Transfusion of Blood and Blood Products



Transfusion of Blood and Blood Products





The transfusion of blood and blood products should be performed only as a last resort in patients with chronic anemia or acute bleeding. Prevention and early diagnosis of anemia or bleeding can help minimize the need for transfusion of blood and blood products. For a patient with chronic anemia, the use of iron and vitamin supplements is often sufficient to raise the hemoglobin level enough so a transfusion isn’t required.

If the patient is experiencing acute bleeding, the first line of treatment should be IV fluids, such as crystalloids or colloids, to help increase the circulating volume. If the patient requires a blood transfusion, it’s very important to make sure that the right patient is receiving the right blood or blood product. If a patient receives the wrong blood or blood product, it could cause a serious reaction and possibly death. Before administering blood or a blood product, you should be familiar with the different types of blood and blood products (See Transfusing blood and selected blood products.)




Equipment

Blood or blood component administration set as appropriate ▪ IV pole ▪ gloves ▪ blood or blood product ▪ 10-mL syringe ▪ 250 mL of normal saline solution ▪ IV catheter equipment, if necessary (should include 14G to 24G catheter).3

Straight line and Y-type blood administration sets (Y-type is most commonly used) contain a standard blood filter designed to eliminate blood clots and cellular debris that occur during blood storage. A standard blood filter will trap particles that are 170 microns or larger. There are times, however, when a specialized blood filter may be required. (See Specialized blood filters, page 745.)


Preparation of Equipment

Avoid obtaining the blood or blood product until you’re ready to begin the transfusion. The transfusion should begin within 30 minutes of obtaining the blood or blood product to decrease the risk of bacterial growth.3 Prepare the equipment when you’re ready to start the infusion.



Nursing Alert

Never store blood in a non–blood bank refrigerator. Return the blood to the blood bank refrigerator if a delay of 30 minutes or more is anticipated.3,4




Implementation



  • Make sure that a written order is in the patient’s medical record. Confirm that the order and the medical record are labeled with the patient’s name and assigned identification number.3,5


  • Verify that the patient or his legally authorized representative has signed an informed consent form before transfusion therapy is initiated and that the form is in the patient’s medical record according to your facility’s policy.6,7 Some facilities don’t require consent for blood components such as albumin; make sure you’re familiar with your facility’s policy.


  • Ensure that the indication for the transfusion is documented in the patient’s medical record.


  • Gather the equipment.


  • Confirm the patient’s identity using at least two patient identifiers according to your facility’s policy.11


  • Explain the procedure to the patient.


  • Perform hand hygiene and put on gloves8,9,10,15


  • If the patient doesn’t have an IV catheter in place, insert one. Use a catheter that’s 24G or larger in diameter.3 The selection of the catheter size depends on the location, size, and integrity of the patient’s veins. A smaller catheter usually requires a slower rate of transfusion. (See “IV catheter insertion and removal,” page 421.)

    If an existing IV catheter is in place, verify it’s an appropriate size and that it’s patent by using a 10-mL syringe to aspirate for blood return.12 Central venous access devices also may be used for transfusion therapy.



Transfusing Blood and Selected Blood Products










































Blood component Indications Compatibility Nursing considerations
Packed red blood cells (RBCs)
Same RBC mass as whole blood but with 80% of the plasma removed

  • To restore or maintain oxygen-carrying capacity
  • To correct anemia and surgical blood loss
  • To increase RBC mass
  • For red cell exchange


  • Group A receives A or O
  • Group B receives B or O
  • Group AB receives AB, A, B, or O
  • Group O receives O
  • Rh type must match1


  • Use blood administration tubing to infuse within 4 hours.
  • Use only with normal saline solution.
  • Avoid administering packed RBCs for anemic conditions correctable by nutritional or drug therapy.
Leukocyte-poor RBCs
Same as packed RBCs with about 70% of the leukocytes removed

  • Same as packed RBCs
  • To prevent febrile reactions from leukocyte antibodies
  • To treat immunocompromised patients
  • To restore RBCs to patients who have had two or more nonhemolytic febrile reactions


  • Same as packed RBCs
  • Rh type must match


  • Use blood administration tubing.
  • May require a 40-micron filter suitable for hard-spun, leukocyte-poor RBCs.
  • Use only with normal saline solution.
  • Cells expire 24 hours after washing.
Platelets
Platelet sediment from RBCs or plasma platelets

  • To treat bleeding caused by decreased circulating platelets or functionally abnormal platelets
  • To improve platelet count preoperatively in a patient whose count is 50,000/μL or less1


  • ABO compatibility identical; Rh-negative recipients should receive Rh-negative platelets1


  • Use a blood filter or leukocyte-reduction filter.
  • As prescribed, premedicate with antipyretics and antihistamines if the patient’s history includes a platelet transfusion reaction or to reduce chills, fever, and allergic reactions.
  • Complete transfusion within 20 minutes or at the fastest rate the patient can tolerate.
  • Use single-donor platelets if the patient has a need for repeated transfusions.
  • Platelets aren’t used to treat autoimmune thrombocytopenia or thrombocytopenic purpura unless patient has a life-threatening hemorrhage.
Fresh frozen plasma (FFP)
Uncoagulated plasma separated from RBCs and rich in coagulation factors V, VIII, and IX

  • To correct a coagulation factor deficiency
  • To replace a specific factor when that factor isn’t available
  • For warfarin reversal
  • To treat thrombotic thrombocytopenic purpura


  • ABO compatibility required
  • Rh match not required


  • Use a blood administration set.
  • Complete the transfusion within 20 minutes or at the fastest rate the patient can tolerate.
  • Keep in mind that large-volume transfusions of FFP may require correction for hypocalcemia because the citric acid in FFP binds calcium.
  • Must be infused within 6 hours of being thawed.
Albumin 5% (buffered saline); albumin 25% (salt-poor)
A small plasma protein prepared by fractionating pooled plasma

  • To replace volume lost because of shock from burns, trauma, surgery, or infections
  • To treat hypoproteinemia (with or without edema)


  • Not required


  • Use the administration set supplied by the manufacturer and set the rate based on the patient’s condition and response.
  • Keep in mind that albumin is contraindicated in severe anemia.
  • Administer cautiously in cardiac and pulmonary disease because heart failure may result from circulatory overload.
Factor VIII concentrate (antihemophilic factor)
Cold insoluble portion of plasma recovered from FFP

  • To treat a patient with hemophilia A
  • To treat a patient with von Willebrand’s disease


  • ABO compatibility not required

  • Administer by IV injection using a filter needle, or use the administration set supplied by the manufacturer.
Cryoprecipitate
Insoluble plasma portion of FFP containing fibrinogen, factor VIIIc, factor VIIvWF, factor XIII, and fibronectin

  • To treat factor VIII deficiency and fibrinogen disorders
  • To treat significant factor XIII deficiency


  • ABO compatibility required1,2
  • Rh match not required1,2


  • Administer with a blood administration set.
  • Add normal saline solution to each bag of cryoprecipitate, as necessary, to facilitate infusion.
  • Keep in mind that cryoprecipitate must be administered within 6 hours of thawing.
  • Before administration, check laboratory studies to confirm a deficiency of one of the specific clotting factors present in cryoprecipitate.
  • Be aware that patients with hemophilia A or von Willebrand’s disease should only be treated with cryoprecipitate when appropriate factor VIII concentrates aren’t available.

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Jul 21, 2016 | Posted by in NURSING | Comments Off on Transfusion of Blood and Blood Products

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