Blood transfusions Acute

What are some components of blood that can be transfused

• Packed Red Blood Cells (PRBC)

• Fresh Frozen Plasma (FFP)

• Platelets

• Leukocytes

• Plasma proteins (immune globulin, albumin, clotting factors)

What is an autologous transfusion

Someone can donate to themselves up to 6 weeks before an elective surgery

What is an intraoperative blood salvage

Special machine filters blood lost from surgery to allow for infusion

Essentially it cleans lost blood so it can be returned

What are some goals of transfusion

• Restore body blood volume or increase RBC (FFP or PRBC)

• Shift fluid back into vascular system (Plasma proteins)

• Improve immunity (leukocytes, FFP)

• Clotting problems (platelets and FFP)

What is a major concern of blood transfusion

incompatibility

What needs to be assessed on the patient before a transfusion

• Lab values

• IV access (needs peripheral 20g or larger, or central line)

• Vitals

• Type and cross-match

What does the nurse need to verify is signed

informed consent

What needs to be verified in the order when giving blood

• Blood product to be given (PRB, FFP, platelets, whole blood, etc.)

• Number of units and rate

• Tylenol, Benadryl, lassie (if appropriate)

What should the nurse check in the patients chart before transfusion

Hx of transfusion Rx

What should the nurse educate the patient on before starting transfusion

Reactions and there S/S

What kind of tubing and what other fluid runs with blood

• Prime IV tubing with NS

• Must use filtered tubing

• Only NS is compatible with blood products

What fluid is compatible with blood products

Normal Saline ONLY

When should vitals be obtained before starting a transfusion

Before getting blood or no more than 15 mins

What is being reviewed during the 2 RN blood check

• Order

• Blood unit number and expiration

• Blood type

• Ensure patient information matches

How long should the nurse stay with the patient after initiating transfusion

First 15 mins

When should vitals be taken after a transfusion is started

15 mins

Should the initial infusion rate start faster or slower

Slower

What should occur if reaction signs occur

• Stop transfusion

• Initiate saline infusion

• Notify MD

• Save blood bag - send bag to blood bank for testing

What is the timeframe for a PRBC transfusion

2-4 hours

What is the timeframe for a platelet infusion

2 hours

What is the timeframe for a FFP transfusion

30mins-1hr

What happens if blood products are not infused within the time frame

Needs to be returned to lab

What is the onset of an anaphylactic reaction

Immediate

What are the S/S of an anaphylactic reaction

• Wheezing

• Dyspnea

• Chest tightness

• Cyanosis

• Hypotension

What are the interventions for an anaphylactic reaction

• Maintain Airways

• Administer Oxygen

• IV fluids

• Antihistamines

• Corticosteroids

• Vaspressors

What is the onset of an acute hemolytic transfusion reaction

Immediate

What are the S/S of an acute hemolytic reaction

• Chills

• Fever

• Low back pain

• Tachycardia

• Flushing hypotension

• Chest pain/tightness

• Tachypnea

• Nausea

• Anxiety

• Hemoglobinuria

What might an acute hemolytic reaction cause or lead to

• Cardiovascular collapse

• ARF

• DIC

• Sepsis

• Death

What is the onset of a mild allergic transfusion reaction

During or up to 24 hr after transfusion

What are the S/S of a mild allergic transfusion reaction

• itching

• Urticaria

• Flushing

What are the interventions for a mild allergic transfusion reaction

Antihistamines (diphenhydramine)

When might a circulatory overload transfusion reaction occur

During or after transfusion

Who is at a higher risk for circulatory overload transfusion reaction

Geriatric

Those with a hx of heart disease/heart failure and renal disease

What are some S/S of a circulatory overload transfusion reaction

Dyspnea, chest tightness, tachycardia, tachypnea, headache, HTN, JVD, Peripheral edema, orthopnea, anxiety, crackles

What is the treatment/plan of care for a patient with circulatory overload transfusion reaction

Stop the infusion and call Dr

Give diuretics

When might someone experience a sepsis transfusion reaction

After transfusion

What are some S/S of septic transfusion reaction

• Fever

• Nausea

• Vomiting

• High WBC

• Chills

• Hypotension

What should be completed following a transfusion

• Vitals

• Dispose of blood administration set

• Monitor blood values (CBC, H&H)

• Complete paperwork/charting

• Document patient response

What should be documented when documenting a patients response to blood transfusion

• Febrile temperature more than 2 degrees from baseline

• Respiratory status

• Sudden increase in anxiety

• Breathe sounds

• Neck-vein distention