blood transfusion ppt

1. The Nurse’s Roles and
Responsibilities in IVI Therapy,
Blood and Blood Products
Administration
Presenter : Jennifer Savariau Morris
R.N. BSc, R.M.,Lecturer,
Phlebotomist

2. Objectives of Discussion
•Define intravenous infusion
•Indications for IVI therapy
•Types of IVI therapy
•Supplies and equipment needed
•Site selection
•Procedure involved

3. Objectives of Discussion
•Nursing responsibilities before, during and
after IVI therapy
•Complications of IVI therapy
•Intravenous therapy calculations

4. What is an Intravenous Infusion

5. What is an Intravenous Infusion
A solution administered into a vein through
an infusion set that includes a plastic or
glass vacuum bottle or bag containing the
solution and tubing connecting the
bottle/ bag to a branula/ catether
in the patient's vein.

6. What is IVI Therapy
•Intravenous infusion therapy is the
administration of drugs by inserting a
hypodermic needle directly into a vein and
allowing medication to run through it.
(IV push)

7. Indications for IVIs

8. Indications for IVIs
•To correct electrolyte imbalances
•Administration of medications
•Administration of blood and blood
•products
•Administration of total parenteral
Nutrition
•Haemodynamic monitoring

9. Indications for IVI Therapy
•Blood sampling
•Chemotherapy

10. Types of IVIs
•Volume expanders (crystolloids and
colloids)
•Blood based products
•Blood substitutes (Gelafusine)
•Medication
•Nutrition

11. Volume Expanders
•Colloids
•Solution that contain large molecules that
do not pass through the cell membranes.
•When infused they remain in the
intravascular space and expand the

intravascular volume and they
draw fluid from the extravascular
space because of their higher
oncotic pressure

12. Volume Expanders
•Crystalloids
•Solutions that contain small molecules
that flow easily across the cell membranes
allowing for transfer from the
bloodstream into the body cells and
tissues.
This will increase fluid in the
intravascular and interstitial space

13. Volume Expanders
Fluids can be further classified into
1.Isotonic
2.Hypotonic
3.Hypertonic

14. Isotonic Solutions
•Most IV therapy solutions are isotonic.
Isotonic solutions are designed to match
the makeup of your intracellular fluid and
are equal in osmotic pressure inside
and outside your cells. This prevents
any fluid shifting in and out of
your cells.

15. Examples of Isotonic Solutions
•Dextrose 5% in water (D
5
W),
•Lactated Ringer's solution
•Normal Saline Solution (0.9% sodium
chloride.)
•Ringer’s Solution

16. Indications for Normal Saline
•Fluid volume deficit eg. Haemorrhage
severe vomiting diarrhea
•Shock
•Mild hyponatremia
•Metabolic acidosis
•Resusitation efforts
•Blood administration

17. Indications for Ringers Lactate
of Hartman’s solution
•Burn injuries and trauma
•GI tract fluid losses
•Acute blood loss or hypovolemia
•Fistula drainage

18. Indications for 5% Dextrose
Water
•Low blood sugar
•Insulin shock
•Dehydration
•Nutritional support
•Diluent for medications

19. Indications for Ringers Solution
•Burns
•Trauma
•Surgery

20. Hypotonic Solutions
•Hypotonic solutions have lesser tonicity
than that of the ICF because it has lesser
solute concentration. ICF becomes more
concentrated, it pulls water from the
ECF, thus, makes the cell swell.

21. Types of Hypotonic Solutions
•0.45% NaCl (half strength normal saline)
•
0.33% NaCl ( one third strength normal
saline)
•
2.5% Dextrose in water

22. Indications for Hypotonic
Solutions
Purpose:
•used to provide free water and treat cellular
dehydration.
•
Note: Free water is desirable to aid
the kidneys in elimination of
solute via urine output.

23. Hypertonic Solutions
•Hypertonic solutions have solute
concentration in ECF greater than that of
the ICF. Therefore, it pulls fluids out of the
ICF and the cell shrinks.

