Sie sind auf Seite 1von 4

BLOOD TRANSFUSION

I. Definition
Blood Transfusionis generally the process of receiving blood or blood products into one's circulation
intravenously. Transfusions are used for various medical conditions to replace lost components of the blood.
Early transfusions used whole blood, but modern medical practice commonly uses only components of the
blood, such as red blood cells, white blood cells, plasma, clotting factors, and platelets.

Indications for blood transfusion


 To increase the oxygen capacity of blood by giving red cells.
 To restore the blood volume to maintain effective tissue perfusion.
 To replace platelets, coagulation factors and other plasma proteins.

FFP Fresh Frozen Plasma


Hb Haemoglobin
HBV Hepatitis B virus
Hct Haematocrit
HCV Hepatitis C virus
HDN Haemolytic disease of the newborn
HIV Human immunodeficiency virus
ITP Idiopathic autoimmune thrombocytopenic purpura
PC Platelet concentrates
PRBC Packed red blood cells
PT Prothrombin time
PTT Partial thromboplastin time

A blood component is a constituent of blood, separated from whole blood, such as:
 Red cell concentrate
 Plasma
 Platelet concentrate
 Cryoprecipitate, prepared from fresh frozen plasma; rich in Factor VIII and fibrinogen

A plasma derivative is made from human plasma proteins prepared under pharmaceutical
manufacturing conditions, such as:
 Albumin
 Coagulation factor concentrates
 Immunoglobulin

II. What makes up our blood?


• RED BLOOD CELLS (Erythrocytes) – The most abundant cells in our blood; they are produced in the
bone marrow and contain a protein called hemoglobin that carries oxygen to our cells.
• WHITE BLOOD CELLS (Leukocytes) – They are part of the immune system and destroy infectious
agents called pathogens.
• PLASMA – This is the yellowish liquid portion of blood that contains electrolytes, nutrients and
vitamins, hormones, clotting factors, and proteins such as antibodies to fight infection.
• PLATELETS (Thrombocytes) – The clotting factors that are carried in the plasma; they clot together in
a process called coagulation to seal a wound and prevent a loss of blood.

III. Administration of Blood Products

When blood is transfused, it is important to keep detailed records including the ff. in the patient’s notes:

o Type and volume of each unit transfused.


o Unique donation number of each unit transfused.
o Blood group of each unit transfused.
o Time at which the transfusion of each unit commenced.
o Signature of the individual responsible for administration of the blood.
o Monitor the patient before, during and on completion of the transfusion.
o Record the time of completion of the transfusion.
o Identify and respond immediately to any adverse effect, by stopping the transfusion.
o Record the details of any transfusion reaction.
The process starts with the request for blood, followed by the selection of the correct blood product for
compatibility testing and finally the issuing of compatible blood for infusion into the patient.

Important considerations

 Gather the pertinent data; know the purpose of the transfusion


 Confirm the physician’s order for the number and type of units and the desired speed of infusion
 Obtain blood in plastic bag from the blood bank; place the blood in a tray covered with a towel
 One unit of whole blood is 500 mL; a unit f PRBC is 200-250 mL
 Ensure that blood is typed and cross matched properly
 Know the complications or adverse effects of blood transfusion and report it to the phycisian
 Note any premedication ordered by the physician; schedule the administration (usually 30 minutes
prior to transfusion)

Equipment

 Unit
 of whole blood, packed RBCs, or other  Venipuncture start kit ( including a gauge
component 20 needle or catheter);
 Blood administration set with filter g18 in some
 Supplemental blood filters , if needed  Alcohol swabs
 IV pump if needed  Micropore Tape
 normal saline for infusion  Sterile gloves
 IV pole

Blood bag should be checked for:

 Any sign of haemolysis in the plasma indicating that the blood has been contaminated, allowed
to freeze or to warm.
 Any sign of haemolysis on the line between the red cells and plasma during storage.
 Any sign of contamination, such as a change of colour in the red cells, which often look darker/
purple/ black when contaminated.
 Any clot, which may mean that the blood was not mixed properly with the anticoagulant when it
was collected or might also indicate bacterial contamination due to the utilization of citrate by prolifer
ating bacteria.
 Any sign that there is a leak in the bag or that it has already been opened.

Preparation

 Verify client consent and obtain baseline data before the transfusion
 Assess vital signs for baseline date
 Determine any known allergies or previous reactions to blood
 Note specific signs related to the client’s pathology and the reason for the transfusion
 Establish the intravenous line; check whether the needle is appropriate to administer blood

Preparing the IV infusion


 Explain to the client what you are going to do, why it is necessary and how he/she can cooperate.
 Provide for client privacy and prepare the client.
 Check the client’s identification; ensure the right patient
 Assist the client in a comfortable position; expose the IV site but provide for client privacy
 Wash hands and observe appropriate infection control procedures
 Prepare the infusion equipment; ensure that blood filters inside the drip chamber is suitable for the
blood component
 Put on gloves; close all clamps on the Y-set
 Insert the piercing pin (spike) into the saline solution and hang on IV pole about 36 inches above the
venipuncture site
 Prime the tubing; start the saline solution
Performance
 Obtain the correct blood component for the client; check the physician’s order with the requisition
 Check the requisition form and the blood bag label with a lab tech or according to agency policy
 Check the client’s name, ID no, blood type and Rh group, blood donor number and expiration date of the
blood
 Observe the blood for abnormal color, clumping, gas bubbles and extraneous material
 Compare the laboratory blood bag label with client’s data
 If any information does not match exactly, notify the charge nurse and the blood bank

