolytic reaction?

• fever, chills

• tachycardia, bradycardia, chest pain, severe HPN

• oliguria, hemoglobinuria

• flank pain

• dyspnea

what is the tx for acute hemolytic reaction?

controlling HPN

What is a non-hemolytic febrile reaction? When can it occur?

• an immune response to RBC

• Occurs during or 1-4hrs after transfusion

what are the s/s of non-hemolytic febrile reaction?

• fever, chills, shivering, flushing

• HA, mild anxiety

What is the tx for non-hemolytic febrile reaction?

benadryl or antipyretics

What is the tx for bacterial reactions?

• hydration and fluids

• antibiotics, steroids, vasopressors

What is transfusion related lung injury (TRALI)? When can it occur?

• Dmg to pulmonary vasculature by antibodies in the blood

• Can occur 6-72hrs after transfusion

What are the s/s of TRALI?

• fever, chills, purpura

• hypoxemia, resp failure, acute onset pulmonary edema, dyspnea (Early sign), bilateral pulmonary edema on CXR, pulmonary infiltrates

  • with stable pulmonary status 12hrs prior to contraction

• Cyanosis

• Pink and frothy sputum

• HPN

What is the tx for TRALI?

• no definitive tx - may use O2 and hemodynamic support

What is transfusion associated circulatory overload (TACO)? When can it occur?

• patient becomes fluid overloaded d/t transfusion

• can occur within 12hrs of transfusion

What are the s/s of TACO?

• resp distress, pulmonary edema, tachypnea

• increased BNP, CVP

• tachycardia, HTN

what is the tx of TACO?

• position pt upright with feet dependent

• diuretics

• O2

• ventilator support

what labs should be monitored in blood transfusions?

• CBC, plt cnt, coags, fibrinogen, ABGs

• Calcium and potassium with massive transfusions

What is a massive transfusion?

10+ units of whole blood or packed RBC within 24hrs

What is an ultra massive transfusion?

12+ units of whole blood or packed RBC within 24hrs

What complications are associated with massive transfusions?

• Acidosis - d/t hyperkalemia and preservatives

• Hyperkalemia - increases naturally in stored blood (esp over 12 days)

• Hypocalcemia - d/t citrate in blood binding to calcium

• Hypomagnesemia - citrate is a magnesium chelator

• Hypothermia d/t blood bags being stored cold

• coagulopathies

• air embolism - d/t pushing blood in fast

What is barotrauma?

Alveolar rupture d/t increased alveolar pressure

What is volutrauma?

general lung trauma d/t overextension

what is pneumothorax?

collapsed lung

how do you recognize barotrauma?

• it may progress to:

  • pulmonary/subcutaneous emphysema

  • pneumothorax

  • pneumopericardium

how do you recognize pneumothorax?

• JVD

• Tracheal deviation, blank space on CXR, SOB, tachypnea

how do you recognize pneumonia?

• High fever

• SOB, sputum, dry/wet productive cough, rapid shallow breathing, pleuritic chest pain, ronchi, infiltrates on CXR

• diarrhea

• occurs 30-48hrs after intubation

what are the interventions for barotrauma/volutrauma?

• adjust settings to prevent further dmg to the alveoli

What are the interventions for pneumonia?

treat infection while keeping the patient ventilated

What are the interventions for pneumothorax?

• prepare for decompression

• monitor chest tube

• apply O2 on pt

How do you prevent barotrauma/volutrauma?

providing ventilation w/a smaller VT and varying amnts of PEEP

How do you prevent pneumonia?

• Daily oral care with CHG solution

• Daily assessment for readiness of extubation

• Elevated HOB 30-45 degrees

• suction mouth as needed

• PPI for GERD

• maintain adequate hydration

• early EN feedings

How do you prevent pneumothorax?

Adjust settings to not be harsh on lungs

• low TV

• tailored PEEP

What is atelectasis?

alveolar collapse

how do you prevent atelectasis?

• CDB

• Incentive spirometer

• mobility/PROM

• position changes