24. Types of Hypertonic Solutions
•D5 in 0.45% NaCl ( 5% Dextrose in half
strength normal saline)
•D5LR (5% Dextrose in Lactated
Ringer's Solution)
•D10W ( 10% Dextrose in water)
•D50W50 (50% Dextrose in 50
ml of water)

25. Indications for Hypertonic
Solutions
•Hypertonic solution draws fluids from the
ICF causing cells to shrink and ECF to
expand.
•Given to patients with hyponatremias
(Na deficits) with edema.

26. Indications for Solutions
•Aside from being isotonic, hypotonic
& hypertonic. IVF may also come
in a form of nutrient solution,
electrolyte solution, alkalizing
solution & acidifying solution....

27. Supplies and Equipment
Needed
•Needles and syringe
•Branula
•Intravenous Fluid
•Intravenous Tubing
•Tape
•Cleaning apparatus

28. Site Selection
Veins of the arm
Antecubital fossa
•1. Cephalic vein
•2. Basilic vein
•3. Median antebrachial vein
Dorsum of the hand (dorsal
digital network)
Wrist
Forearm (cephalic, antebrachial)

29. Site Selection
•Veins of the hand

30. Site Selection
Veins of the foot
•Great saphenous vein
•Lesser saphenous vein
•Dorsal venous arch

31. Site Selection
•Extra jugular vein (if necessary)
•Scalp veins

32. Quick Note
•Use veins that provide ease of access
•Non dominant limb
•Avoid joint areas
•If lower extremities and the scalp can
be avoided do so
•Choose an area that can
accommodate the branulae
•Try to select straight veins

33. Procedure Involved
•Select a suitable vein for venepuncture.
• Prepare the venepuncture site.

34. Procedure Involved
(1) Apply a constricting band two
inches above the venepuncture site.
The constricting band should be
tight enough to occlude venous flow,
but not so tight that distal pulses are
lost.

35. Procedure Involved
(2) Select and palpate a prominent vein.
(3) Cleanse the skin with an alcohol swab
using a spiral motion starting with the
entry site and extending outward
about two inches. Allow the site
to dry.
(4) Don gloves.

36. Procedure Involved
•d. Perform the venepuncture.
•(1) Using your non-dominant hand, pull
all local skin taut to stabilize the vein.
•(2) With your dominant hand, position
the distal bevel of the needle up
and insert the branula into the vein
at approximately a 30 degree angle.

37. Procedure Involved
•(3) Continue inserting the needle until
blood is observed in the flash chamber of
the catheter.
•(4) Decrease the angle to 15 to 20
degrees and carefully advance the
cannula approximately 0.5
centimeter farther.

38. Procedure Involved
•(5) While holding the needle stationary,
advance the catheter into the vein with a
twisting motion. Insert the catheter all the
way to the hub.
•(6) Place a finger over the vein at the
catheter tip and put pressure on the
vein to prevent blood from
flowing out the catheter.

39. Procedure Involved
•(7) Remove the needle while
maintaining firm catheter control.
•e. Remove the constricting band.
•f. Obtain venous blood samples
as required.

40. Procedure Involved
•g. Attach the administration tubing to the
branula hub while maintaining
stabilization of the hub with the non-
dominant hand.

41. Procedure Involved
•h. Open the flow-regulator clamp and
observe for drips in the drip chamber.
Allow the fluid to run freely for several
seconds.
•Note: You may drop the solution bag
lower than the casualty's heart to
observe for a back flash of blood
to verify catheter placement.

42. Procedure Involved
•i. Adjust to the desired flow rate.
•j. Clean the area of blood, if necessary,
and secure the hub of catheter with
tape, leaving the hub and tubing
connection visible. Make a
small loop in the IV tubing and
place a second piece of tape over
the first to secure the loop.

43. Procedure Involved
•k. Apply a 2x2, a 4x4 micropore tape over
the venipuncture site.
•l. Label a piece of tape with date and
time the IV was initiated, the catheter
size, and your initials. Secure
the tape over the dressing.

