BLOOD TRANSFUSION in nursing and patient care during transfusion.

blood transfusion modalities in nursing care

1. BLOOD TRANSFUSION BRENDA OCHIENG’

2. INTRODUCTION • BLOOD TRANSFUSION Is defined as the process of receiving blood products into one’s circulation intravenously. This is usually done as a life saving maneuver to replace blood cells or blood products lost through severe bleeding, during surgery when severe blood loss occurs or to increase the blood count in an anemic patient. •Transfusions usually involve the use of two sources of blood one’s own(autologous transfusion) or someone else’s( allogenic transfusion). • Blood transfusions involves the use of whole blood, red blood cells, white blood cells, plasma, clotting factors and platelets.

3. PURPOSE FOR TRANSFUSION: To restore the hemodynamic status of the patient. To treat factor specific deficiencies For immunotherapy INDICATIONS: Massive blood loss of ≥ 25-50% of a person’s total blood volume. Severe hemolysis in the newborn. Severe anemia. Peri-operatively in major surgeries. Bleeding disorders e.g. thrombocytopenia, hemophilia and DIC etc.

4. BLOOD AND BLOOD PRODUCTS Blood is collected from donors who have been previously screened to exclude any blood or blood products that may have the potential to harm the patient. Each unit of blood is tested for evidence of hepatitis-b, hepatitis c, human immunodeficiency virus I & II and syphilis. The ABO and rhesus d blood group is determined as well as the presence of irregular red cell antibodies. The blood is then processed into sub-components.

5. WHOLE BLOOD Whole blood is unseparated blood containing an anticoagulant–preservative solution. One unit of whole blood contains- 450ml of donor blood. 50ml of anticoagulant-preservative solution. Hemoglobin approx.12g/ml & hematocrit 35%-45%. No functional platelets. Since it is not sterilized, capable of transmitting any agent present in cells or plasma which has not been detected by routine screening. However whole blood transfusion has significant advantages over packed cells as it is coagulation factor rich and if fresh, more metabolically active than stored blood.

6. Stored between +2 and +6 degrees centigrade in a blood bank refrigerator. Transfusion should be started within 30 minutes of removal from the refrigerator and completed within 4hours of commencement because changes in the composition may occur due to red cell metabolism. Indications red cell replacement in acute blood loss with hypovolemic. Exchange transfusion contraindications chronic anemia incipient cardiac failure

7. PACKED RED CELLS Packed red cells are cells that are spun down and concentrated. One unit of packed red cells is approx. 330ml and has a hematocrit of 50-70%. They are stored in a sag-m(saline-adenine-glucose- mannitol ) solution to increase their shelf life to 5weeks at 2-6 degrees centigrade. It carries the same infection risk as in whole blood. Indicated in replacement of red cells in anemic patients and also used with crystalloid and colloid solutions in acute blood loss conditions.

8. FRESH FROZEN PLASMA Fresh frozen plasma is rich in coagulation factors. It is separated from whole blood and stored at -40 to -50 degrees centigrade with a 2year shelf-life. It is the first line therapy in the treatment of coagulopathy hemorrhage. Transfused 30min after removal from refrigeration. Also used in the replacement of multiple coagulation factor deficiencies like liver disease, warfarin overdose, depletion of coagulation factors inpatients receiving large volume transfusions, disseminated intravascular coagulation and thrombotic thrombocytopenic purpura. Precautions acute allergic reactions are common severe life-threatening anaphylactic reactions occasionally occur. • Dosage initial dose of 15ml/kg.

9. PLATELETS Platelets are supplied as a pooled platelet concentrate containing about 250x109 cells per litre . Platelets are stored on a special agitator and have a shelf life of only 5days. Are usually given to patients with thrombocytopenia or those with platelet dysfunction who are bleeding or undergoing surgery and inpatients with bone marrow failure. Not indicated in Patients with untreated DIC and in cases of hypersplenism.

10. Cont … Dosage –1unit of platelet concentrate/10kg body weight. complications – Febrile and allergic urticarial reactions are common especially in patients receiving multiple transfusions. Patients on aspirin therapy rarely pose a problem but those patients on clopidogrel who are actively bleeding and under going major surgery must begin a continuous infusion during the course of the procedure.

11. PROCEDURE ASSESSMENT RATIONALE Indications /order for blood products Patient’s transfusion history (reaction or pre-transfusion meds) Vital signs Type, integrity and patency of venous access Signs and symptoms that may be interpreted for reaction during transfusion Required equipment If patient understands the procedure 8. Mental and physical state of patient Allows for precision of transfusion treatment Determine pre-meds required to prevent reactions Provides the baseline Allows successful completion of transfusion, no infiltrating tissues Prevent erroneous stoppage of blood transfusion Determines availability Determines educational needs of patient Determines if assistance or restraints are required

12. PLANNING Self Knowledge of anatomy and physiology of blood. Review procedure of blood transfusion and institutional policy on the same. Wash and dry hands. Patient Explain procedure and obtain consent Tell pt reasons, expected outcome and duration of transfusion. Explain normal experiences and that should alert the health care worker when itching, swelling, chest pain, dyspnea or unusual feeling.

13. CONT… Clean tray containing: Sterile blood transfusion set IV solution of 0.9% NaCl Disposable gloves Leukocytes depleting filter if required Vital signs observation set Unit of blood/ blood component

14. IMPLEMENTATION Wash and dry hands. Take equipment to patient’s bedside Ensure emergency drugs including antihistamines, steroids, and extra IV infusion fluids are within reach. Explain procedure to the patient again. Review patients understanding of the procedure. Obtain vital signs observations.

15. Cont … 8. Verify blood products and identification of patient with a nurse : Patient’s name Blood group/Rh type Cross match compatibility Unit and hospital number Expiration date and time 9. Instruct patient to empty bladder. 10. Wash hands again and put on gloves. 11. Open blood administration tube and open clamp to start transfusion.

16. Cont … 12. After transfusion is complete allow tubing to clear with normal saline. 13. Dispose the bag, tubing and gloves according to waste disposal procedure. 14. Explain to patient signs of delayed reaction and the need to report.

17. EVALUATION Evaluate for: Any adverse reaction during and after the procedure. Improvement of patient’s condition or relief of symptoms. Client’s understanding of signs of delayed reaction to watch for and report to health workers.

18. DOCUMENTATION Record: Range of vital signs during the procedure All vital signs, observed findings of blood transfusion. Outcome of evaluation. Any medication given prior, during and after transfusion. Start and completion time of transfusion. Amount of blood administered.

19. References NCK (2009) Manual of Clinical Procedures , 3rd edition. Nairobi: Nursing Council of Kenya. Potter P., et al (2017) Fundamentals of Nursing , 9th Edition. Elsevier Saunders, Missouri Smeltzer , S., et al (2014) Brunner & Surddath’s Textbook of Medical Surgical Nursing 10th Edition. Wolters Kluwer, New York. WHO (2009) Clinical Management and Referral Guidelines , Volume III, MMS/MPH, Nairobi