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Welcome to learning plan 4: Blood administration.
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In this learning plan we will be discussing blood components, blood transfusion, potential reactions, and nursing interventions related to blood administration.
The Food and Drug Administration has progressively strengthened safeguards that protect patients from unsuitable blood and blood products.
Blood donors are now asked specific and very direct questions about risk factors that could indicate possible infection with a transmissible disease.
The "up front" screening eliminates approximately ninety percent of unsuitable donors.
The FDA requires blood centers to maintain lists of unsuitable donors to prevent the use of collections from them.
In addition to these safeguards the FDA has significantly increased its oversight of the blood industry.
The FDA inspects all blood facilities at least every two years.
While a blood supply with zero risk of transmitting infectious disease may not be possible, the blood supply is safer than it has ever been.
Blood donations are tested for seven different infectious agents.
Chagas disease is a serious often fatal disease caused by a parasite.
The agent is endemic in the Americas but most commonly occurs in Latin America.
Hepatitis B is caused by the Hepatitis B virus.
It is spread through contact with blood and body fluids of an infected person.
It is a virus that affects the liver.
Hepatitis C is caused by the Hepatitis C virus, it is spread by contact with an infected person's blood.
Hepatitis C is a disease caused by a virus that also affects the liver.
In time it can lead to permanent liver damage as well as cirrhosis liver cancer and liver failure.
Human immunodeficiency virus or *** is caused by the *** virus.
After *** is in the body it attacks and destroys the CD4+ cells which are part of the body's immune system that fights infection and disease.
When *** weakens or destroys the immune system it may lead to certain illnesses or diseases such as some types of pneumonia or cancer that are more likely to develop in someone who is a weakened immune system.
These conditions are sign that *** has progressed to AIDS.
HTLV1 is a human type C retrovirus that has been associated with neoplastic conditions and a variety of demyelinating disorders and also is a virus link to leukemia.
Transmission of HTLV1 is believed to occur by *** contact, from mother to child via breastfeeding, and through exposure to contaminated blood either through blood transfusion or sharing of contaminated needles.
Syphilis is a highly contagious disease spread primarily by *** activity.
It can be transmitted through blood products.
Syphilis was once a major public health threat commonly causing serious long-term health problems such as arthritis, brain damage, and blindness.
West Nile Virus is a flavivirus commonly found in Africa, West Asia, and the Middle East that is most commonly transmitted to humans through mosquito bites.
It was first introduced in the United Sates in 1999 and reached epidemic proportions in 2002.
Most people infected with West Nile Virus do not have symptoms.
Others have mild symptoms and in rare cases infection can lead to inflammation of the brain and spinal cord.
The number one reason donors say they give blood is because they "want to help others".
Two most common reasons cited by people who don't give blood are "they never thought about it" and "they don't like needles".
One pint of blood can save up to three lives.
An homologous donor is a volunteer donor and a autologous donor is a donor to self.
The blood type most often requested is Type O. Type O negative blood can be transfused to patients of all blood types.
Type AB positive plasma can be transfused to patients of all other blood type.
AB plasma is usually in short supply.
The average adult has about ten pints of blood in his body. Roughly one pint is given during a donation.
There are four types of transfusable products that can be derived from blood: red cells, platelets, plasma, and cryoprecipitate.
Typically two or three of these are produced from a pint of donated whole blood.
Hence each donation can help save up to three lives.
Donors can either give whole blood or specific blood components only.
This process of donating specific blood components: red cells plasma or platelets is called apheresis.
Healthy bone marrow makes a constant supply of red cells plasma and platelets. The body will replenish the elements given during a blood donation some in a matter of hours and others in a matter of weeks.
A lab test which is extremely important to you to understand is the Complete Blood Count. The Complete Blood Count is one of the most frequently ordered screening tests and is a tool used to evaluate anemia.
The primary care provider will order this test to evaluate the clients overall condition.
The components of the complete blood count or CBC include the red blood cells, hematocrit, hemoglobin, the red blood cell index, white blood cells with differential, and platelets.
The RBC or erythrocyte count determines the total number of erythroctes in a cubic millimeter of blood.
