Administering blood products is a common life-saving procedure in any hospital setting. The nurse should know why the healthcare provider has ordered a specific blood product to be given to a patient as well as the institution’s policies and procedure in administering that product. The nurse must also recognize early signs of adverse reactions to prevent life-threatening complications.
What is a Blood Transfusion?
A blood transfusion is the administration of a component of blood or whole blood intravenously.
What are examples of blood components?
- Complete or Whole Blood: used to restore blood volume and replace red cell mass.
- Packed red blood cells: preferred method in replacing red cell mass; contains 80% less plasma volume than whole blood to correct anemia or surgical blood loss.
- Leukocyte-depleted RBCs: to treat immunocompromised patients and prevent febrile reactions and non-hemolytic transfusion reactions.
- White blood cells (leukocytes): whole blood with 80% of plasma and all RBCs removed. This is used to treat sepsis.
- Platelets: treat bleeding caused by low circulating platelet count or functionally abnormal platelets; Used in patients with thrombocytopenia
- Fresh Frozen Plasma: used to treat postoperative hemorrhage.
- Albumin 5% (buffered saline); albumin 25% (salt-poor): used to replace blood volume loss and treat hypoproteinemia in burns and hypoalbuminemia in shock and coagulation factors and complement; used in control of bleeding when replacement of coagulation factors is needed.ARDs; used to support blood pressure in dialysis and acute liver failure.
- Factor VIII concentrate (hemophilic factor): used to treat patients with hemophilia and von Willebrand’s disease
- Cryoprecipitate: used to treat patients with factors VIII and XIII deficiencies, von Willebrand’s factor, and fibrinogen.
Who Needs Blood Transfusions?
A patient may require a transfusion for the following:
- To increase blood volume after surgery, trauma, or hemorrhage;
- To increase the number of red blood cells in a patient with severe anemia;
- To provide platelets to patients with low platelet counts caused by treatment with chemotherapy;
- To provide clotting factors in plasma for patients with hemophilia, von Willebrand’s disease, or disseminated intravascular coagulopathy (DIC); or
- To replace plasma proteins such as albumin.
Before Transfusing Blood
- Assess why the patient needs to be transfused so that he/she can evaluate specific response to the procedure.
- Verify the health care provider’s order for the type of blood product to be given.
- Review the patient’s transfusion history. Watch out for any reactions or pretransfusion medications to be given. If prior reaction has occurred, pre-medications can be given to prevent a subsequent reaction.
- Review the patient’s baseline vital signs to compare with vital signs during the transfusion. Changes in baseline such as increased body temperature, heart rate, and respiration rate may indicate a transfusion reaction.
- Assess the type, integrity, and patency of the venous access in place so the transfusion will be completed without infiltration of the IV.
- Verify that a large-bore catheter (18- or 19- gauge) is to be used. Small-bore needles may cause hemolysis as red blood cells are large and will not flow through a small-bore needle.
- Review institution policy and procedure for the administration of blood components. Each institution has its own guidelines to ensure safe administration of blood products.
- Make sure that the client has signed an informed consent that includes potential risks and benefits of the procedure.
|REACTION||SIGNS AND SYMPTOMS||NURSING ACTIVITY|
|Allergic reaction: allergy to blood transfused||Anaphylaxis, itching, urticaria, local erythema, hives, coughing, nausea, vomiting, respiratory distress, wheezing, hypotension, loss of consciousness, and possible cardiac arrest.||
|Febrile reaction: fever develops during infusion||Fever and chills, headache, flushing, and malaise||
|Hemolytic transfusion reaction: incompatibility of blood product||
Facial flushing, fever, chills, headache, nausea, low back pain, chest pain, tachycardia, sensation of heat and pain along vein receiving blood, bronchospasm, anxiety, hypotension, vascular collapse, shock and possibly
|Circulatory overload: too much blood administered or transfused too fast||Difficulty breathing, Dry cough, crackles at the base of the lungs, tachypnea, distended neck veins, headache, hypertension, tachycardia, and Pulmonary edema||
|Bacterial reaction: bacteria present in blood||Fever, hypertension, abdominal pain, vomiting, diarrhea, back pain, profound hypotension and dry, flushed skin||
Fundamental & Advanced Nursing Skills, 3rd Edition, 1-4180-5233-7, P1062-1070
Visual Nursing: A guide to Diseases, Skills and Treatments, 2nd Edition, 978-1-60913-650-5, P330-331
Clinical Nursing Skills, 4th Edition, 978-1-4511-9271-1, P888
Clinical Nursing Skills and Techniques, 8th Edition, 978-0-323-08383-6, P737-750