Nursing care of patients undergoing blood transfusion

the presentation focuses on the management of clients undergoing blood transfusion and management of complications

1. BLOOD
TRANSFUSION
BY E.CHAULUKA

2. Objectives
•Identify common blood products
•List steps in blood administration
•Identify complications of blood administration
•Acute Transfusion Reactions
•*Transfusion reactions
•Circulatory overload
•Septicemia

3. TRANSFUSION
Infusion of blood products for the purpose of
restoring circulating volume.
Increases the blood’s oxygen carrying capacity
Reverses tissue hypoxia

4. Objectives of transfusion
Increase circulating blood volume after surgery,
trauma or haemorrhage
To increase the number of red blood cells and
aid haemoglobin maintenance
Provide cellular components as replacement
therapy

5. Further recommendations in the light of recent
research have shown that a closed system of
infusion is maintained whenever possible
This reduces the risk of extrinsic bacterial
contamination

6. Principles of blood
transfusions
Blood replacement or transfusion is the iv
administration of whole blood or blood product
such as plasma, packed red blood cells or
platelets.

7. Blood groups and types
The determination of blood groups is based on
the presence or absence of A and B red cell
antigen
The most important grouping for transfusion
purpose is the ABO system, which includes
A,B,O,AB blood types

8. The Rh factor
Other considerations when matching for blood
transfusions is the Rh factor, which is an
antigenic substance in the erythrocyte of most
people
A person with the factor is Rh positive and a
person without the factor is Rh negative

9. Types of Blood Components

Whole Blood
To replace blood volume and O2 carrying
capacity in
Treat hemorrhage and shock
Contains PRB’C, plasma proteins, clotting
factors and plasma
(few platelets & granulocytes)
Volume = 500ml/unit
__________________
**Packed Red cells (PRBCs)
Treat anemia, replace blood volume (ordered
when Hgb 8-9 & HCT 24-27)
1 unit PRBC = Hgb by 1/HCT by 3
From whole blood (2/3 of plasma removed)
Only RBCs used
Purpose: O2 carrying capacity in patients
with slow bleeding, anemia, leukemia,
surgery
Volume = 300-350ml/unit
Risks & Benefits
Possible incompatibility issues
Circulatory overload
**Deficient in some clotting factors
Rarely used
Use Lasix to prevent overload
________________
Risks & Benefits
Use leukocyte poor red cells or leukocyte
filter if history of febrile reaction
*No viable platelets or granulocytes
Incompatibility may cause hemolytic
reaction
Less chance of fluid overload than whole
blood
Takes 4-6 hours for Hgb & HCT to
change
Shelf life: 42 days
(takes 1 day to process)
Most commonly used!!

10. Types of Blood Components con’t
Platelets
Control or prevent bleeding in
platelet deficiencies, i.e.
thrombocytopenia-(ordered when
platelets count <10-20,000 - unless?
From whole fresh blood-
(plateletpharesis)

Expected platelet 10,000uL/U
Measure at 1hr & 18-24 hr post
admin
Volume = 30-60ml/unit
________________________
Albumin (plasma derivative)

Expand blood volume or replace
protein
Treat shock from trauma, infection,
3
rd
spacing, hypovolemia,
*hypoalbuminemia burns and in
surgery,
Available in 5% -25% solution
Paid donation
Volume 25g/100ml = 500ml of plasma
Risks & Benefits
Not a substitute for whole blood
May form antibodies
Hypersensitivity reaction
Use within 5 days of donation
Can keep at room temp depending
upon storage/collection
Risks & Benefits
Vascular overload
Hyperosmolar solution moves
water from extravascular space to
intravascular space
Outcome: adequate BP & volume
Hypersensitivity reaction
Can be stored for 5 years
 Albumin therapy
Platelet donations

11. Types of Blood Components cont
Frozen RBCs
Rarely used *
Successive washing with saline
removes most WBCs & plasma
proteins
________________________
Fresh Frozen Plasma (FFP)
Treat DIC, reverse effects of
Coumadin(warfarin), treat liver failure
pts
From liquid portion whole blood,
separated from cells > frozen
*Rich in clotting factors
Volume = 200-250ml/unit
Outcome- Improved coagulation, PT
& PTT (partial prothrombin time)
Risks and Benefits
- Store for 10 years/use within 24 hr
thawing
- Use within 24hrs of thawing
- *Atotransfusion; stockpiling or
rare donors for patients with
alloantibodies
___________________
Risks & Benefits
No platelets
Use for volume expansion to
restore clotting factors in
hypovolemic shock- being
replaced by albumin plasma
expanders. (from text)
Can store for 1 yr; *use within 2
hrs post thawing
Risk for vascular overload
/hypersensitivity reaction/
Hemolytic reactions

