Blood transfusion -procedure,precaution and complication

medical and surgical,introduction,blood and blood products,GENERAL INSTRUCTIONS FOR GIVING BLOOD TRANSFUSIONS,Nursing Implications -Before transfusion:
Check physician’s orders
Review hospital policy
Ensure informed and written consent is provided
Check laboratory values
Understand the indications and rationale
Verification procedure occurs with
two nurses
Before transfusion (con’t):
Compatibility of blood type and Rh factor
Inspect the blood product for discolouration, clots, leaking, or presence of bubbles
Check the unit number on the unit of blood and on the form
Check the expiration date and time on unit of blood
Ask client to state first and last name
Check patient’s identification number on wristband and record
Nursing Implications in a Reaction
Stop transfusion
Remove tubing that contains blood product
Infuse with 0.9% normal saline
Monitor vital signs
Notify physician
Notify blood bank and return blood component
Administer medication depending on type of reaction
Epinephrine, antihistamines, antibiotics, antipyretics, analgesics, diuretics, corticosteroids

1. PRANATI PATRA M.SC NURSING 1 ST YEAR BLOOD TRANSFUSION-: PROCEDURE,PRECAUTION AND COMPLICATION

2. OBJECTIVES At the end of class student will be Able to define blood transfusion. Enlist the purpose of blood transfusion  List out the blood products   Enumerate the general instruction follow before, during and after blood transfusion ?   List out the articles needed before blood transfusion Explain the procedure blood transfusion ?  Describe the complication arises in blood transfusion ?

3. DEFINITION Blood transfusion is the transfusion of whole blood or its components such as blood cells and plasma from one person to another person through an intravenous live . Transfusions usually involve the use of two sources of blood – ONE’S OWN ( AUTOLOGOUS TRANSFUSION ) OR SOMEONE ELSE’ ( ALLOGENIC TRANSFUSION ).

4. PURPOSE To replace blood volume and blood pressure during hemorrhage { hemoptysis , hematemesis,operation } , trauma and burns . To increase the hemoglobin level in cases of severe anemia. To correct and treat deficiency of plasma proteins, clotting factors .

5. COMPONENTS OF BLOOD PACKED RED BLOOD CELLS ( RBCs ) PURPOSE: increase RBC mass and oxygen-carrying capacity assists the body to rid carbon dioxide and other waste products INDICATIONS: Symptomatic and chronic anaemia - Blood loss due to injury or surgery

6. WHOLE BLOOD COMPOSITION: Red Blood Cells White Blood Cells Plasma Platelets INDICATIONS – Red cell replacement in acute blood loss with hypovolaemia exchange transfusion CONTRAINDICATION S chronic anaemia cardiac failure

7. FRESH FROZEN PLASMA FRESH FROZEN PLASMA IS RICH IN COAGULATION FACTORS.  Composition : Plasma All coagulation factors Purpose : Increase blood plasma Replenish clotting factors Indication s: Bleeding in patients with coagulation factor deficiencies; plasmapheresis Liver Failure Severe Infection

8. PLATELETS Composition: Platelets Plasma RBCs WBCs Purpose: Helps to stop bleeding (restore clotting ability) Essential for coagulation of blood PLATELETS

9. PLATELETS INDICATIONS: Decreased platelet count Hemophilia Platelet dysfunction CONTRAINDICATION - Autoimmune thrombocytopenia .

10. BLOOD TYPES There are four blood types: 1 . A 2 . B 3. AB 4. O Every person has one of the above four blood types. In addition, each person's blood is either: Rh-positive, or Rh-negative .

11. CONT…. Rh-positive and Rh-negative People who have Rh-positive blood can receive Rh-positive or Rh-negative blood. If a person has Rh-negative blood, they should only receive Rh-negative blood. Rh-negative blood is used for emergencies when there is not time to test a person's Rh type.

12. Donors should not have any history of cancer ,jaundice , hepatitis,tuberculosis ,allergies. Donors must have normal temperature, pulse and blood pressure. They should be physically healthy, and should be between 18 and 65 years of age with in average height and weight. GENERAL INSTRUCTION

13. CONT…. Explain the procedure to the donor and reassure him/her to win his confidence and co-operation . Blood should not be collected empty stomach. Following the donation of blood the donor should be given a sweetened drink and asked to take rest for one to two hr to prevent fainting attacks.

14. CONT……. The donor’s haemoglobin level is checked . Once collected, the blood is examined and screened for possible infectious agents such as HIV and hepatitis . Blood should be fresh. Blood should be stored at a temperature 1’C to 6’C.

15. - Don’t administered medication through the same line, where blood product is transfused. - Cover the bag with a towel when it hangs on the iv pole. Gently rotate the blood bag periodically . 1unit of blood contain 350ml of blood. Preservative – Citrate Dextrose Phosphate Adenine.

16. Cont... Freezing ,heating of the blood will destroy the blood cells . when sending the recipients blood sample for grouping and cross matching , it must be carefully labeled at the bedside of the recipient with identification.

