Blood transfusion (BT) therapy involves transfusing whole blood or blood components (specific portion or fraction of blood lacking in patient). Learn the concepts behind blood transfusion therapy and the nursing management and interventions before, during and after the therapy. Show
Advantages
PrinciplesWhole blood transfusion Generally indicated only for patients who need both increased oxygen-carrying capacity and restoration of blood volume when there is no time to prepare or obtain the specific blood components needed. Packed RBCs Should be transfused over 2 to 3 hours; if patient cannot tolerate volume over a maximum of 4 hours, it may be necessary for the blood bank to divide a unit into smaller volumes, providing proper refrigeration of remaining blood until needed. One unit of packed red cells should raise hemoglobin approximately 1%, hemactocrit 3%. Platelets Administer as rapidly as tolerated (usually 4 units every 30 to 60 minutes). Each unit of platelets should raise the recipient’s platelet count by 6000 to 10,000/mm3: however, poor incremental increases occur with alloimmunization from previous transfusions, bleeding, fever, infection, autoimmune destruction, and hypertension. Granulocytes May be beneficial in selected population of infected, severely granulocytopenic patients (less than 500/mm3) not responding to antibiotic therapy and who are expected to experienced prolonged suppressed granulocyte production. Plasma Because plasma carries a risk of hepatitis equal to that of whole blood, if only volume expansion is required, other colloids (e.g., albumin) or electrolyte solutions (e.g., Ringer’s lactate) are preferred. Fresh frozen plasma should be administered as rapidly as tolerated because coagulation factors become unstable after thawing. Albumin Indicated to expand to blood volume of patients in hypovolemic shock and to elevate level of circulating albumin in patients with hypoalbuminemia. The large protein molecule is a major contributor to plasma oncotic pressure. Cryoprecipitate Indicated for treatment of hemophilia A, Von Willebrand’s disease, disseminated intravascular coagulation (DIC), and uremic bleeding. Factor IX concentrate Indicated for treatment of hemophilia B; carries a high risk of hepatitis because it requires pooling from many donors. Factor VIII concentrate Indicated for treatment of hemophilia A; heat-treated product decreases the risk of hepatitis and HIV transmission. Prothrombin complex Indicated in congenital or acquired deficiencies of these factors. Blood Components
Objectives
Nursing Interventions
Complications1. Allergic Reaction – it is caused by sensitivity to plasma protein of donor antibody, which reacts with recipient antigen. Assess for:
2. Febrile, Non-Hemolytic – it is caused by hypersensitivity to donor white cells, platelets or plasma proteins. This is the most symptomatic complication of blood transfusion Assess for:
3. Septic Reaction – it is caused by the transfusion of blood or components contaminated with bacteria. Assess for:
4. Circulatory Overload – it is caused by administration of blood volume at a rate greater than the circulatory system can accommodate. Assess for:
5. Hemolytic reaction – it is caused by infusion of incompatible blood products. Assess for:
Assessment findings
Nursing Diagnosis
Planning and ImplementationHelp prevent transfusion reaction by:
On detecting any signs or symptoms of reaction:
Intervene as appropriate to address symptoms of the specific reaction:
Nursing Interventions
Evaluation
What should you do first before you administer blood transfusion?Before the Transfusion. Find current type and crossmatch. Take a blood sample, which will last up to 72 hours. ... . Obtain informed consent and health history. Discuss the procedure with your patient. ... . Obtain large bore IV access. ... . Assemble supplies. ... . Obtain baseline vital signs. ... . Obtain blood from blood bank.. Which action should be performed by the nurse during the administration of platelets to a client?The nurse should administer platelets with a special transfusion set that has a smaller filter and shorter tubing. If a standard blood administration set is used, the filter can trap the platelets and the longer tubing increases platelet adherence to the lumen.
What are the nursing responsibilities before blood transfusion?Verify that an order for the transfusion exists. Conduct a thorough physical assessment of the patient (including vital signs) to help identify later changes. Document your findings. Confirm that the patient has given informed consent.
How do nurses administer platelets?Platelets are transfused at the bedside through intravenous tubing with an in-line filter (screen filter of 170-260 micrometer pore size) to remove fibrin clots and large debris. The tubing can be primed with normal saline or blood product itself.
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