Blood transfussion

Define blood transfusion
Enlist the purpose of blood transfusion
Brief the history of blood transfusion
Describe various component of blood
Understand types of blood transfusion
Perform the steps of the procedure
Recognize the adverse reaction of blood transfusion

1. GIVE THE GIFT OF LIFE “DONATE BLOOD”

2. KRISHNA V GANDHI BLOOD TRANSFUSION

3. OBJECTIVES At the end of the procedure student will be able to : Define blood transfusion Enlist the purpose of blood transfusion Brief the history of blood transfusion Describe various component of blood Understand types of blood transfusion Perform the steps of the procedure Recognize the adverse reaction of blood transfusion

4. 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 Administration of blood to the recipient. DEFINITION

5. PURPOSE To restore the blood volume when there is sudden loss of blood due to hemorrhage. To raise the Hb level in cases of severe anemia To treat deficiencies of plasma protein, clotting factors or hemophilic globulin etc. To provide antibodies to those persons who are sick and having lowered immunity. To replace the blood with hemolytic agents with fresh blood To improve the leukocyte count in blood as in agranulocytosis . To combat infection in leucopenia

6. HISTORY

7. Components of blood Whole blood Packed cell volume Fresh frozen plasma P latelets Cryoprecipitate

8. WHOLE BLOOD  Whole blood is unseparated blood containing an anticoagulant – preservative solution. 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 4 hours of commencement because changes in the composition may occur due to red cell metabolism.  

9. PACKED RED CELLS Packed red cells are cells that are spun down and concentrated.  One unit of packed red cells is approx. 330 ml and has a haematocrit of 50-70%.  They are stored in a SAG-M (saline-adenine- glucose- mannitol ) solution to increase their shelf life to 5weeks at 2-6degrees centigrade.  

10. 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 coagulopathic haemorrhage

11. CRYOPRECIPITATE Cryoprecipitate is a supernatant precipitate of fresh frozen plasma and is rich in factor VIII and fibrinogen. It is stored at -30 degrees centigrade with a 2 years shelf life. Indicated in low fibrinogen states (<1g/l) or in cases of factor VIII deficiency (hemophilia-a), von will brand's disease and as a source of fibrinogen in disseminated intravascular coagulation. Pooled units containing 3-6 gms fibrinogen in 200-500 ml raises the fibrinogen level by approx. 1g/L.  Must be infused within 6 hours.  

12. TYPES OF TRANSFUSION TYPES OF TRANSFUSION

13. PRE TRANSFUSION REQUISITS

14. BLOOD GROUPING AND CROSS MATCHING

15. SELECTION OF BLOOD DONORS Screening of blood donors is rigorous. To protect the donor from possible ill effects of donation 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, or 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. ASSESSMENT

17. PLANNING

18. EQIUPMENT NEEDED • Unit of whole blood, packed RBCs, or other component • Blood administration set • IV pump, if needed • 250 mL normal saline for infusion • IV pole • Venipuncture set containing a 14- to 22-gauge catheter (if one is not already in place) • Alcohol swabs • Tape • Clean gloves

19. PREPARATION If the client has an IV solution infusing, check whether the IV catheter and solution are appropriate to administer blood. The IV catheter size ranges between 14 and 22 gauge, and the solution must be normal saline. Dextrose (which causes lysis of RBCs), Ringer’s solution, medications and other additives, and hyperalimentation solutions are incompatible. If the client does not have an IV solution infusing, check agency policies. In this case, will need to perform a venipuncture on a suitable vein and start an IV infusion of normal saline.

20. STEPS OF PROCEDURE

21. 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.

22. 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.

23. 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.

24. 9. Obtain the correct blood component for the client. Check the primary care provider’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.

25. If any of the information does not match exactly, notify the charge nurse and the blood bank. Do not administer blood until discrepancies are corrected or clarified. Sign the appropriate form with the other nurse according to agency 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.

26. 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.

27. 12. ESTABLISH THE BLOOD TRANSFUSION.

28. 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

29. 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.

30. 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. AFTER TERMINATION : 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.

31. 15.TERMINATE THE TRANSFUSION. 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

32. 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.

33. Definition- Blood transfusion reaction is a systemic response by the body to blood incompatible with that of recipient It is mainly caused due to-  ABO incompatibility  Allergic reactions to the WBCs, platelets, or plasma protein components of the transfused blood  Potassium or citrate preservative in the blood   ADVERSE REACTION

34. ADVERSE REACTION Acute hemolytic transfusion reaction Delayed hemolytic transfusion reaction Pyrogenic reaction Allergic reaction Anaphylactic reaction Transmission of infectious diseases Circulatory overload Infiltration and Hematoma Thrombophlebitis Pulmonary embolism

35. SUMMARY

36. ANY QUARRY??

37. ASSIGNMENT Note on the management of ADVERSE REACTION due to blood transfusion.

38. EVALUATION

39. Basvanthappa B.T”MEDICAL SURGICAL NURSING”1 st edition , 2005 Jaypee Brothers Publications, NewDelhi,Page No.1142- 1144. Chintamani Lewis”MEDICAL SURGICAL NURSING ”South Asia edition 2 nd ,volume1 2015,Elseiver Publication,Page No.1541. Clinical Nursing Procedures: The Art of Nursing Practice, 3 rd Edition, Published by Annamma Jacob, Rekha R and Jadhav Sonali Tarachand , page no.187 & 561. Smeltzer S . Sumanzme “BARE AND BRENDA HINKLE I JANICE BRUNNER AND SUDDHARTHS TEXTBOOK OF MEDICAL SURGICAL NURSING” 13 TH Edition,Volume 2 ,2015,Wolter Kluwer pvt.ltd , New Delhi The Trained Nurses Association of India (TNAI), Books of Fundamentals of Nursing (A Procedure Manual), page no.175-182. BIBLIOGRAPHY