Administering Blood and Blood Products Readings
Required Readings:
Read Potter & Perry, pp. 1242-1244
Read Clinical Procedures, 5.11 Blood Transfusion Management, pp. 230-237
Recommended:
Delmar CAIs: Intermediate, Blood Transfusion, Transfusion Reactions
Mastering Clinical Skills CAIs in lab: Blood Administration or Platelet Administration
Video: "Administering Blood & Blood Components", NV #278
Review INS Standards
Potter & Perry, pp. 1242-1244
Clinical Procedures, 5.11 Blood Transfusion Management, pp 230-237
Review INS Standards #28 Transfusion Reaction, #43.VI Blood Administration Sets,
#44.III Blood Filter, #46 Blood Warmer, # 42, Latex Allergy/Sensitivity
Kim, K.T., etal. (1998). Implementation recommendations for making health care facilities latex safe. AORN Journal, 67 (3), 615-632.
Kim, K.T., etal. (1999). All gloves are not created equal. Surgical Services Management. July 5(7): 29-32.
Latex allergy:
Warshaw, E.M. (2003). Latex allergy. SKINmed. 2(6):359-366. www.medscape.com/viewarticle/464479
http://www.dermadoctor.com/pages/newsletter52.asp?AID=1067 http://www.immune.com/rubber/
http://www.latexallergyresources.org/ http://latexallergylinks.tripod.com/
http://www.nurseweek.com/features/96-12/latex.html http://www.osha.gov/SLTC/latexallergy/
Administration of Blood & Blood Products
Blood Products
Whole blood
Leukocyte-poor RBC
Fresh frozen plasma (FFP)
packed RBC’s
platelets
5% or 25% albumen
Factor VIII & Factor IV
Cryoprecipitate
Sources of Blood
Homologous
Autotransfusion
Autologous
Indications
Anemia
To increase circulating blood
post surgery
post trauma
hemmorhage
Type and CrossMatch
Type A
has A antigens
has B antibodies
Type B
Type AB
universal recipient, no antibodies
Type O
universal donor
Rh factor
85% Rh positive
antigenic substance in RBCs
If Rh neg receives Rh +
RBC destruction
hemolysys
anemia
Mom Rh-/baby Rh+
problem, next time
Assessments - What
Vital signs (before, during, after)
Skin color/condition
Breath sounds
IV site
I & O
JVD
Lab values (before and after)
Make sure you have patent IV
Check before you go for blood
Patency
Size of vein
Gauge
14 – 23 gauge
small–half pack
large–more turbulence/damage
Timing is everything
20-30 min. from lab to hanging
4 hours from lab until finished
Don’t let it out of sight
Second nurse double check
Any questions, take it back
Hanging blood
Y-tubing with NS
Dilute blood
Filter
Rid debris or dead,clotting cells
Monitor Lab Values
Potassium levels
increase in K+ in stored blood
destruction of RBC
20 - 30% RBC gone after 21 days
Calcium
decrease in Ca
combines with citrate
Iron
increases with hemosiderosis
Refer to Potter & Perry, pages 1242
Blood groups & types
What kinds of problems or reactions could occur with blood transfusion?
Most serious occur during first 50 ml, so no faster than 1-2 cc/min x 15 min, RN stay with client, frequent VS
If reaction
Stop blood
Maintain IV site with new tubing with bag of NS (save 2 hrs p D/C)
Take vital signs
Notify primary care provider
Send blood, tubing, UA, blood sample to lab
Monitor I & O
Documentation
Time infusion started and completed
Amount and type infused
Client response to blood therapy
I & O
All vital signs