Administering Blood and Blood Products Readings

Required Readings:

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

Ref. Potter & Perry, pp 1244–1245
Clinical Procedures book, page 243
Transfusion reactions

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