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this document tackles: DEFINITION OF BLOOD PORTIONS OF THE BLOOD ETIOLOGY OF BLOOD CELL UNDERSTANDING BLOOD TRANSFUSION THERAPY ELIGIBLE & INELIGIBLE FOR BLOOD DONATION BLOOD CLOTTING FACTORS NURSE’S RESPONSIBILITY TRANSFUSION PRECAUTIONS DOCUMENTATION BLOOD PRODUCTS BLOOD TRANSFUSION TRANSFUSION REACTIONS
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Course Outline DEFINITION OF BLOOD PORTIONS OF THE BLOOD ETIOLOGY OF BLOOD CELL UNDERSTANDING BLOOD TRANSFUSION THERAPY ELIGIBLE & INELIGIBLE TO BLOOD DONATION BLOOD CLOTTING FACTORS NURSE’S RESPONSIBILITY TRANSFUSION PRECAUTIONS DOCUMENTATION BLOOD PRODUCTS BLOOD TRANSFUSION TRANSFUSION REACTIONS
mechanism T – transports hormones R – removes waste products R – regulates body temperature P – protects the body P – promotes hemostasis S – supplies oxygen
Blood is composed of 55% of plasma and 45% cellular components. The body contains 10-12 pints (5-6 L) of blood, your whole blood donation approximately 1 pint or equivalent to 450 - 500 ml. Plasma is the main component of blood and consists mostly of water with CHON, ions, nutrients, lipids, glucose, and salt mixed in. Platelets is a blood cell that is responsible for blood clotting. It stops the bleeding and promote blood clotting. White blood cells are cells that play a major role in defense in microorganisms, so they fight viruses, bacteria, and other foreign invaders that threaten your health. Red blood cells are responsible for carrying and transportation of oxygen and carbon dioxide. Erythropoietin is a hormone that is produced by the kidneys when oxygen levels in the blood are low. It acts in bone marrow to stimulate the production of mature red blood cells, to maintain healthy oxygen levels in our tissues.
Blood cells do not originate in the bloodstream itself but in specific blood-forming organs, notably the marrow of certain bones. In the human adult, the bone marrow produces all the red blood cells. The lymphatic tissues, particularly the thymus, the spleen, and the lymph nodes, produce the lymphocytes. And then, the reticuloendothelial tissues of the spleen, liver, lymph nodes, and other organs produce the monocytes.
▪ The infusion of whole blood or blood component into the patient’s venous circulation. ▪ Lifesaving therapy for patients with medical or surgical conditions that need blood. ▪ RA 7719 [National Blood Services Act of 1994] – an act of promoting voluntary blood donation. ▪ The volume of fluids will adjust within a few hours after your donation. The RBC will be replaced within a few weeks. ▪ The minimum interval between 2 donations is 12 weeks or 3 months. Indications of blood transfusion: (a) Hemorrhage caused by trauma (b) High blood loss surgery (c) Hemolysis (d) Anemia Purposes: To restore and maintain blood volume. To improve the oxygen-carrying capacity of the blood. To replace deficient blood components.
