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Blood or Blood Component Transfusions

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The computer generated label can be applied to the Hollister specimen label. (The Hollister label may not be placed on top of a computer label. ... – PowerPoint PPT presentation

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Title: Blood or Blood Component Transfusions


1
Blood or Blood Component Transfusions
2
Blood Transfusion
  • Blood and Blood product administration is an area
    where the potential for mistakes can be very
    high.
  • Following the policies exactly can help prevent
    mistakes

3
Blood Transfusion
  • JCAHO and the FDA monitor errors in blood
    administration.
  • The goal is to administer these products safely
    and not harm a patient nor have to report any
    errors.
  • Every effort should be made to assure safe
    administration.

4
Why do we transfuse RBCs?
  • Red blood cells contain hemoglobin and serve to
    transport oxygen through the bloodstream and to
    the tissues.
  • Whole blood or red blood cells are given to
    increase patients oxygen carrying capacity.

5
Competency Check-off
  • RNS and LVNs criteria for competency
  • Attending orientation
  • Blood Exam grade of 85 or better
  • check-off completed in Blood Administration with
    preceptor
  • LVNs Need to take IV concepts class within the
    first year of employment

6
PROCEDURE
  • A physician or licensed independent
    practitioner will initiate the order, utilizing
    EDITH.
  • The order must include any special instructions
    or requirements. (Example- if irradiated blood
    is required ONCOLOGY)

7
BLOOD TRANSFUSE PROCEDURE
  • Check the electronic chart for a consent or
    refusal form. If no forms are found, explain
    the procedure to patient and complete a Consent
    for Transfusion of blood or Refusal to Permit
    Transfusion of Blood and Blood Components if the
    patient refuses a transfusion. Scan the consent
    in CPRS.

8
BLOOD TRANSFUSE PROCEDURE
  • Refer to text.

Please refer to the pages in your orientation
manual and review these forms. These forms are
scanned into EDITH
9

BLOOD TRANSFUSE PROCEDURE
  • A phlebotomist or nurse will draw and label the
    type and crossmatch specimen,
  • apply red blood band to patient.
  • Nurse draws are allowed in ICU/CCU ER
    OR PACU/POCU

10
PROCEDURE for IDENTIFYING BLOOD SAMPLE AND PATIENT
  • Secure the Hollister I-denta-blood labels and
    red blood arm band.
  • (form on next slide)
  • Note that the form stickers all have the same
    R. This will be used for all testing on that
    specimen and any products prepared for this
    patient)

11
LRW
6/14/07 1540 LRW
12
PROCEDURE for IDENTIFYING BLOOD SAMPLE AND PATIENT
  • Fill out the specimen label ( located in the
    upper right hand corner of the page) and
  • armband insert (Located at the bottom of the
    form) to contain only the following
  • Date and time specimen was drawn
  • Initials of person drawing the sample
  • Apply label to tube and armband to patient before
    leaving the patients bedside.

13

PROCEDURE for IDENTIFYING BLOOD SAMPLE AND PATIENT

14
PROCEDURE for IDENTIFYING BLOOD SAMPLE AND PATIENT
  • Draw sample into a red topped tube (For adults
    MINIMUM of 3 cc, however a full 10 cc tube is
    best)
  • (For infants and children ask the lab how much
    specimen is needed)
  • After applying label to specimen tube, send it
    along with the remaining blood tab label sheet to
    the lab.

15
PROCEDURE for IDENTIFYING BLOOD SAMPLE AND PATIENT
  • NOTE A computer generated label may be utilized
    with additional information added so that all
    required information is available. The computer
    generated label can be applied to the Hollister
    specimen label. (The Hollister label may not be
    placed on top of a computer label. The lab will
    reject a specimen with that type of label.)

16
To Obtain Blood Products
  • Either the blood bank will call when the blood is
    ready or you can check the computer for the
    order and a notification that component testing
    is complete.
  • Check (CPRS) EDITH for a completed, signed, and
    scanned patient Consent to Transfuse form.

17
To Obtain Blood Products
  • Obtain a Component Requisition Slip (on next
    slide)
  • take to patient room and verify that the patient
    has a red blood band on.
  • Complete the following
  • name
  • Medical record number,
  • R and
  • component requested on the requisition slip from
    the information on the patient blood band and
    patient ID band.
  • Do not take the information from the patients
    chart.

