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Administration of Blood and Blood Products

Administration of Blood and Blood Products. PN 3 November 2005. Donation and Deferrals. http://www.pbs.org/wnet/redgold/index.htm www.bloodservices.ca. Transfusions. Typing and Cross Matching. To determine if blood of donor is compatible with blood or recipient

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Administration of Blood and Blood Products

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  1. Administration of Blood and Blood Products PN 3 November 2005

  2. Donation and Deferrals • http://www.pbs.org/wnet/redgold/index.htm • www.bloodservices.ca

  3. Transfusions

  4. Typing and Cross Matching • To determine if blood of donor is compatible with blood or recipient • If incompatible may result in “clumping” or agglutination and hemolysis of recipients blood cells. This may result in death. • Typing determines blood type(A, B, AB, O) • Cross match determines compatibility

  5. Blood group AIf you belong to the blood group A, you have A antigens on the surface of your red blood cells and B antibodies in your blood plasma. Blood group BIf you belong to the blood group B, you have B antigens on the surface of your red blood cells and A antibodies in your blood plasma. Blood group ABIf you belong to the blood group AB, you have both A and B antigens on the surface of your red blood cells and no A or B antibodies at all in your blood plasma Blood group 0If you belong to the blood group 0 (null), you have neither A or B antigens on the surface of your red blood cells but you have both A and B antibodies in your blood plasma

  6. Agglutinin • An antibody that causes a “clumping” of specific antigens • Type A have an A antigen, type B have a B antigen, AB have both A and B antigens; type O have neither A or B • A types have agglutinin for B; B have Agglutinin for A, AB have none and O has A and B agglutinins

  7. Rh Factor • Inherited antigen in human blood • There are 5 but we concern ourselves with the one identified as “D” • A person who is identified as having “D” is called Rh positive • Rh negative recipient must receive negative blood • If the receive positive blood future tx may cause death

  8. Types of Transfusions • Whole Blood • Red blood cells • Platelets • Plasma • Cryoprecipitate

  9. Pre-Transfusion • Agency policy • Consent • Hx of previous transfusion • What symptoms do you want pt to report

  10. Initiating the transfusion • IV with large bore needle • Blood tubing primed with 0.9% NaCl • Blood filter • Baseline vital • Have pt. comfortable, i.e. go to bathroom

  11. During the Transfusion • Blood not initiated within 30 mins returned to lab • Infused no longer than 4 hours • All info on pt and blood must be exactly the same • Check vital signs q5 mins x 3 and then q15 mins x 4 then hourly

  12. Transfusion Reactions • Listen to the pts complaints • Check vitals, observe the patient Types of Reactions: Hemolytic Allergic Febrile Bacterial Circ overload

  13. Hemolytic • Blood type or Rh incompatibility • Destruction of cells and inflammatory response • Maybe immediate or at next transfusion • Mild with fever and chills or life threatening • Apprehension, HA, chest pain, low back pain, Tachycardia, Tachypnea, Hypotension, hemoglobinuria, impending doom

  14. Allergic • Clients with a history of allergy • Uticaria, itching, bronchospasm, anaphylaxis. • Occurs during and up to 24 hours after • Sometimes given washed RBC to remove WBC and plasma

  15. Febrile • Occurs after multiple transfusions • Develop anti WBC antibodies • Give WBC reduced blood (filter, washed) • S and S: chills, tachycardia, fever, hypotension, tachypnea

  16. Bacterial • Contaminated blood transfusion • Gram negative because these grow fast in blood • S and S: tachycardia, hypotension, fever, chills, shock • Onset is rapid

  17. Circulatory Overload • Blood infused to quickly • Whole blood or multiple infusions • Older adults are most at risk • S and S, hypertension, bounding pulse, distended jugular veins, dyspnea, restlessness, confusion. • Manage and prevent by monitoring I & O; infusing slowly, diuretics, chest assessment!

  18. Transfusion-Associated Graft-versus-Host Disease • Rare but life-threatening • Immune suppressed individuals • 90% mortality rate • Thrombocytopenia, anorexia, nausea, vomiting, chronin hep, wt loss, recurrent infections. • Occurs 1-2 weeks

  19. Incidentals • Blood warmers • Pumps and pressure bags • Dilutents and concurrent fluid and meds

  20. RPN Responsibility • Pick up blood from blood bank • Prime blood tubing • Confirm client identity with other Registered Nurses (not another RPN) • Independent double check of all ID • Re-verify the MD order and concent • Time the transfusion • WATCH and ASSESS the patient • Documentation

  21. What not to Do X

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