▪ Eligible donors must: 18 and above Weigh at least 110lb Skin disease free Not donated in the past 56 days Hgb level is at least 12.5g/dl [women] or 13.5g/dl [men] Normal VS
Blood volume collected will depend mainly on your body weight. ▪ Ineligible donors include: HIV, AIDS, STD Took illegal drugs Had sex with prostitutes in the past 12 months Had sex with anyone above categories Pregnant Hepatitis B/C Certain types of cancer Hemophilia Who have receive clotting factor concentration Chronic alcoholism Body piercing and tattooing
I Fibrinogen II Prothrombin III Thromboplastin IV Calcium V Proaccelerin VII Proconvertin (stable factor) VIII Antihemophilic Factor A IX Antihemophilic Factor B X Stuart-Prower Factor XI Plasma thromblastin antecedent XII Hageman factor XIII Fibrin stabilizing factor
Assure that informed consent has been obtained prior starting transfusion. Patient education regarding benefits, risks, alternatives to transfusion [iron/ ESAs] RESPONSIBILITIES: Check blood or blood components have been typed & cross-matched for compatibility. Two nurses verify the blood type, Rh factor, serial number, extraction date and expiration date. Don’t administer blood without warming it. Obtain VS before and 15 minutes after transfusion. Always have an isotonic solution set up as a primary line along with the transfusion. Maintain standard precaution in handling blood or IV equipment Inform the client or assure them that risk for AIDS is minimal because the blood is screened. Gently suspend the RBC within the plasma Observe signs of hemolytic reaction that generally occurs within first 10-15 minutes. Shivering, headache, low back pain, increased RR & PR, hemoglobinuria, oliguria, and hypotension Observe signs of febrile reaction that usually occurs withing 30 minutes Shaking, headache, elevated temperature, back pain, confusion, and hematemesis. Act promptly if the patient develops bronchospasm and wheezing. This may indicate allergic reaction or anaphylaxis. INTERVENTIONS PRIOR BLOOD TRANSFUSION ✓ Proper cross-matching of donor’s and recipient’s blood to assure compatibility. ✓ After receiving delivery from blood bank, check if you receive both the product and the transfusion record that corresponds to it. ✓ Inspect the label, integrity of unit, and the appearance. SAFETY PRECAUTIONS ❖ PPE ❖ Hand hygiene or hand washing. ❖ If possible, use needleless system. ❖ Do not recap the needle. ❖ Observe proper waste disposal. ❖ Don’t touch blood with bare hands. ❖ Secure blood bag. ❖ Always double or triple check. ❖ Perform disinfection technique.
1 Don’t add medications to the blood. 2 Don’t transfuse if you suspect or discover discrepancy in blood number, blood type or pt identification number. 3 Don’t piggyback blood into the port of an existing infusion set.
□ Date and time of transfusion was started and completed. □ Name of HCW who verified information of the patient and the blood. □ Type of catheter and gauge. □ Total amount of transfusion. □ Pt vital signs before and after transfusion
✓ Observe for blood transfusion reactions.
➢ Reaction of the body to transfusion of blood that’s not compatible with its own blood. ➢ Usually attributed to major antigen-antibody reactions. ➢ Acute transfusion reactions usually appear within the first 5 to 15 minutes after transfusion started. WHEN BT REACTION OCCURS… SPIN S – stop the infusion P- pulse and other vital signs assessment I – infuse NSS N – notify the physician TRANSFUSION REACTION MANAGEMENT (i) Hemolytic Nursing Interventions: keep track BP, treat shock as indicated [IVF, O2, epinephrine, diuretic, and vasopressor]. Obtain post transfusion reaction, blood and urine sample for evaluation. Observe signs of hemorrhage resulting from DIC Prevention: Before transfusion, check donor & recipient blood types to ensure compatibility. Identify pt with another nurse or doctor present. Transfuse the blood slowly for the first 15 to 20 minutes closely observe the patient for the first 30 minutes of the transfusion. (ii) Febrile Nursing Interventions: Administer antipyretic, antihistamine or meperidine. Prevention: premedicate with an antipyretic, antihistamine or steroid. Use leukocyte-poor or washed RBCs. Use leukocyte-poor removal filter specific to the component. (iii) Allergic Reaction Nursing Interventions: administer antihistamines Prevention: premedicate with antihistamine if pt has hx of allergic reactions. Observe pt closely for the first 30 minutes of the transfusion. (iv) Plasma Protein Incompatibility Nursing Interventions: treat shock by administering O2, fluids, epinephrine, or steroid as ordered. Prevention: transfuse only IgA-deficient blood or well washed RBCs. (v) Bacterial Contamination Nursing Interventions: broad-spectrum antibiotics and steroids treatment. Prevention: inspect blood prior transfusion for gas, clot, & dark purple color. Use air free, touch-free methods to draw & deliver blood. Maintain strict storage control. Change the blood tubing and filter q4h. Infuse each unit of blood over 2 - 4hrs; terminate the infusion if the time period exceeds 4hours. Maintain sterile technique when administering blood products. (vi) Circulation Overload Nursing Interventions: stop infusion and maintain IV with NSS. Administer O2 while the head is elevated. Administer diuretics as ordered by the physician. Prevention: transfuse blood slowly. Don’t exceed 2 units in 4 hours; less for elderly, infants or pt with cardiac conditions.