18
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19
To Obtain Blood Products
  • Confirm that the patient has a patent IV with a
    catheter of sufficient size to allow the blood
    to drip without damaging the cells.
  • Make sure that all necessary supplies are
    available
  • Blood Administration set
  • 0.9 Normal Saline (Prime tubing with saline)
  • Transfusion Administration Record form (see next
    slide)

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21
To Obtain Blood Products
  • Send or take the completed requisition slip to
    the blood bank located in the basement of the
    hospital.
  • Only hospital employees may pick up blood
    components from the lab. (Note Nursing students
    working as nurse techs may pick up blood when
    working as a nurse tech, but if they are here as
    a student, they may not pick up blood)

22
To Obtain Blood Products
  • Give the component requisition slip to the blood
    bank technician who will secure the component
    from the blood bank refrigerator
  • Confirm the following with the blood bank
    technician
  • Patient Name (Including middle initial if
    available)
  • R Number
  • Blood Component Number
  • Component type/Rh
  • Type of component
  • Component expiration date

23
To Obtain Blood Products
  • If all the information correlates between
  • the Component Requisition Slip,
  • the component label,
  • the cross-match report and
  • the blood bank computer,
  • the hospital employee will sign the Cross match
    Report slip on the Received by line.
  • The blood bank technician will sign on the
    Issued By line

24
To Obtain Blood Products
  • By signing the component requisition form, each
    person has verified that the above information is
    correct. The date and time issued are those of
    the blood bank computer.
  • If for any reason, there are items that do not
    match, the process stops until the problem is
    identified and resolved.

25
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26
Blood Products in cooler
  • For some areas, when more than one unit of
    components are requested, the units will be
    issued in a cooler.
  • Inside the cooler is a thermometer and a SIGN
    OUT SHEET FOR BLOOD PRODUCTS REMOVED FROM BLOOD
    BANK TRANSPORT COOLER AT MMH form. (see
    orientation manual)

27
Blood Products in cooler
  • The SIGN OUT SHEET FOR BLOOD PRODUCTS REMOVED
    FROM BLOOD BANK TRANSPORT COOLER form is to be
    completed as the component is removed from the
    cooler.
  • Document the following information
  • Unit number
  • Component (type)
  • Temperature when removed from Cooler
  • Signature of person removing component
  • Time removed from cooler

28
Blood Products in cooler
  • SIGN OUT SHEET FOR BLOOD PRODUCTS REMOVED FROM
    BLOOD BANK TRANSPORT COOLER form (cont.)
  • The last space is utilized by the blood bank if
    the component is returned to the blood bank.
  • After completion, the form is returned to the
    cooler and sent to the blood bank. (An example
    of the form is in the orientation book)

29
Transfusing the component
  • The blood component is then taken immediately to
    the patients room where two licensed nurses (one
    must be an RN) will verify
  • Patient name with middle initial if available
  • Medical Record
  • R and
  • complete the Patient Identification Infusion
    Record on the Crossmatch Report Slip.
  • ALL MUST MATCH EXACTLY

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31
Transfusing the component
  • Compare the R Number on the patients red blood
    band with the R Number on the blood component and
    the Crossmatch Report Slip. All must match
    exactly.
  • Document the R number on the Blood
    Administration Record
  • Compare the component unit number on the
    component label and the cross match report slip.
    All must match exactly.

32
Transfusing the component
  • Compare the ABO/Rh on the component label and the
    Cross match Report Record-All must match exactly.
  • After all information has been checked and
    verified by the two licensed nurses, both must
    initial the information and sign the Patient
    Identification Infusion Record (on the Cross
    match Report Slip)
  • If at any point there are mismatches, the process
    stops immediately, the component is returned to
    the blood bank for correction.