44. Procedure Involved
•m. Monitor the casualty and continues to
observe the venipuncture site for signs of
infiltration. Discontinue the infusion if signs
of infiltration are observed.
•n. Remove your gloves and disposes
of them appropriately.

45. Procedure Involved
•Document the procdure in the patient’s
notes

46. Types of Vascular Access
Devices
•Peripheral branula: short term use
inserted into the peripheral veins of arms
and foot (48-96 hrs)
•Midline catheters: designed for short
term use, inserted peripherally
up to 20cm into the vein

47. Types of Vascular Access
Devices
•Peripherally inserted central catheter
(PICC) used medium term to long term for
total parenteral nutrition
•Percutaneous central venous catheter
•Hickman line( Long term use)

48. Nursing Responsibilities
•Patient should be correctly identified and
consent where applicable explained and
signed
•Procedure explained for cooperation
•The medical order is verified by a
second nurse
•Observe the rights of the patient

49. Nursing Responsibilities
•Use aseptic techniques to keep devices
free from infection
•Ensure devices used in are
undamaged
•Ensure IV fluid is within its expiry date
•Ensure IV administration is via a
closed system

50. Nursing Responsibilities
•Any problems encountered during siting of
IV is recorded or reported
•The infusion rate is calculated properly
•The patients vital signs is done and
their condition closely monitored
•Maintain patency of the line

51. Nursing Responsibilities
•All actions are documented in the
patients notes and on the fluid
balance chart

52. Complications of IVI Therapy
•Phlebitis
•Thrombophlebitis
•Infiltration and extravasation
•Infection
•Circulatory overload
•Anaphylaxis/allergic reactions

53. IVI Calculation
•Formula:
•Volume (mL)
•Time (min)x Drop Factor (gtts/mL) = Y
(Flow Rate in gtts/min)

55. Break Time!!!!!
•Two minutes water break.

56. Objectives of Discussion
•Define Blood
•Blood types and grouping
•Define Blood products
•List types of Blood products
•Labeling of the Blood bag
•Storage and handling of Blood
•Define Blood transfusion
•Indications for Blood transfusions

57. Objectives of Discussion cont’d
•Nursing responsibilities prior to, during
and after Blood transfusion
•Post transfusion reactions
•Nursing responsibilities
•Ethical issues related to Blood
transfusion

58. Define Blood
Blood
The fluid circulating through the blood
vessels and, carrying nutriment and
oxygen to body cells, and removing
waste products and carbon dioxide
It consists of plasma and the
formed elements (erythrocytes,
leukocytes, and platelets)

59. Blood Types and Grouping
Patient (Rh Positive) Donor
Packed Cells O Positive O Positive or Negative
A Positive A Positive or Negative
O Positive or Negative
B Positive B Positive or Negative
O Positive or Negative
AB Positive Any Group
Plasma O Any Group
A A , AB
B B, AB
AB AB

60. Blood Types and Grouping
Patient (Rh Negative)Donor
Packed Cells O negative O Negative
A Negative A Negative
B Negative B Negative
AB Negative AB Negative

61. Blood Types and Grouping
•Universal Donor is ‘O’ (negative) which
gives to all groups and receives only from
itself
•Universal Recipient is ‘AB’ and
receives blood from all groups and
can give only to itself

62. Blood Transfusion Scenario
A patient who is A positive is hemorhaging
during surgery. From your knowledge of
blood typing and grouping which group
would you select?
AB Positive
O Negative
B Positive

63. Define Blood Products
Blood Products
The constituents of whole blood that are
used in replacement therapy

64. Types of Blood Products
Whole Blood
Packed Red Blood Cells
Plasma
Cryoprecipitate
Platelets
Clotting Factors (VIII, IX)

65. Define Blood Transfusion
Blood transfusion is generally the process
of receiving blood products into
one's circulation intravenously

66. Indications For Blood
Transfusions
To replace blood lost during surgery or in
haemorrhage
To replace a deficiency of specific blood
componients e.g. erythrocytes
To increase the oxygen-carrying
capacity of the blood as is Anaemia
To increase the intravascular
volume in shock

