Blood transfusion by M.Sc.Second year, 2020-21 Btach, SVBCON, Silvassa

Role of Nurse in Blood Transfusion done by M.Sc.Nursing Second Year 2020-21 Batch, SVBCON, Silvassa.

1. PRESENTED BY M.Sc.Nursing Second year, 2020-21 Batch SHRI VINOBA BHAVE COLLEGE OF NURSING , SILVASSA

2. I NTRODUCTION Blood is a connective tissue in liquid form . It is considered to be the fluid of life as it supplies oxygen to various parts of the body . Blood transfusion can be defined as the transfusion of the whole blood or its components from one person to the other.

3. HISTORY OF BLOOD TRANSFUSION

4. DEFINITION Blood transfusion is the transfusion of the whole blood or its component such as blood cells or plasma from one person to another person. Blood transfusion involves two procedure that is collection of blood from donor a dministration of blood to the recipient

5. C OMPOSITION OF BLOOD Er y t h roc y t e s [5 m i l l i on /c umm ] Leucocytes [4000 – 11000/ cumm] Agranulocytes Granulocytes T hro m bo c y t e s [1.5-4 lakhs] 91% Water 9% solids 1% inorganic 8% organic P las m a(55%) B lo o d Cells (45%)

6. BLOOD AND BLOOD PRODUCT TRANSFUSION Whole Blood Packed Cells Platelets Fresh Frozen Plasma (FFP) Cryoprecipitate

7. 6:35 AM

8. Red Cells Whole Blood Platelets ( also apheresis) Fresh Frozen Plasma Pl a s m a Cryoprecipitate Paediatric FFP Paediatric Cryo Fractionation Factor concentrate s , egFVIII, FIXs SD plasma , Immunoglobulin Albumin, Anti D (Non UK Plasma)

9. Indi cat i o n s : After trauma or haemorrhage Severe anemia Haemophilia Leucopoenia Agranulocytosis Throblastosis fetalis Surgical and obstetric patients with platelet count <50,000 cells/cu.mm

10. TYPES OF TRANSFUSION

11. USES OF BLOOD TRANSFUSION

12. Improve oxygen carrying capacity of blood. Reduce hypovolemia. Symptom improvement 1 UNIT of Blood should increase the Hb by approx.1g/ dL within 24 hours If no improvement or reduction in Hb – it may be ongoing blood loss or destruction . We need to treat the underlying cause .

13. PRE TRANSFUSION REQUISITS

14. BLOOD GROUPING AND CROSS MATCHING

15. SELECTION OF BLOOD DONORS Screening of blood donors is rigorous t o protect the donor from possible ill effects of donation and to protect the recipient from exposure to diseases transmitted through the blood. Donors are eliminated by a history of hepatitis, HIV infection (or risk factors for HIV infection), heart disease, most cancers, severe asthma, bleeding disorders, and seizures . Donation may be deferred for people who have malaria, have been exposed to malaria or hepatitis, are anemic, have high or low BP, have low body weight, or who are pregnant, have had recent surgery, or take certain medications.

16. ROLE OF NURSE

17. ASSESSMENT Assess Vital signs sess Physical examination including fluid balance and heart and lung sounds as manifestations of hypo- or hypervolemia sess Status of infusion site sess Blood test results such as hemoglobin value or platelet count Sess Any unusual symptoms

18. Check the Blood unit and document in both Case sheet of patient and slip of blood products

19. PLANNING

20. EQUIPMENTS NEEDED Articles Rationale A tray containing : A blood transfusion set Transfuse blood A mackintosh and a towel Protect the bed A tourniquet Constrict the blood vessel Cotton swab with antiseptic(Iodine and spirit) Clean the site of infusion Adhesive tape and scissors Secure tubings and needles Gloves Prevent infection A kidney tray, a paper bag Discard the waste IV stand Hold blood bottle Normal Saline Start the blood

21. Articles Rationale Blood or any of its components with cover received from blood bank with the name of the recipient Make sure that the blood sent from the blood bank is meant only for this particular patient. Avoid mistake in identification.

22. P RECAUTIONS TO BE TAKEN DURING BLOOD TRANSFUSION

23. Use of Sterile Apparatus. Blood bag should be checked Temperature of blood to be transfused must be same as body temperature. Transfusion rate must be slow in order to prevent increase load on heart. Care full watch on the recipients condition for 10 mins

24. STEPS OF PROCEDURE

25. 6. Prepare the infusion equipment . Ensure that the blood filter inside the drip chamber is suitable for the blood components to be transfused. Attach the blood tubing to the blood filter, if necessary. Rationale: Blood filters have a surface area large enough to allow the blood components through easily but are designed to trap clots. Wear gloves. Close all the clamps on the Y-set: the main flow rate clamp and both Y-line clamps. Insert the piercing pin (spike) into the saline solution. Hang the container on the IV pole about 1 m (39 in.) above the venipuncture site.

26. 7. Prime the tubing. • Open the upper clamp on the normal saline tubing, and squeeze the drip chamber until it covers the filter and one third of the drip chamber above the filter. • Tap the filter chamber to expel any residual air in the filter. • Open the main flow rate clamp, and prime the tubing with saline. • Close both clamps.

