BLOOD INFUSIONS

Intraoperative Blood Management

  • Definition of Terms:

    • Intraoperative: Referring to the period during a surgical procedure.

    • Auto: Refers to an automatic process; in the context of blood donation, it indicates donating one's own blood for future use during surgical procedures.

  • Autologous Blood Donation:

    • Involves donating blood to oneself prior to a surgery known to be bloody.

    • Maximum donation timeline: Up to six weeks prior to surgery, contingent upon having stable hemoglobin (H) and hematocrit (Hct).

    • Abbreviation:

    • H and H refers to hemoglobin and hematocrit, respectively.

  • Intraoperative Blood Salvage:

    • Process of collecting and reinfusing blood during surgery if significant blood loss is anticipated.

    • Time frame: Collected blood must be reinfused within six hours of collection after which it is no longer viable.

  • Indications for Blood Transfusion:

    • Significant blood loss leading to conditions such as:

    • Anemia

    • Kidney failure

    • Clotting factor deficiencies

    • Examples of specific scenarios:

    • Hemophilia and terms:

      • Recumbent Blood: This refers to clotting factors, associated with cryoprecipitate.

      • Associated conditions: Burns and hypoproteinemia, often linked with albumin deficiency.

  • Types of Blood Components:

    • Transfusions are categorized into several types:

    • Platelet transfusions

    • Plasma transfusions

    • White blood cell transfusions

    • Washed red blood cells

Pre-Procedure Considerations

  • Compatibility Testing:

    • Type and Crossmatch: Essential to prevent adverse reactions; based on ABO antigens (A, B, AB, O) and Rh factor.

    • Universal donor: Type O has no antigens, making it universally accepted.

    • Universal recipient: Type AB, as it has no antibodies against A or B antigens.

  • Nursing Responsibilities:

    • Explain the procedure to the patient and obtain consent.

    • Monitor vital signs, specifically in the first 15 to 30 minutes of transfusion, as this is a critical monitoring phase.

    • Be present with the patient directly during the initial 15 minutes when blood is infused: any adverse reaction may occur during this period.

    • Review lab work, blood products received, previous transfusion reactions, and ensure compatibility.

Blood Product Administration Protocols

  • Equipment and Administration Considerations:

    • Preferred IV size: 18-gauge catheter (sometimes a 20 gauge may be acceptable).

    • Normal saline is the only acceptable fluid to be infused with blood products.

    • Use wide tubing for blood administration.

    • Blood must be warmed only upon specific orders, especially for hypothermic patients.

  • Monitoring During Transfusion:

    • Remain with the patient for the duration of the initial period, doing vital checks.

    • If there is no reaction after initial observation, you may then increase the infusion rate.

    • Regular vital checks may occur post-procedure at intervals of 3 hours and 6 hours.

  • Emergency Protocols:

    • In cases of severe hemorrhage, two IV lines for blood transfusion may be employed to expedite transfusion rates.

    • In critical cases, clinicians may opt not to use infusion pumps, instead manually squeezing bags to hasten delivery.

Blood Transfusion Complications

  • Acute Hemolytic Reaction:

    • Timing: Can occur immediately or at any time during transfusion, often considered acute due to its rapid onset.

    • Cause: Incompatibility due to Rh factor (as few as 10 mL can trigger a reaction).

    • Symptoms may include:

    • Chills

    • Fever

    • Lower back pain

    • Tachycardia

    • Flushing

    • Hypotension

    • Chest pain

    • Nausea

    • Anxiety

    • Hemoglobinuria (presence of hemoglobin in urine)

    • Sense of impending doom.

    • Nursing Action: Stop the transfusion; do not reuse tubing—everything including the normal saline bag should be discarded.

    • Place all remainings (blood bag, tubing) in a biohazard bag before sending to the lab.

  • Febrile Non-Hemolytic Reaction:

    • Timing: Typically occurs within two hours after starting the transfusion.

    • Cause: Development of anti-white blood cell antibodies, especially in patients with a history of multiple transfusions.

    • Symptoms: Temperature change, flushing, hypotension, and tachycardia.

    • Nursing action includes stopping the transfusion and administering antipyretics, with a new infusion of normal saline through new tubing.

  • Allergic Transfusion Reaction:

    • Timing: Can occur during or up to 24 hours after a transfusion.

    • Symptoms: Hypersensitivity responses including pruritus, rash, to anaphylactic reactions (angioedema).

    • Nursing action: Stop infusion; new tubing and administration of antihistamines. If anaphylactic symptoms are present, administer epinephrine and assess the patient accordingly.

  • Bacterial Transfusion Reaction:

    • Timing: Occurs during or several hours after the transfusion.

    • Cause: Contamination in blood products.

    • Symptoms: Severe hypotension and shock. Rare occurrence attributed to effective blood testing.

  • Circulatory Overload:

    • Complication commonly associated with the addition of excess fluid volume in a patient.

    • Can lead to increased blood pressure and difficulty in breathing.

Summary of Key Protocols

  • Initial actions if a transfusion reaction is suspected:

    • Stop the transfusion immediately.

    • Maintain the IV access using normal saline, and reassure the patient.

    • Gather relevant data (vital signs, symptoms) to report to the provider promptly.

    • Document all findings and actions taken during the incident.

  • General Characterization of Blood Incompatibility Reactions:

    • Focus findings on specific symptoms relevant to the type of reaction: e.g., presence of fever in febrile reactions, or blood in urine for acute hemolytic reactions.