The hematocrit indirectly measures the RBC mass.
Hematocrit results are expressed as a percentage by volume of packed red blood cells and whole blood.
The normal reference range is 36% - 48% in women and 42%-52% in men.
The hemoglobin is a protein molecule which enables the RBC to transport oxygen and carbon dioxide.
The normal hemoglobin for men ranges from 14-17 g/dl. For womens its 12-16g/dl.
The same conditions that raise some lower hemoglobin values also raise and lower hematocrit.
Causes of decreased hemoglobin & hematocrit or H & H are anemia, acute or chronic hemorrhage, and liver disease.
Causes of increased H & H include chronic obstructive pulmonary disease and polycythemia vera.
The RBC indexes have four components which are used to determine the type of anemia a patient has.
The WBC's help to fight infection.
The normal reference value for a WBC count in adults is 4,500-10,000 cells/mm
Causes of increased WBC count include acute infections and tissue necrosis.
Causes of decreased WBC count include overwhelming bacterial infections, bone marrow depression, and pernicious anemia.
Platelets are essential for normal coagulation.
A value of 140,000-400,000 cells/mm is normal for adults.
Causes of high platelet count include renal failure, malignancies, and chronic pancreatitis.
Causes of low platelet count include disseminated intravascular coagulation, hemolytic anemia, and bone marrow malignancies.
Many drugs including heparin and aspirin can affect the platelet count.
The following are blood products which may be transfused: whole blood which has a volume of 400-500ml.
It is rarely used except in circumstances of severe hemorrhage.
However before elective surgery many patients give autologous donations of whole blood to be returned to them if necessary.
Packed red blood cells or PRBC is the standard unit of blood. It is obtained from removing the fluid portion or plasma from the cellular constituents.
One unit of packed red blood cells contain between 225-350ml.
Packed red blood cells substantially increase the recipients oxygen carrying capacity.
You can expect one unit of blood to raise the hemoglobin 1 g/dl and the hematocrit 3%.
It is given for patients with anemia.
Platelets are given to assist in clotting.
They are infused as fast as the patient can tolerate to diminish platelet clumping during administration.
Fresh frozen plasma is approximately 250ml and must be ABO compatible.
Fresh Frozen plasma is ordered to reverse warfarin therapy, in patients with life-threatening bleeding, or those undergoing emergency surgery.
It is administered at 200ml/hr.
Cryoprecipitate is used mainly as replacements for fibrinogen.
It is given IV push over three minutes.
Albumin is used as a volume expander.
Albumin expands the intravascular space by pulling fluid from the interstitial spaces. Albumin is a water soluble protein.
You will need the following equipment to administer a blood transfusion.
Y tubing. This type of administration set has a filter on it and allows you to hang normal saline along side with blood.
Normal saline is the only solution compatible with blood.
Solutions with dextrose may lead to clumping of red blood cells and hemolysis.
Most facilities will use new tubing with each unit of blood.
Ideally the blood transfusion should infuse over two and a half to three hours.
To avoid bacterial growth you should never allow packed red blood cells to hang more than four hours.
You should begin the blood transfusion within thirty minutes of obtaining the blood on your unit so it's very important you do the following before you request the blood to be released from the blood bank.
Make the client has had a type and cross match.
Blood type and cross match are done to make certain that a person who needs a transfusion will receive blood that compatible with his own.
People must receive blood of the same blood type otherwise a serious, even fatal transfusion reactions can occur.
If the client needs to receive blood products in an emergency situation there may not be enough time to complete the type and cross match.
In such cases type O is the universal donor meaning this blood type is safe for almost everyone.
The client will also need to give informed consent for a blood transfusion.
You will want to make sure that the client has a patent IV line that's functioning properly.
You also want to make sure when using a peripheral line that it is a minimum of 20-22 gauge needle. Any smaller could cause occlusions or slow the infusion.
Obtain a Y-type administration set and sodium chloride. Sodium chloride is the only solution which should be used with blood administration.
And lastly obtain and document a full side of pre-transfusion vital signs.
This will give you baseline information for comparison during transfusion.
