Blood Administration

Question 1

Benefits to Blood management

Answer 1

1. Improves patient outcomes
2. Lessens exposure to infection
3. Facilitates faster recovery
4. Decreases post operative infection rates

Question 2

Blood transfusion is?

Answer 2

the replacement of blood or blood components when O2 delivered to the tissue is compromised.

Question 3

blood and blood products are used to?

Answer 3

1. Improve or restore oxygen carrying capacity & tissue oxygenation
2. Restore blood volume lost d/t trauma, haemorrhage, surgery, and burns etc.
3. Correct red blood cell deficiency
4. Maintain or improve blood’s clotting ability

Question 4

Components of whole blood:

Answer 4

1. Concentrated Red Cells
2. White cells
3. Plasma (proteins, globulins, albumin)
4. Platelets

Question 5

Non Fractionated Blood Products

Answer 5

1. Red Blood Cells
2. Fresh Frozen Plasma
3. Platelets
4. Cryoprecipitate
5. Autologous Whole Blood- where the PTs whole blood is injected into places to help healing/clotting

Question 6

Fractionated Blood Products

Answer 6

1. Immune Globulin- antibodies Y
2. Albumin- in blood plasma. Proteins that reg blood vol
3. Factor Concentrations- clotting factors

Question 7

Albumin

Answer 7

> Red Blood Cells

> Fresh Frozen Plasma- fluid portion of blood. Contains components of : coagulating factors, oncotic pressure and modulate immunity

> Platelets- stop bleeding

> Cryoprecipitate- frozen blod product prepared from plasma. clotting factors

> Autologous Whole Blood- process where PTs own blood is injected into an area of the body for the purpose of healing

Question 8

Pentaspan

Answer 8

1. plasma expander
2. synthetic cornstarch derivative in saline solution
3. no risk of disease transmission
4. 1.5 x greater vol expander than albumin with longer duration of expansion

Question 9

blood group O

Answer 9

is a universal donor

Question 10

blood group AB

Answer 10

is a universal recipient

Question 11

Rh factor

Answer 11

> antigen D is an inherited antigen in the surface of RBCs
ppl with antigen D are Rh+
ppl without are Rh -
exposure to antigen D is necessary for production of Rh antibodies

Question 12

If the reciepient blood cell antigen is not compatible with the donor cell antigen,

Answer 12

a reaction called agglutinin (antibody)

> antibodies destroy or neutrilize antigens by clumping (agglutination) YYYyyYyY

Question 13

Massive blood transfusions

Answer 13

> PRBCs are deficient in clotting factors & platelets

> Calcium binds with preservatives in PRBCs

> For these reasons, FFP, platelets, calcium and cryoprecipitate are given to patients receiving massive blood transfusions.

> Rule of thumb – for every three units of PRBCs the patient is given 1 FFP and 1 bag of platelets

Question 14

General rule of thumb for blood and blood prod admin

Answer 14

> Written consent is required to administer non-fractionated blood products (2 nurses needed to check)

> RN, RPN, Physician & LPN may check fractionated blood products without a second person.

> No Medication may be added to the blood or infused through the same tubing.

Question 15

Transfusion reactions:

Answer 15

A systemic response to the administration of a blood product that is either incompatible with that of the recipient, contains allergens to which the recipient is sensitive or is contaminated with bacteria

Question 16

Most common occurance of transfusion reaction is d/t:

Answer 16

1. admin errors. incompatible blood

2. misidentification

Question 17

Types of blood transfusion reactions

Answer 17

1. Acute hemolytic - chills, rigors, dyspnoea, chest and/or flank pain, discomfort at infusion site, sense of dread, abnormal bleeding
2. Febrile, non hemolytic (most common) > 38 degress or 1 degree above baseline. Chills, rigors, increased respiratory rate, change in blood pressure, anxiety and a headache
3. Mild allergic- hives (urticarial), upper resp, N/V, abd pain
4. Anaphylactic- sudden onset of severe hypotension, cough, bronchospasm (respiratory distress and wheezing), laryngospasm, angioedema, urticaria, nausea, abdominal cramps, vomiting, diarrhoea, shock and loss of consciousness. This may be a fatal reaction.
5. Circulatory Overload- dyspnoea, orthopnea(SOB lying flat), cyanosis, tachycardia, increased blood pressure and pulmonary edema
6. Sepsis- high fever, rigors (shiver), hypotension, tachycardia, N/V,

Know your signs and symptoms associated with each type of transfusion reaction!!

Question 18

recognizing transfusion reactions

Answer 18

Rash, Pruritis

Headache, flushing, back pain, chest pain

Fever (oral T more than 38 and more than 1 degree rise above baseline)

Rigors, restlessness, anxiety, facial or tongue swelling, dizziness, nausea/vomitting

Heat/pain at IV site, hypertension, hypotension, tachycardia

Dyspnea, wheezing, hypoxia and oliguria

Question 19

Immediate interventions for transfusion reactions:

Answer 19

1. Stop transfusion & disconnect at site
2. Run 0.9% NS via new tubing
3. Verify pt’s ID band to blood product tag
4. Check VS and symptoms
5. Notify physician and transfusion services
6. Complete transfusion reaction form and any follow up investigation of the reaction

Question 20

a PT recieves a transfusion of RBCs that is their own which they donated prior to surgery

Answer 20

autologous blood transfusion

Question 21

Recieving a transfusion of RBCs from an anonymous donor

Answer 21

homologous donor

Question 22

determining the ABO and Rh compatibility of the donor and recipient prior to transfusion

