NR33 Blood Transfusion Worksheet Student Fall06

SUFFOLK COUNTY COMMUNITY COLLEGE NR33 Lab Blood Transfusions Worksheet

Instructions: All worksheets should be reviewed prior to the lab. You will be required to demonstrate your preparation by participating in the discussion which includes completing the worksheet and performing the skills demonstrated by the instructor. Procedure checklist should be reviewed in the clinical skills book.

Blood Transfusions: is the IV administration of whole blood or a component such as plasma, packed cells, platelets, clotting factors, albumin and cryoprecipitate.

Indications for use:  correct severe anemia

 replace blood volume

Blood groups and types:  A  B  AB  O

Rh factor:  Rh positive  Rh negative

Before administering any blood a type and crossmatch must be done.

Two kinds of transfused blood  homologous

 autologus

Types of Transfusion: the patient’s condition determines which type of transfusion is needed.

 Whole Blood: Volume: 500cc Infusion Time: 3-4 hours Indication for use: Massive hemorrhage, hypovolemic shock.

 Packed Red Blood Cells: Volume: 250cc Infusion Time: 2-3 hours Indications for use: To increase oxygen (02) carrying capacity in anemic patients without a need for volume expansion.

 Modified Blood Products: Leukocyte poor RBC: Volume: 250cc Indications for use: Prevent recurrence of febrile reaction, utucaria and anaphylactic reactions.

Platelet Concentrations: Volume: One Unit (50-70cc) (from one unit of fresh whole blood) Indications for use: To control or prevent bleeding associated with platelet deficiencies. Ten or more units may be required at one time. Because platelets contain few RBC’s, ABO compatibility is not required, multiple donors may be used.

Fresh Frozen Plasma: (FFP) Volume: 200-250cc Indications for use: Plasma contains albumin, globulin, antibodies and clotting factors. It is given to increase the level of clotting factors. Volume: 5-20cc Indications for use: Contains clotting factors: VIII, XIII and fibrinogen.

The RN must check, verify and inspect to prevent the patient from receiving the wrong blood product. You want to prevent a fatal hemolytic reaction.

The nurse checks for:  consent form  name, ID#, DOB  order 

The nurse verifies for:  2nd nurse verifies the same information according to facility guidelines  

List the data the nurse must check for on the requisition form and the blood unit:    

Compare these 2 labels. Are they the same? What should the nurse do if the labels are not correct?

Mary S. Smiley Mary S. Smiley DOB 02/02/22 DOB 02/02/22 MR#2536460 MR#25364160 Dr. S Bonneraco Dr. S Bonneraco

Unit #31945A Unit #31945A Exp.10/10/06 Exp.10/10/06 B AB Rh positive Rh positive

Procedures for Blood Transfusion: (refer to blood bank slip)

 Verify physician order, obtain consent, and explain procedure to patient.  Notify blood bank (Type and Crossmatch [TXM])  Take vital signs and ascertain patency of I.V. with at least a 20g. or larger angio catheter  Hang IV of Normal Saline to run KVO (Note: only 0.9% N.S. [normal saline] is infused with blood). Must transfuse using blood transfusion tubing  Obtain blood from blood bank.  With a second nurse check transfusion slips , blood bag and patient ID  Prime unit of blood, check the patient’s I.D. band with the # on the blood.  Begin infusion slowly (25-50mL of blood) for first 5-15 minutes (rate 100mL/hr. Stay with the patient. Most reactions occur in the first 15minutes.  Observe patient frequently throughout the transfusion  Document

When transfusion is completed:  Flush the tubing with the IV of 0.9% NS, close clamp on completed unit of blood

 Reassess the patient, including vital signs

Blood Transfusion Reactions: can occur immediately or up to 96 hours after.  Stop transfusion immediately  Change the tubing, infuse normal saline  Assess patient, including vital signs  Notify MD  Obtain urine and blood samples  Prepare for further treatment  Complete reports (see blood reaction form)

The nurse started a transfusion 30 minutes ago. The blood is not infusing. The nurse should:    

The nurse hung a unit of packed cells 30 minutes ago. The patient now complains of a back ache. List the actions the nurse should take in order of priority.    

Review transfusion reaction chart (see chart)

The nurse is responsible for assessment of a possible transfusion reaction. List 10 interventions the nurse should perform before, during and after the transfusion?

 Verifies MD order         

Demonstration/Practice: Case scenario: administering a blood transfusion and documentation

Rev.atm 07/06 TRANSFUSION REACTION

REACTION CLINICAL OBSERVATION TREATMENT PREVENTION

Chills, fever, low back pain, chest Stop transfusion. Notify M.D. Minimize Risk by: pain, hypotension, nausea, Administer 02, Adrenaline, fluids -Double-check patient I.D. and HEMOLYTIC vomiting, and bleeding as ordered. Collect blood and urine blood type abnormalities, headache, shock. samples for lab. Record I&O. -Remain with patient 1st 20 min. Observe for diuresis or oliguria. -Begin transfusion slowly From mild chills and fever to Stop transfusion. Notify M.D. Minimize Risk by: extreme symptoms. Starts about Administer Antipyretics as -Keeping patient warm and FEBRILE one hour after start of I.V. ordered. covered. Persists 8-10 hours. -Use saline washed RBC & P.C. *Never add antihistamines to blood. Urticaria, rash, pruritis. In rare Stop transfusion. Notify M.D. Minimize Risk by: cases, asthma, pulmonary edema, Administer antihistamine or, for -Determine if patient had prior ALLERGIC facial or glottal edema. Nausea or more serious reaction, epinephrine reaction to transfusions. vomiting. or steroids as ordered. -Administer antihistamines pre-transfusion as ordered. Chills, fever, hypotension. Stop transfusion. Notify M.D. Minimize Risk by: Vomiting and bloody diarrhea. Treat with antibiotics and steroids -Use air free-touch free methods BACTERIAL Dry flushed skin, abdominal and as ordered. to draw and deliver blood. extremity pain. -Change filter and tubing between transfusions. Engorged neck veins. Chest Stop or slow transfusion. Notify Minimize Risk by: CIRCULATORY constriction, dyspnea, dry cough, M.D. Place patient in sitting -Use packed cells instead of OVERLOAD rales at base of lungs, pulmonary position. Administer diuretics, whole blood. edema. rotating tourniquets if ordered. -Infuse split units for high risk patients. Cyanosis, Dyspnea, Shock, Stop transfusion. Notify M.D. Minimize Risk by: AIR EMBOLISM Cardiac Arrest Turn patient on his left side with -Expel air from tubing before his head down. Treat for shock. transfusion. -Do not allow blood bag to run dry.

NOTE: ALWAYS NOTIFY BLOOD BANK IF PATIENT HAS A TRANSFUSION REACTION.