Prepare for transfusion


 Invert the blood bag gently several times to mix the cells with the plasma
 Expose the port on the blood bag by pulling back the tabs
 Insert the remaining Y spike into the blood bag
 Suspend the blood bag
 Establish the blood transfusion; closed the upper clamp below the IV saline solution; open the upper
clamp below the blood bag; readjust the flow rate with the main clamp
 Run the blood slowly for the first 15 minutes at 20 drops/ minute
 Observe the client closely for the first 15 minutes
 Note any adverse reactions and remind the client to call a nurse immediately if any unusual symptoms
are felt during the transfusion

IV. Documentation of the transfusion


Monitor the patient before, during and on completion of the transfusion.

 At each of these stages, record the following information on the patient’s chart:
- Patient’s general appearance. - Blood pressure.
- Temperature. - Respiratory rate
- Pulse.

 Make note of the following:


- Time the transfusion started.
- Time the transfusion was completed.
- Volume and type of blood products transfused.
- Unique donation number of all products transfused.
- Any adverse effect.

 Record in the patient’s notes:


– Type and volume of each unit transfused.
– Unique donation number of each unit transfused.
– Blood group of each unit transfused.
– Time at which the transfusion of each unit commenced.
– Signature of the individual responsible for administration of the blood.
– Record the time of completion of the transfusion.
– Record the details of transfusion reaction.

 Identify and respond immediately to any adverse effect, by stopping the transfusion.
 Whether the patient and/or relatives were informed about the transfusion.
 The reason for transfusion.
 Signature of the prescribing clinician.

 Pre‐transfusion checks of:


- Patient’s identity.
- Blood bag.
- Compatibility label.
- Signature of individual performing the pre‐transfusion identity check.
 The transfusion:
o Type and volume of each product transfused.
o Unique donation number of each unit transfused.
o Blood group of each unit transfused.
o Time at which the transfusion of each unit commenced.
o Signature of the person administering the blood component.
o Monitoring of the patient before, during and on completion of transfusion.
o All other details related to the transfusion process.
o Informed consent.
o Administration of the unit.
o Set‐up time of each unit transfused.
o Time of transfusion.

V. Use of medication at time of transfusion

It is generally not recommended to routinely use pre‐medication like anti‐


histamines, steroids or other medication before transfusion. This practice may mask or delay the signs a
nd symptoms of an acute transfusion reaction and therefore delay recognition and action to stop the transfusi
on.

Addition of medicine or other fluids with blood and blood components

 Medicines or other fluids should never be infused within the same line as blood and blood components.
The exception is normal saline (sodium chloride 0.9%) which may be used in special circumstances, e.
g. when the flow is slow due to increased Hct, or when saline is used to prepare washed red cells.
 Use a separate IV line if an intravenous fluid has to be given at the same time as blood transfusion.

VI. Adverse Effects of Transfusion

1. The very first step is to stop the transfusion immediately. If the reaction is severe, the needle should be
removed to prevent any further transfusion of blood.
2. All suspected acute transfusion reactions should be reported immediately to the blood transfusio
n centre and to the doctor responsible for the patient. With the exception of urticarial allergic reactions
and febrile non‐haemolytic reactions, all are potentially fatal and require urgent treatment.
3. Acute reactions may occur in 1% to 2% of transfused patients. Rapid recognition and management of th
e reaction may save the patient’s life. Once immediate action has been taken, careful and repeated clini
cal assessment is essential to identify and treat the patient’s problems.
4. Errors and failure to adhere to correct procedures are the common causes of life‐
threatening acute haemolytic transfusion reactions.
5. Bacterial contamination in red cells or platelet concentrates is an under
recognized cause of acute transfusion reaction.
6. Patients who receive regular transfusions are particularly at risk of acute febrile reactions. These shoul
d be recognized so that transfusion is not delayed or stopped unnecessarily.
7. Transfusion transmitted infections are the serious delayed complications of transfusion. Since a delaye
d transfusion reaction may occur days, weeks or months after the transfusion, the association wi
th the transfusion may not be recognised.
8. The transfusion of a large volume of blood and intravenous fluids may cause haemostatic defects or m
etabolic disturbances in the patient. There should be an availability of various treatments including ox
ygen, adrenaline, corticosteroids, bronchodilators, diuretics and an emergency team.

In an unconscious or anaesthetized patient, hypotension and uncontrolled bleeding may be the only sign of an
incompatible (mismatched) transfusion. In a conscious patient undergoing an acute severe haemolytic transfusion
reaction, signs and symptoms may appear within minutes of transfusion of 510 mL of blood. Close observation at the
start of the transfusion of each unit is therefore essential.

Das könnte Ihnen auch gefallen