Blood transfusion Prepared by : Christian Raveina

Definition •Blood transfusion is the IV administration

of whole blood or its component such as plasma , packed red blood cells or platelets to a patient

Purposes • To increasing circulating blood volume

• To increase the no. of red blood cells & to maintain hemoglobin level

• To provide plasma clotting factors, to help in controlling bleeding

• To combat infection due to decreased or defective white cells or antibodies

Indications • After surgery , trauma or hemorrhage

• Severe anemia

• Leukopenia(↓se WBC)

• Agranulocytosis (bonemarrow does not produce enough or mature WBC)

Blood groups & their respective agents

•Group :

AB A B O• The group O is universal “donor”• The group AB is universal “recipient “

Pre-transfusion assessment • Patient history of previous transfusion , reactions to

transfusions , No. of pregnancies a women has , health problem , cardiac , pulmonary & vascular diseases

• Physical assessment – baseline vital signs , auscultation of lungs & patients use of accessory muscles , edema , jugular vein distention , skin rashes , petechial , echymosis , icterus etc

• Patients teaching : patient should be taught about the sign & symptoms of adverse reactions

Selection of donor • Should not be suffering from any illness

• Should not have donated blood within previous 3 months

• Should be healthy & in the age group of 18-65 years

• Should not be pregnant

• Should have Hb level above 12 gm %

• Should have normal vital signs

Preparation of recipient

• Explain the procedure to the patient & relatives

• Ask whether he/she has undergone prior transfusion & reactions

• Take informed consent from the patient/relative

• Provide comfortable position to the patient

•Check & record the vital signs of the patient

•Offer a bedpan before starting the procedure

•Educate the patient about adverse reactions & ask her/him to report immediately

Preparation of articles

•A tray containing : • A blood transfusion set , a mackintosh & a towel • A tourniquet , cotton swabs with antiseptic • Adhesive tape & scissors , gloves , kidney tray • IV stand ,NS, paper bag , Blood or any of its

components with cover received from blood bank with the name of recipient

Procedure

• Wash hands , wear gloves

• Perform vein puncture by selecting a large vein which allows the patients mobility

• Check the blood to be transfused for group , Rh type , expiry date etc. Also inspect for abnormal colour , cloudiness , clot & excess air

• Open the packing of blood transfusion set aseptically & insert infusion set into

• Check the needle & solution of previous IV infusion whether they are appropriate for administering blood. The needle no.18 or 19 & solution must be NS

• Put pressure by placing tourniquet 10-12 cm above insertion site & ask patient to clench fist

• Clean the insertion site with iodine & spirit

• Insert the needle & start infusion with NS

• Firstly identify blood product & patient thoroughly & the transfusion is begun

• For first 15 min adjust flow at 2ml/min & remain with patient . If any reaction is suspected , notify the physician

• Monitor vital signs every 5 min for first 15 min

• Observe for flushing , itching , dyspnea , rash or any other adverse reaction

• Then infusion rate should be set as per physician’s order

• Remove & dispose of gloves, wash hands

• Record with date , time , blood group , adverse reactions & amount of blood infused • 1 unit of blood contains 350ml of blood • Preservative – citrate dextrose phosphate adenine

Complications of BT

• Hemolytic transfusion reaction :• Occurs due to incompatibility of blood, incomplete storage of

blood , storage beyond 21 days , warming of blood above 40◦C or by exposure of red cells to dextrose solutions It is indicated by fever , chills , head-ache , dyspnea , cyanosis , chest pain etc. There may be a drop in B.P. , oliguria or may cause anuria

• Pyrogenic reactions :• Its incidence gets decreased now a days due to use of

disposable sets .It occurs when there are some external substances present in the tubings , characterized by fever with chills , nausea , vomiting , diarrhea , headache , backache , delirium , shock & renal failure

• Allergic reactions :• There are due to individual sensitivity to plasma

proteins characterized by itching , laryngeal edema & bronchial spasms

• Circulatory overloads :• It occurs in people suffering from severe anemia ,

as they need only RBC’s , but when they receive the whole blood . Patients with heart failure are more vulnerable for circulatory overload

• Transmission of infectious diseases :• Various diseases like hepatitis, AIDS , malaria ,

syphilis etc. are transmitted through blood when not properly checked

• Anaphylactic reactions :• These occur rarely but are life threatening

condition characterized by a severe respiratory & cardio-vascular collapse , severe GI disturbances

Nursing responsibilities

• Nurse is responsible for safety & effectively administering IV infusion

• Nurse must have legal knowledge about infusion

• Nurse should do through assessment of patients

• Physical condition , medical history , allergies & dietary pattern should be known by nurse

• Nurse should have knowledge about calculation of flow rate & methodical approach

• Nurse should apply physiological , anatomical & aseptic principles

• Nurse should have vigilant observation throughout the procedure so as to prevent adverse reactions which can sometimes be fatal

Thank you …