33
Transfusing the component
  • The primary nurse will take a complete set of
    vital signs and record on the Blood
    Administration Record.
  • Complete vital signs include
  • Temperature
  • Blood Pressure
  • Pulse
  • Respirations
  • (Refer to the Orientation Booklet to review the
    Blood Administration Record form)

34
Transfusing the component
  • Carefully spike the blood bag,
  • (Note The best method of spiking the bag is to
    hang the blood bag, then insert the spike into
    the bag very carefully. Holding the bag while
    spiking, seems to be connected with increased
    incidence of spiking through to puncture the
    bag. This causes the unit to be wasted)
  • mix in the saline and begin the transfusion,
  • Begin transfusion at a rate of 120 cc/hr for the
    first 15 minutes
  • while observing the patient for potential signs
    of a transfusion reaction.
  • Document the time the transfusion is started on
    the Blood Administration Record and on the
    Crossmatch Slip.(See a copy of the Blood
    Administration Record in your orientation book)

35
Transfusing the component
  • You must stay with the patient for the first 15
    minutes of the transfusion in case of a reaction.
  • Most ABO incompatibilities occur in the first
    fifteen minutes.

36
Transfusing the component
  • the blood component must be started within 30
    minutes or returned immediately to the blood bank
  • EXCEPTION storing component in a red blood bank
    transport cooler which has been set up by the lab
    with the proper documentation forms and a
    thermometer.

37
Transfusing the component
  • After the first 15 minutes have passed and no
    reaction noted,
  • take and record a second set of vital signs
  • increase the rate of infusion.
  • (Once started, the transfusion must be completed
    within 4 hours. .
  • If for some reason it does not appear possible to
    finish in 4 hours, the blood bank should be
    consulted. A doctors order is needed to possibly
    divide the unit into two equal parts )

38
Transfusing the component
  • Every 30 minutes until the transfusion is
    completeThe nurse is to physically return to the
    patients room to
  • assess the patient,
  • take and document another complete set of vital
    signs
  • (While an automatic blood pressure machine may
    be utilized, the nurse is to rely on a physical
    assessment)

39
Transfusing the component
  • When the transfusion is complete, take a full set
    of vital signs, document on the Blood
    Administration Record form, discontinue the blood
    tubing and resume IVs as per physician order.

40
Transfusing the component
  • Complete the information on the Crossmatch slip
    which has been left on the blood bag during the
    transfusion, and place the Crossmatch report on a
    piece of paper and scan into CPRS under the
    appropriate title.

41
Transfusing the component
  • Dispose of the used blood bag and IV Tubing into
    a red biohazard bag and place the red bag into a
    red biohazard tub. (Blood bags and tubing are
    the exception to the hazardous waste rule and are
    considered hazardous waste)

42
Transfusing the component
  • One hour post transfusion, the nurse physically
    returns to the patients room to reassess the
    patient, take and record the final set of vital
    signs for this transfusion process.

43
Transfusing the component
  • Who should receive Rh immunoglobulin?
  • The Rh(D) negative patient who has either
    Received Rh positive platelets Is a female
    under 50 who has received Rh positive
    FFP Is a postpartum patient who has
    delivered an Rh positive baby. (Must be given
    within 72 hours of delivery or termination of
    pregnancy).

44
Transfusion Reactions
45
Clinical Signs and symptoms ( of a blood
transfusion reaction )
  • Increased pulse Hypertension
  • Hypotension Congestive Heart Failure
  • Cyanosis Chills
  • Dyspnea Fever (a 2rise is
    considered a
  • Chest pain febrile reaction)
  • Nausea Hemoglobinuria
  • Vomiting Rash
  • Back pain Heat or pain along the
  • Flushing vein of transfusion
  • Urticaria
  • Other symptoms that would cause concern to the
    nurse or patient

46
Transfusion Reaction
  • In the event of a transfusion reaction, the nurse
    administering the blood will initiate the
    following interventions
  • Stop the transfusion by discontinuing the blood
    as close to the IV Cannula as possible

47
Transfusion Reaction
  • Keep the IV open with 0.9 normal saline (Secure
    a fresh IV tubing and bag of saline. --- Do not
    open the saline side of the Y Blood tubing or
    you could potentially give the patient an extra
    bolus of 50 or more ccs)

48
Transfusion Reaction
  • Report the reaction to the physician.(The final
    decision to diagnose a transfusion reaction is
    made by the physician) In addition notify the
    Blood Bank, the charge nurse and House
    Supervisor/Nurse Manager of the potential
    reaction)(Monday-Friday, 8 AM to 4 PM the nurse
    managers/division directors fulfill the function
    of the house supervisor. After 4 PM daily and
    all day on weekends, a house supervisor is in
    house and should be notified.)

