ATI Therapeutic Procedure Blood and Blood Product Transfusions

PROCEDURE NAME Blood and Blood Product Transfusions REVIEW MODULE CHAPTER Description of Procedure Clients can receive transfusion of whole blood or components of whole blood for replacement due to blood loss or blood disease. AUTOLOGOUS TRANSFUSIONS: The client’s blood is collected in anticipation of future transfusions (elective surgery). This blood is designated for and used only by the client. Clients can donate up to 6 weeks prior to the scheduled surgery. If the client’s hemoglobin and hematocrit remain stable, donation can occur weekly until the desired amount of blood for the anticipated transfusion is collected. INTRAOPERATIVE BLOOD SALVAGE: Sterile blood lost during a procedure is saved or retrieved into a device that filters and drains the blood into a bag for transfusion intraoperatively or postoperatively. Reinfusion must occur within 6 hr of salvaged blood collection. Indications POTENTIAL DIAGNOSES Excessive blood loss: packed RBCs Anemia: (Hgb less than 6, or 6 to 10 g/dL, depending on findings): packed RBCs Kidney failure: packed RBCs Coagulation factor deficiencies such as hemophilia: fresh frozen plasma Thrombocytopenia/platelet dysfunction: platelets Hemophilia A: cryoprecipitate Burns, hypoproteinemia: albumin CONSIDERATIONS Nursing Interventions (pre, intra, post) Platelet transfusion: Platelet do not need to match the client blood type. Platelet infusion bags contain 200 to 300 mL Plasma transfusion: *Platelets are fragile and must be immediately infused once brought to the clients room and given over 15 to 30 min using a special transfusion set with a small filter and short tubing. * Vital signs are taken before the infusion, 15 min after the infusion starts and upon completion Plasma transfusion: *Plasma is frozen immediately following donation and is then in the form of fresh plasma (FFP). *FFP is transfused as soon as the unit is thawed while clotting factors are still active. *The client can react to the FFP transfusion if the ABO compatibility is not matched White blood cell transfusion (granulocyte) -Nursing Actions: WBCs suspended in 400 mL plasma should be infused over 45 to 60 min and vital signs are taken every 15 min. The presence of the provider may be required according to agency policy. Washed RBC (WBC-poor packed RBCs) Outcomes/Evaluation Clients can receive transfusions of whole blood or components of whole blood for replacement due to blood loss or blood disease Potential Complications Onset: Immediate or can manifest during subsequent transfusions Findings: -Results from a transfusion of blood products that are incompatible with the clients blood type or Rh factor. Can occur following the transfusion of a few as 10mL of a blood product. -Can be mild or life-threatening, resulting in disseminated intravascular coagulation (DIC) or circulatory collapse. -Include chills, fever, low-back pain, tachycardia, flushing, hypotension, chest tightening or pain, tachypnea, nausea, anxiety, hemoglobinuria and an impending sense of doom Nursing Actions: -Stop the transfusion -Assist with removing the blood tubing from the IV access. Avoid infusing further blood products into the circulatory system -Ensure that an infusion of 0.9% sodium chloride using new tubing is initiated. - Monitor vital signs and fluid status -Send the blood bag and administration set to the lab for testing -Stop the transfusion and administer antipyretics Client Education Nursing Interventions Platelet transfusion: *Platelets are fragile and must be immediately infused once brought to the cliets room and given over 15 to 30 min using a special transfusion set with a small filter and short tubing. * Vital sign are taken before the infusion, 15 min after the infusion starts and upon completion Plasma transfusion: A unit of 200 mL of FFP should be infused rapidly over 30 to 60 through a regular Y-set or straight filtered tubing White blood cell transfusion (granulocyte): WBCs suspended in 400mL plasma should be infused over 45 to 60 min and vital signs are taken every 15 min. The presence of the provider may be required according to agency policy. Washed RBCs (WBC-poor packed RBCs): * should be transfused a unit of 200 mL over 2 to 4 hr. * Administer to a client who has history of transfusion reactions or to a client who had a hematopietic stem cell transplant