12. Blood transfusions
Transfusing blood or blood products is a
nursing procedure. The nurse is responsible
for the assessment before, during and after the
transfusion and for regulation of the
transfusion.
Assessment is critical because of the risk of
allergic reactions

13. To ensure that the right client receives the
correct type of blood or blood product a
thorough procedure is used to check the
identity of the blood or blood product, the
compatibility of the blood and the client
Two registered nurses must check the label
on the blood product against the clients
identification number, blood group and
complete name.
Guideline Checks

14. Because of the dangers of a reaction it is very
important to follow guidelines for the correct
policy of administration
The nurse must obtain the patients baseline
vital signs before the transfusion begins as this
allows the nurse to determine when changes in
vital signs occur, which indicates a transfusion
reaction occurring

15. The expiry date on the blood is also checked
Even if a minor discrepancy exists the blood
should not be given and blood bank notified
immediately
Initiation of the transfusion begins slowly to
allow for early detection of a reaction

16. The rate of transfusion is usually specified by
the doctor
Ideally a unit of whole blood or packed red
blood cells is transfused over 2-4hours.
Beyond 4 hours there is a risk of the blood
becoming contaminated

17. To calculate drip rates /
transfusion rates
To calculate the drip rate (drops / minute)
Drip Rate gtt = Volume to be infused (ml) x Drop Factor (gtt/ml)
min Time (minutes)
1 unit of blood is approximately 400ml in volume
E.g. A unit of blood is prescribed to run over 2 hours; The giving
set has a drop factor of 20 gtt /ml. What is the drip rate
(drops /min)?
(See next slide for answer and calculation)
The calculations used here are similar to those used for crystalloid
transfusions.

18. Example one – Calculate the
Transfusion rate
E.g. A unit of blood is prescribed to run over 4 hours; The giving
set has a drop factor of 20 gtt /ml. What is the drip rate
(drops /min) ?
Drip rate = 400 ml x 20 gtt ; Drip Rate is drops / minute
4 hour 1ml
Thus Drip Rate = 400ml x 20 gtt x 1 hour
4 hour 1 ml 60 minutes
By multidimensional analysis units are correct (drops / minute)
Drip Rate = 100 / 3 = 33 drops / minute
Drop rate is rounded up or down to the nearest drop
In the clinical setting to be able to count drops / minute it is
sensible to have a number divisable by 4 - Thus you would set
this drip at 32 drops per minute

19. Throughout the infusion the nurse monitors
periodically for side effects, and assesses vital
signs, and records all findings

20. A reaction to the blood will usually occur in the
first 15 mins. If a reaction is anticipated the
nurse will obtain vital signs more frequently
The rate of transfusion is usually specified by
the doctor

21. Ideally a unit of whole blood or packed red
blood cells is transfused over 2-4hours.
Beyond 4 hours there is a risk of the blood
becoming contaminated

22. Transfusion reactions and nursing
interventions
A transfusion reaction is a systemic response
by the body to incompatible blood
Blood transfusion reactions are life
threatening, but prompt nursing intervention
can maintain the clients physiological stability

23. If a blood reaction is suspected the nurse
stops the infusion immediately
The line is kept open by the infusion of 0.9%
saline solution
The doctor is informed immediately
The nurse remains with the patient
monitoring their vital signs as often as every 5
mins

24. The nurse prepares to administer emergency
drugs I.e. antihistamines/adrenaline etc and if
needed to perform CPR
The blood containers, giving set, labels, form
etc are retained and returned to blood bank
for further investigation

25. Summary
The nurse is responsible for the administration of
intravenous fluids by the methods listed. In order
to do this he/she requires a thorough knowledge
of the principles, and their application, and a
responsible attitude
The nurse must also be able to justify any actions
taken and be prepared to be accountable for the
action taken.