49
Transfusion Reaction
  • Perform a clerical check at the bedside by
    comparing the patient information on the
    Hollister armband with the cross match report
    slip. Make sure that all information matches
    exactly.

50
Transfusion Reaction
  • Treat symptoms per physicians order and monitor
    patient vital signs.
  • Document thoroughly on Transfusion Reaction
    Report note in CPRS. This must be completed
    whether or not the MD calls it a true reaction.
  • (The Blood Bank requests a Transfusion Reaction
    Report be completed as a tracking device even if
    the physician does not diagnose the symptoms
    seen as a transfusion reaction )

51
Transfusion Reaction
  • If diagnosed by the physician, order a
    transfusion reaction workup in the computer.
  • Send the blood with attached administration set
    to the blood bank.
  • ( Refer to your orientation book for an example
    of the Transfusion Reaction Report note.)

52
Transfusion Reaction
  • Hemolytic transfusion reaction
  • The destruction of transfused red cells. The
    most common cause of acute hemolytic reactions is
    transfusion of ABO incompatible blood, resulting
    from identification errors occurring at some
    point(s) in the transfusion process. Type and
    cross matches are done to try to prevent this
    type of reactions.
  • Acute hemolytic reaction
  • Characteristically begin with an increase in
    temperature and pulse rate symptoms may include
    chills, dyspnea, chest or back pain, abnormal
    bleeding or shock. Instability of blood pressure
    is frequent, the direction and magnitude of
    change depending upon the phase of the
    antigen-antibody event and the magnitude of
    compensatory mechanisms

53
Transfusion Reaction
  • Delayed Hemolytic reactions
  • Occur in previous alloimmunized patients in
    whom antigens on transfused red cells provokes
    anamnestic production of antibodies that reaches
    a significant circulating level while the
    transfused cells are still present in the
    circulation
  • the usual time frame is 2 to 14 days after
    transfusion.
  • Signs may include unexplained fever,
    development of a positive direct antiglobulin
    test, an unexplained fall in hemoglobin/hematocrit
    . Hemaglobinemia and hemoglobinuria are
    uncommon, but elevation of LDH or bilirubin may
    be noted. Most delayed hemolytic reactions have
    a benign course and require no treatment.

54
Transfusion Reaction
  • Febrile non-hemolytic reaction
  • Typically manifested by a temperature
    elevation of 1C or 2F occurring during or
    shortly after a transfusion and in the absence of
    any other pyrexic stimulus.
  • (At MMH a 2 rise in temperature is considered a
    febrile reaction).
  • This may reflect the action of antibodies against
    white blood cells or the action of cytokines,
    either present in the transfused component or
    generated by the recipient in response to
    transfused elements.
  • Febrile reactions may accompany about 1 of
    transfusions they occur more frequently in
    patients alloimmunized by transfusion or
    pregnancy and in patients immune dysfunction due
    to neoplasm or autoimmunity.
  • Patients who experience repeated, severe febrile
    reactions may benefit from receiving luekocyte
    reduced components.
  • Allergic Reactions
  • Usually occurs as urticaria, but may also
    include wheezing or angioedematous reactions.

55
Transfusion Reaction
  • ABO Compatibilities
  • THE ABO group of all red cell-containing
    components must be compatible with the ABO
    antibodies in the recipients plasma. Whole blood
    must be ABO identical with the recipient. Red
    Blood Cells which contain a much reduced volume
    of antibody containing plasma, need not be ABO
    identical. Refer to the following charts which
    delineate what types are compatible.
  • Notice O NEGATIVE is the universal donor
    type.
  • (Refer to the compatability charts on
    page 131 of the Orientation Book)

56
Transfusion Reaction
  • EMERGENCY TRANSFUSIONS
  • Except in cases when any delay in transfusion
    will be life-threatening, serologic compatibility
    must be established before any red-cell-containing
    component is transfused. MMH will release type
    specific or uncross matched blood in an
    emergency upon receipt of a completely filled out
    EMERGENCY TRANSFUSION SLIP .
  • (A Licensed Nurse is allowed to take a verbal
    order to initiate the process to get type
    specific or uncross matched blood in an
    emergency. The form must be taken to the blood
    bank or they will not release the blood product.
    The blood bank must have a way of tracing all
    products)
  • Refer to the Emergency Release of Blood
    Components form in your orientation book.

57
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