67. Information on Blood Bag
•Identification number
•Client’s name
•Blood group
•Rhesus factor
•Expiry date

68. Why is this information
important

69. Storage of Blood

Blood
Componient
Shelf life Stored
Temperature
(degrees celcius)
Fresh Whole
Blood
35 days 20 - 24 (RT)
2 - 6
Platelets 5 days 20 – 24
Fresh Frozen
Plasma
12 months - 25 or below
Cryoprecipitate12 months -25 or below
Red Blood Cells35 - 42 days 2 – 8

70. Storage and Handling of Blood
Whole blood and packed cells can be out
of the Blood Bank refrigerator for up to 6
hours
It should be kept in a cool area eg a
air conditioned room
Do not store platelets in a
refrigerator

71. Storage and Handling of Blood
Do not place blood in a domestic
refrigerator or freezer
Do not filter platelets during transfusion
Use filter for plasma, red blood cells
and cryoprecipitate during transfusion
Do not store blood until its
expiration date has passed

72. Storage and Handling of Blood
FFP must not be thawed unless there is
surety of use
Allow all frozen products to thaw until
they have reached room temperature
Do not thaw frozen products by
running them under the pipe
or boiling it. Use a blood warmer

73. Storage and Handling of Blood
Do not transfuse cold blood
Do not give blood to a patient that was
prescribed for another patient because
they have the same blood group
If the unit of blood is not used please
return the unit to the Blood Bank
or Laboratory

74. Storage and Handling of Blood
Do not continue transfusion for more than
3 hours especially if the blood flow is
unsatisfactory.

75. Transfusion Record
•Patient name
•Location
•Date of Birth
•Age
•Sex
•Patient blood group
•Unit number
•Product name

76. Transfusion Record
•Volume
•Expiry date
•Condition of the unit
•Date of order
•Issue date
•Verification of information
•First nurse
•Second nurse

77. Transfusion Record
•Starting date and time
•Stop date and time
•Volume transfused
•Chart for vital signs 15 mins,
30 mins, 1 hour, 2 hour,
3 hour at completion
•Nurse Id number for each
section

78. Nurses Responsibilities for
Blood Transfusions
The patient should be fully informed about
the procedure and any questions should
be answered
Ask if the patient has had a
transfusion or transfusion reaction in
the past
The consent form should be
explained and signed prior to
administration

79. Nurses Responsibilities for
Blood Transfusion cont’d
The patient’s mobility will be restricted
during transfusion so patient comfort
should be ensured
Wash hands and don gloves
The unit of blood should be checked
by at least two persons to ensure
the right patient and it is the correct
blood type for transfusion

80. Nurses Responsibilities for
Blood Transfusion cont’d

Note the expiration date on the unit of
blood. Observe for clots or abnormal
particles or cloudiness
Start intravenous infusion with 0.9%
Normal Saline
Use a 18 or 19 inch branulae

81. Nurses Responsibilities for
Blood Transfusion cont’d
Take baseline vital signs prior to beginning
transfusion
Inform the patient to report an chills,
itching, rash, or unusual symptoms.
Start the infusion of the blood product
and record the time
Start administration of blood
slowly no more than 2 ml/min for
the first 15 minutes or as required

82. Nurses Responsibilities for
Blood Transfusion cont’d
Check vital signs every 5 minutes for first
15 minutes, 30 minutes, 1 hour and every
hour until completion
Observe the patient for reactions such
as flushing, dyspnoea, itching, hives or
rash
Maintain the prescribed flow
rate as ordered

83. Nurses Responsibilities for
Blood Transfusion cont’d
Stop blood transfusion and allow infusion
of normal saline if a reaction is suspected
Notify the physician and the Blood Bank
. Return all blood bag to the Blood
Bank along with blood samples (red
and purple top) urine sample
If unable to return blood bag
promptly store at 1- 6 C/ 24 hours