After you have completed these steps you will be ready to request the blood to be released from the blood bank.
After the blood has been delivered it must be verified with two licensed nurses.
The verification process has two steps.
The first step in that both nurses should make sure the information found on the tag attached to the blood matches the information on the patients wristband which includes validating the patient first and last name, type and cross match number, identification number, and date of birth.
The second part is to check the tag attached to the blood with the label affixed to the blood.
This will include the unit number, blood group/ RH, blood product and expiration date.
DON'T hang the blood if any differences are found during any part of the verification.
STOP and notify the blood bank.
If you verify with another nurse that everything matches then both of you should sign the appropriate areas to indicate positive verification.
You are now ready to hang the blood.
The RN is responsible for the safety of the client during all aspects of blood transfusion therapy and assumes all accountability.
The RN is expected to continually assess, evaluate, and document the clients responses in the period proceeding administration, throughout administration as it is discontinued, and during the post transfusion period.
When initiating a blood transfusion start SLOWLY. No more than 25-50 ml/hr for the first fifteen minutes.
Transfusion reactions typically occur during this period and a slow rate will minimize the volume of red blood cells infused.
During the fifteen minute observation period the RN must stay with the client and observe for flushing, dyspnea, itching, hives, or rash or any unusual comments from the client.
If no adverse effects occur during this time the infusion rate can be increased so the transfusion will be complete within four hours.
The vital signs should be taken at fifteen minutes and then according to facility policy, usually every hour until the infusion is complete.
Blood transfusion reactions typically occur when the recipien'st immune system launches a response against blood cells or other components of the transfused product.
These reactions may occur within the first few minutes of transfusion classified as an acute reaction or may develop hours to days later: a delayed reaction.
If red blood cells are destroyed the reaction is called a hemolytic reaction.
The following table lists common transfusion reactions along with signs and symptoms to observe for.
When a client develops an allergic reaction you will see hives, itching, or a rash.
Encourage the client and family to notify you if they develop any of these symptoms.
It is important to monitor the client's vital signs during a blood transfusion to alert for signs of blood transfusion reaction.
Antipyretics are sometimes given pre-transfusion to prevent a febrile type of reaction.
A hemolytic reaction occurs when there is blood incompatability and has an immediate onset.
The client may have facial flushing, fever, chills, headache, low back pain, tachycardia, hypotension, and signs of shock.
Circulatory overload happens when too many fluids are administered in too short a period time.
An early sign of circulatory overload is crackles present in the client's lungs.
It is important to monitor the clients lung sounds for crackles, dyspnea, and assess for neck vein distention.
In order to prevent a bacterial infection the blood should be administered within four hours.
Analphylaxis is a life threatening type of allergic reaction. It is a severe whole body reaction. Tissues in different parts of the body release histamine and other substances which causes the airways to tighten.
Some signs of analphylaxis include: arrthymias, pulmonary edema, hives, low blood pressure, mental confusion, rapid pulse swelling in the throat, weakness, and wheezing.
During the transfusion, stay alert for signs and symptoms of a reaction.
When a reaction occurs immediately stop the transfusion and change the IV tubing.
Keep the IV line open with normal saline.
Notify the primary care provider and blood bank.
Intervene for signs and symptoms as appropriate.
The primary care provider may order and antihistamines, antibiotics, steroids, or diuretics depending on your clients symptoms.
Continue to monitor the client's vital signs.
Lastly return the blood products including the blood tubing to the blood bank and collect laboratory samples per facility policy.
Carefully document transfusion related events.
Blood transfusions are a life-sustaining and life-saving treatment but they aren't without risk.
To help prevent immunological transfusion reactions the primary care provider may order such medications as acetaminophen and diphenhydramine before the transfusion begins to prevent fever and histamine release.
Most fatal transfusion reactions result from human error.
The most important step in preventing error is to know and follow your facilities policies and procedures for administering blood products which include verification of the blood prior to administration.
Be aware though that prevention isn't always possible which means you must be able to anticipate potential reactions and be prepared to manage them effectively.
This concludes learning plan 4 on blood transfusion.