17. Cont... Re warming of blood may be done by covering the blood with a blanket. Transfusion should be completed over a period of 4hrs.

18. CONT.................. Pre medication avil may be prescribed. Furosemide Treatment Before Blood Transfusion in Patients With Systolic Dysfunction.

19. Benadryl

20. Inj emeset or Ondansetron

21. Tab.paracetamol

22. TRAMADOL

23. ULTRACET

24. Prednisone

25. OMEPRAZOLE

26.   Nifedipine

27. Erythromycin

28. Diazepam

29. ARTICLES Blood transfusion set.

30. CONT.... Normal saline Blood /blood components- sterile in appropriate container. Cannula no ; 18 / 20G

31. CONT..... Alcohol/iodine swabs Sterile gauze Tourniquet Adhesive tape Infusion stand Disposal bag Disposable gloves

32. PROCEDURE 1.Check physician;s order,patients condition,and history of transfusion /infusion reaction,reason for present transfusion etc 2.Identify patients

33. Cont….. 4.Explain the procedure to the patient. Obtain informed consent from patient 5.Obtain blood from blood bank in accordance with agency policy. 6.Encourage patient to empty bowel and bladder and assist to a comfortable position .

34. 7.Ensure privacy . 8.Wash and dry hands 9.Check vital signs and record. 10.Use disposable gloves

35. 11.Insert IV cannula [18g.19g] 12. Inspect the blood product[by 2 nurses] for Identification number Expiry date. Compartibility Patients name Abnormal colour,clots,excess air etc

36. 13.Warm blood if needed using special blood warmer . 14.Start infusion of blood product slowly , for first 15mn adjust flow rate at 5 to 10ml/min .check vital signs every 15mn for first 30mn or as per agency policy. 15.Increase infusion rate if no adverse reaction are noticed. the flow rate should be within safe limits.

37. 16.Assess the condition of pt every 30minutes and if any adverse effect is observed stop transfusion and start saline. send urine sample ,blood sample, and remaining blood product in container with transfusion set, back to the blood bank. 17.Complete transfusion and administer saline [ as per physician's order] if no adverse reaction is observed. 18.Dispose blood product container and set in a appropriate receptable .

38. 19.Wash hands . 20. Record the following ;product and volume transfused ,identification number and blood group. Time of administration. stated and completed. Name and signature of nursing staff caring out procedure and patient condition. if agency policy requires remove label from blood bag and paste it on patients record.

39. 21.Assist patient to comfortable position.

40. COMPLICATION 1.HEMOLYTIC REACTION - Incompatibility between clients blood and donors blood . CLINICAL SIGNS Chills, fever, headache, backache, dyspnea , Cyanosis, chestpain,hypotension .

41. NURSING INTERVENTION Stop transfusion as soon as a reaction is suspected. Replace the donor blood with normal saline. Examine the blood to determine if the patient was the intended recipient and then send the unit back to the blood bank. Furosemide may be administered to increase renal blood flow. Low-dose dopamine may be considered to improve renal blood flow. Make efforts to maintain urine output at 30-100 mL /h.

42. ALLERGIC REACTION CLINICAL SIGNS - Chills - Abdominal cramps - Dyspnoea - Vomiting - Diarrhoea - Tachycardia - Flushing

43. NURSING INTERVENTION Stop transfusion immediately and notify MD Support airway ( endotracheal intubation may be needed) and circulation as needed Anticipate administering epinephrine, diphenhydramine , and corticosteroids Maintain intravascular volume

44. CIRCULATORY OVERLOAD CLINICAL SIGN- Dyspnea , orthopnea , cyanosis, sudden anxiety If severe : Coughing of pink, frothy sputum, neck vein distension, crackles in bases of lungs

45. NURSING INTERVENTION Position patient in sitting position Stop transfusion and notify MD Keep IV open with slow infusion of normal saline . Anticipate diuretics, oxygen, morphine, and aminophylline

46. FEBRILE REACTION Sensitivity of client to white blood cells ,platelets and with plasma protein. CLINICAL SIGN - Fever - Chills, - Dyspnoea, - Headache, - Muscle pain.

47. NURSING INTERVENTION Discontinue the transfusion immediately. Give antipyretics as ordered. Keep a vein open with a normal saline.

48. CONCLUSION Transfusions of blood & blood components are labour intensive & expensive but are frequently life saving. In a few patients, however they can result in potentially fatal complications. It is therefore essential that they are only given when the benefits outweight the risks

49. BIBILIOGRAPHY 1.The who handbook on the clinical use of blood – who blood transfusion safety, Geneva, 2017.   2. Bailey & love’s short practice of surgery – 25 th edition –2010 3.Davidson’s principle & practice of medicine – 21 st edition – 2008. 4.Essential paediatrics – o.p . ghai – 6 th edition. 5.Online text from the british medical journal www.bmj.co.uk/bloodtransfusionsafety31781/o3.