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.