27. 8. Start the saline solution. If an IV solution incompatible with blood is infusing, stop the infusion and discard the solution and tubing according to agency policy. Attach the blood tubing primed with normal saline to the IV catheter. Open the saline and main flow rate clamps and adjust the flow rate. Use only the main flow rate clamp to adjust the rate. Allow a small amount of solution to infuse to make sure there are no problems with the flow or with the venipuncture site. Rationale: Infusing normal saline before initiating the transfusion also clears the IV catheter of incompatible solutions or medications.

28. 9. Obtain the correct blood component for the client. Check the Doctor’s order with the requisition. Check the requisition form and the blood bag label with a laboratory technician or according to agency policy. Specifically, check the client’s name, identification number ,blood type (A, B, AB, or O) and Rh group, the blood donor number, and the expiration date of the blood. Observe the blood for abnormal color, RBC clumping, gas bubbles, and extraneous material. Return outdated or abnormal blood to the blood bank.

29. If any of the information does not match exactly, notify the Sister in-charge and the blood bank. Do not administer blood until discrepancies are corrected or clarified. Sign the appropriate form with the other nurse according to hospital policy. Make sure that the blood is left at room temperature for no more than 30 minutes before starting the transfusion. Rationale: As blood components warm, the risk of bacterial growth also increases. If the start of the transfusion is unexpectedly delayed, return . Do not store blood in the unit refrigerator. Rationale: The temperature of unit refrigerators is not precisely regulated and the blood may be damaged.

30. 11. PREPARE THE BLOOD BAG. Invert the blood bag gently several times to mix the cells with the plasma. Rationale: Rough handling can damage the cells. Expose the port on the blood bag by pulling back the tabs. Insert the remaining Y-set spike into the blood bag. Suspend the blood bag.

31. 12. ESTABLISH THE BLOOD TRANSFUSION.

32. 13.OBSERVE THE CLIENT CLOSELY FOR THE FIRST 15 MINUTES. “transfusions of RBCs be started at 1–2 ml/min for the first 15 minutes of the transfusion” Rationale: This small amount is enough to produce a severe reaction but small enough that the reaction could be treated successfully. Note adverse reactions, such as chills, nausea, vomiting, skin rash, dyspnea , back pain, or tachycardia. Rationale: The earlier a transfusion reaction occurs, the more severe it tends to be. Promptly identifying such reactions helps to minimize the consequences

33. Check the vital signs. If there are no signs of a reaction, establish the required flow rate. Most adults can tolerate receiving one unit of blood in 1.5 to 2 hours. Do not transfuse a unit of blood for longer than 4 hours. If the client has a reaction and the blood is discontinued, send the blood bag and tubing to the laboratory for investigation of the blood.

34. 14. DOCUMENT RELEVANT DATA . Record starting the blood, including vital signs, type of blood, blood unit number, sequence number (e.g., 1 of three ordered units), site of the venipuncture, size of the catheter, and drip rate . POST PROCEDURE CARE Record completion of the transfusion, the amount of blood absorbed, the blood unit number, and the vital signs. If the primary IV infusion was continued, record connecting it. Also record the transfusion on the IV flow sheet and intake and output record.

35. Apply clean gloves. If no infusion is to follow, clamp the blood tubing. Check agency protocol to determine if the blood component bag needs to be returned or if the blood bag and tubing can be disposed of in a biohazard container. The IV line can be discontinued or capped with an adapter or a new infusion line and solution container may be added. If another transfusion is to follow, clamp the blood tubing and open the saline infusion arm. Check agency protocol. A new blood administration set is to be used with each component

36. If the primary IV is to be continued, flush the maintenance line with saline solution. Disconnect the blood tubing system and reestablish the IV infusion using new tubing. Adjust the drip to the desired rate. Often a normal saline or other solution is kept running in case of delayed reaction to the blood. Measure vital signs.

37. COMPLICATIONS Reactions associated with high morbidity Transfusion related acute lung injury Transfusion associated circulatory overload Haemolytic reactions Anaphylaxis Transfusion associated graft vs. host disease Post transfusion purpura Reactions associated with low morbidity Febrile non haemolytic transfusion reactions Mild allergic reactions Acute hypotensive transfusion reactions

38. Minimizing the need for blood transfusion Preoperative planning- History and examination including surgical or bleeding history Full blood count, blood chemistry, coagulation, Consider autologous blood deposit Consider erythropoietin to boost haemoglobin concentration Treat iron or folate deficiency Stop aspirin prophylaxis if possible Day of admission Chec k i f t aki n g aspi r i n , no n - s t e r o i dal a n t i - i n fla m m a t o r y dr u gs, anticoagulants Repeat full blood count Consider drugs to reduce bleeding (such as aprotinin)

39. During surgery Be prepared for longer duration to secure haemostasis Consider hypotensive surgery if appropriate Avoid hypothermia—give all fluids through a warmer Consider fibrin glues and sealants Postoperative care Accept lower postoperative haemoglobin concentration Accept transfusions of just one unit of blood, to exceed transfusion trigger Use continuous face mask oxygen if patient has low haemoglobin concentration Prescribe iron and folic acid routinely Consider Tranexamic acid