84. Nurses Responsibilities for
Blood Transfusion cont’d
If no reactions are observed infuse
with 0.9% Normal Saline on the
completion of the transfusion
Document administration of blood
and clients reactions if any

85. Transfusion Reaction Report
Form
•Patient’s Name
•Sex
•Blood group
•Blood product
•Unit number

86. Transfusion Reaction Report
Form
•Transfusion date
•Who started the transfusion
•Volume infused
•Who ended the transfusion

87. Transfusion Reaction Report
Form
•Nurses observation
•What was done
•Other information (lab)

88. Post Transfusion Reactions
Minor Blood Reactions
•Fever
•Itching

89. Post Transfusion Reactions
Nursing Responsibilities
•Stop transfusion and inform the doctor
of findings
•Give 0.9% NaCl slowly KVO
•Give antipyretic
•Give antihistamine
•Monitor temperature and itching

90. Post Transfusion Reactions
Nursing Responsibilities
•Wait for symptoms to subside
•On the advise of the Doctor continue
blood transfusion

91. Post Transfusion Reactions

Allergic Reaction
•Hives
•Itching
•Anaphylaxis

92. Post Transfusion Reactions
Nursing Responsibilities
•Stop transfusion immediately and keep
vein open with normal saline
•Notify Physician stat
•Administer antihistamine as ordered
parenterally as necessary

93. Post Transfusion Reactions
Febrile Reaction
•Fever and chills
•Headache
•Malaise

94. Post Transfusion Reactions
Nursing Responsibilities
•Stop transfusion immediately and keep
vein open with normal saline
•Notify physician
•Treat symptoms

95. Post Transfusion Reactions
Haemolytic Transfusion Reaction
•Immediate onset
•Facial flushing
•Fever, chills
•Headache
•Low back pain
•Shock

96. Post Transfusion Reactions
Nursing Responsibilities
•Stop infusion immediately and keep vein
open with normal saline
•Notify physician stat
•Obtain blood samples from site
•Obtain first voided urine
•Treat shock if present
•Send unit, tubing and filter to the lab

97. Post Transfusion Reactions
Nursing Responsibilities cont’d
•Draw blood sample for serologic testing
and send urine specimen to lab

98. Post Transfusion Reactions
Circulatory Overload
•Dyspnoea
•Dry cough
•Anxiety
•Weak pulse
•Cyanosis
•Pulmonery oedema

99. Post Transfusion Reactions
Nursing Responsibilities
•Slow or stop infusion
•Monitor vital signs
•Notify physician
•Place the patient in an upright
position

100. Post Transfusion Reactions
Bacterial Reaction
•Fever
•Hypertension
•Dry, flushed skin
•Abdominal pain

101. Post Transfusion Reactions
Nursing Responsibilities
•Stop infusion immediately
•Obtain culture of client’s blood and
return blood bag to lab
•Monitor vital signs
•Notify physician
•Administer antibiotics as prescribed
stat

102. Ethical Considerations Related
to Blood Transfusion
•Religious beliefs
•Signed statement if treatment is
refused

103. Questions Anyone

104. Nurses!!!
“ Be not afraid of greatness. Some are
born great, some achieve greatness,
and others have greatness thrust
upon them.”
― William Shakespeare

105. Shine !!! Wherever You Are

108. References
•http://medical-dictionary.thefreedictionary.com/intravenous+infusion
•http://us-mg6.mail.yahoo.com/neo/launch?.rand=51qo1pt6c91ti
•http://en.wikipedia.org/wiki/Intravenous_therapy
•http://www.wisegeek.com/what-is-intravenous-infusion-therapy.htm
•http://www.slideshare.net/kholeif/iv-fluid-therapy-types-indications-doses-calculation
•http://voices.yahoo.com/iv-therapy-isotonic-solutions-are-6707862.html?cat=5

•http://www.drugs.com/mtm/dextrose-5-in-water-injection.html
•http://nursingreference.blogspot.com/2009/01/intravenous-fluids.html
•http://nursing411.org/Courses/MD0553_Intravenous_Infusions/1-06_Intravenous_Infusions.html+&cd=3