Answer 22

a cross match

Question 23

a marker that identifies a cell as “self” or non-self”

Answer 23

an antigen

Question 24

a complex glycoprotein produced in response to the presence of an antigen

Answer 24

an antibody

Question 25

RBC, WBC, plasma, platelets, are:

Answer 25

a component of whole blood

Question 26

cryoprecipitate

Answer 26

is a component of plasma

Question 27

platelets are pooled from ____ donors

Answer 27

5

Question 28

Cryoprecipitate is obtained from:

Answer 28

FFP (fresh frozen plasma) rich in factor 8 (blood clotting protein) and fibrinogen

Question 29

ppl with antigen D are:

Answer 29

Rh +

Question 30

ppl with O type can recieve

Answer 30

only O

Question 31

if you have antibodies AB in your plasma then

Answer 31

you have type O

Question 32

if you have no antibodies in your plasma then

Answer 32

you have type AB

Question 33

why is O the universal donor?

Answer 33

bc they do not have AB antigents

Question 34

when do we use blood and blood products?

Answer 34

to improve PT outcomes, lessen their chance of post-op infections, and optimize recovery time.

Question 35

when would we choose to use albumin over PRBCs?

Answer 35

when the PT has CHF and is at risk for fluid overload and thier hemoglobin is high enough to support their O2 carrying capability

Question 36

admin of blood and blood products is done for what purpose?

Answer 36

to restore circulating blood vol, improve O2 carrying capacity, and replace clotting factors

Question 37

25% albumin in hyperoncotic (osmotic pressure) - if you give 100mls, then what would you expect to happen to your PTs extravascular fluid

Answer 37

it will pull aprox 300mls of fluid from the extravascular

Question 38

name two types of transfusion reactions you need to watch for

Answer 38

1. Allergic 2. Febrile 3. circulatory overload 4. hemolytic reaction 5. TRALI- transfusion related acute lung injury

Question 39

admin of incompatible blood or a rare antibody causes a hemodynamic blood reaction. name 4 signs and symp which indicate a hemodynamic blood reaction

Answer 39

1. ha 2. flushing 3. lumbar pain 4. pain 5. chills 6. fever 7. burning sensation 8. sensation along vein 9. angina like chest pain

Question 40

Allergic reaction are more common d/t the presence of some protein in donor blood that is foreign to the recipient and to which the recipient is allergic. What are 2 S and S of allergic reaction?

Answer 40

1. Urticarcia- hives 2. elevated temp 3. pruritits 4. ha 5. epigas pain 6. nausea

Question 41

why would your PT experience circulatory overload and what would be the S and S?

Answer 41

from rapid admin for large amounts of blood product especially in the elderly and infants s and s- chest tight, dry cough, engorged neck muscles, dyspnea, pulm edema, frothy pink sputum, tachycardia and hypertension

Question 42

what are two common reasons for transfusion reaction?

Answer 42

incorrect PT | admin of incompat blood

Question 43

Steps of blood admin

Answer 43

> verify doc order- amount and type. date, pre and post med orders r/t transfusion > be sure informed consent > obtain pt transfusion hx > inform PT of tx and rationale > obtain aprop expipment > ensure IV acess with NS is running in primary line. ensure that IV needle canula is 18-20 gauge > ensure any necessary PT prep. has the PT peed prior, pain manage? > obtain blood from Transfusion Service (TS) - - bring doc identifying PT and prod required (doc orders...) - - verify info on blood bag tag with info TS personnel** **If blood not initiated within 30 min it has to be returned to TS > obtain vitals, temp, immediate bfr trans. > varify if non-factionated blood and blood products by 2 qualified personelle (doc, RN, LPN, Perfusionist) AT THE BEDSIDE (all frac blood products are to be verifies by one qualified person), IN PTs PRESENCE - - confirm product serial number and ABO/Rh from the identification label on the product matches the blood product tag. - - visual inspect the blood for color, clump. leak > verify PT ID with the blood prod by 2 qualified personnel AT THE BEDSIDE, IN THE PT PRESENCE. - - have PT spell first and last name if poss and DOB to confirm with ID band - - read aloud and spell PTs full name and PTs hosp number from the Id band. ensure identical to blood product tag > doc info on the FHA blood prod admin record > admin the blood product a) gently rotate bag several times and insert spike of blood admin set and prime b) ensure filter is completely covered with product to maximize effeciency of filter c) remove primary IV set and connect blood tubing to PT. Open roller clamp and adjust the flow rate to infuse slowly; maximum of 25ml in the first 15min (100ml/hr). d) document start time on blood prod admin record > assess - - remain with the PT for a full 5 min to observe SE. - - check vitals, 15 after initiating transfusion and hrly throughout transfusion. > adjust flow rate so that blood flows no longer than 4 hrs. but 2 hrs is more ideal > upon completion of transfusion, a) clear blood admin set with a max of 50mls NS b) obtain PTs vital signs c) disconnect blood admin set and attach ordered IV tubing/bag > remove and complete blood prod tag and return to TS > discard the blood bag in apporp biohazard container unless the PT has had a transfusion reaction. If reaction, then all gear ahd to go to TS > doc the completion of admin on the following: a) blood prod admin record b) blood prod tag c) fluid balance sheet - -> date and time - -> type and amount of blood prod. If no vol, record vol as 350mls for RBC and 200mls for plasma d) nurses notes- baseline vitals, transfusion start ,and completion time, observations throughout, completion vital signs e) clinical record - - vital signs, temp > assess vital signs for delayed transfusion reaction q4h x 24 hrs