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Blood Transfusions in Nursing Practice

Adapted from DepositPhotos.com
Adapted from DepositPhotos.com

 

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

  1. Assess why the patient needs to be transfused so that he/she can evaluate specific response to the procedure.
  2. Verify the health care provider’s order for the type of blood product to be given.
  3. 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.
  4. 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.
  5. Assess the type, integrity, and patency of the venous access in place so the transfusion will be completed without infiltration of the IV.
  6. 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.
  7. Review institution policy and procedure for the administration of blood components. Each institution has its own guidelines to ensure safe administration of blood products.
  8. Make sure that the client has signed an informed consent that includes potential risks and benefits of the procedure.

Unexpected Outcomes

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.
  • Discontinue transfusion immediately.
  • Notify health care provider immediately.
  • Give antihistamine parenterally, as necessary.
Febrile reaction: fever develops during infusion Fever and chills, headache, flushing, and malaise
  • Discontinue transfusion immediately.
  • Notify health care provider immediately.
  • Treat symptoms.
Hemolytic transfusion reaction: incompatibility of blood product

Immediate onset;

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

Death.

  • Discontinue transfusion immediately.
  • Notify health care provider immediately.
  • Obtain blood samples from site and send to laboratory.
  • Obtain first voided urine and send to laboratory.
  • Treat shock if present.
  • Send unit, tubing, and filter to laboratory.
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
  • Slow or discontinue transfusion.
  • Notify health care provider immediately.
  • Monitor vital signs.
  • Place in upright position with feet dependent or in high Fowler’s position.
  • Give diuretics as ordered.
Bacterial reaction: bacteria present in blood Fever, hypertension, abdominal pain, vomiting, diarrhea, back pain, profound hypotension and dry, flushed skin
  • Discontinue transfusion immediately.
  • Notify health care provider immediately.
  • Monitor vital signs.
  • Obtain culture of patient’s blood and return bag to laboratory.
  • Administer antibiotics stat.

 

Sources:

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

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