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Blood transfusion therapy involves transfusing whole blood or blood components. Whole blood stored for more than 6 hours does not provide therapeutic platelet transfusion. Platelets should be administered as rapidly as tolerated.
Blood transfusion therapy involves transfusing whole blood or blood components. Whole blood stored for more than 6 hours does not provide therapeutic platelet transfusion. Platelets should be administered as rapidly as tolerated.
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Blood transfusion therapy involves transfusing whole blood or blood components. Whole blood stored for more than 6 hours does not provide therapeutic platelet transfusion. Platelets should be administered as rapidly as tolerated.
Droits d'auteur :
Attribution Non-Commercial (BY-NC)
Formats disponibles
Téléchargez comme DOCX, PDF, TXT ou lisez en ligne sur Scribd
involves transfusing whole blood or blood components (specific
portion or fraction of blood lacking in patient). One unit of whole blood consists of 450 mL of blood collected into 60 to 70 mL of preservative or anticoagulant. Whole blood stored for more than 6 hours does not provide therapeutic platelet transfusion, nor does it contain therapeutic amounts of labile coagulation factors (factors V and VIII).
1. Avoids the risk of sensitizing the patients to other blood components. 2. Provides optimal therapeutic benefit while reducing risk of volume overload. 3. Increases availability of needed blood products to larger population.
1. Whole blood transfusion Generally indicated only for patients who need both increased oxygen -carrying capacity and restoration of blood volume when there is no time to prepare or obtain the specific blood components needed. 2. Packed RBCs Should be transf used over 2 to 3 hours; if patient cannot tolerate volume over a maximum of 4 hours, 3. Platelets Administer as rapidly as tolerated (usually 4 units every 30 to 60 minutes). Each unit of platelets should raise the recipient¶s platelet count by 6000 to 10,00 0/mm3. 4. Granulocytes May be beneficial in selected population of infected, severely granulocytopenic patients (less than 500/mm3) not responding to antibiotic therapy and who are expected to experienced prolonged suppressed granulocyte production. 5. Plasma Fresh frozen plasma should be administered as rapidly as tolerated because coagulation factors become unstable after thawing. 6. Albumin Indicated to expand to blood volume of patients in hypovolemic shock and to elevate level of circulating albumin in patients with hypoalbuminemia. The large protein molecule is a major contributor to plasma oncotic pressure. 7. Cryoprecipitate Indicated for treatment of hemophilia A, Von Willebrand¶s disease, disseminated intravascular coagulation (DIC), and uremic bleeding. 8. Factor IX concentrate Indicated for treatment of hemophilia B; carries a high risk of hepatitis because it requires pooling from many donors. 9. Factor VIII concentrate Indicated for treatment of hemophilia A; heat-treated product decreases the risk of hepatitis and HIV transmission. 10. Prothrombin complex -Indicated in congenital or acquired deficiencies of these factors.
1. Clinical manifestations of transfusions complications vary depending on the precipitating factor. 2. Signs and symptoms of hemolytic transfusion reaction include: Fever Chills low back pain flank pain headache nausea flushing tachycardia tachypnea hypotension hemoglobinuria (cola -colored urine) 3. Clinical signs and laboratory findings in delayed hemolytic reaction include: fever mild jaundice gradual fall of hemoglobin positive Coombs¶ test 4. Febrile non-hemolytic reaction is marked by: Temperature rise during or shortly after transfusion Chills headache flushing anxiety 5. Signs and symptoms of septic reaction include; Rapid onset of high fever and chills vomiting diarrhea marked hypotension 6. Allergic reactions may produce: hives generalized pruritus wheezing or anaphylaxis (rarely) 7. Signs and symptoms of circulatory overload include: Dyspnea cough rales jugular vein distention 8. Manifestations of infectious disease transmitted through transfusion may develop rapidly or insidiously, depending on the disease. 9. Characteristics of GVH disease include: skin changes (e.g. erythema, ulcerations, scaling) edema hair loss hemolytic anemia 10. Reactions associated with massive transfusion produce varying manifestations
1. Ineffective breathing pattern 2. Decreased Cardiac Output 3. Fluid Volume Deficit 4. Fluid Volume Excess 5. Impaired Gas Exchange 6. Hyperthermia 7. Hypothermia 8. High Risk for Infection 9. High Risk for Injury 10. Pain 11. Impaired Skin Integrity 12. Altered Tissue Perfusion
1. Help prevent transfusion reaction by: Meticulously verifying patient identification beginning with type and cross match sample collection and labeling to double check blood product and patient identification prior to transfusion. Inspecting the blood product for any gas bubbles, clothing, or a bnormal color before administration. Beginning transfusion slowly ( 1 to 2 mL/min) and observing the patient closely, particularly during the first 15 minutes (severe reactions usually manifest within 15 minutes after the start of transfusion). Transfusing blood within 4 hours, and changing blood tubing every 4 hours to minimize the risk of bacterial growth at warm room temperatures. Preventing hypothermia by warming blood unit to 37 C before transfusion.
2. On detecting any signs or symptoms of reaction:
Stop the transfusion immediately, and notify the physician. Disconnect the transfusion set -but keep the IV line open with 0.9% saline to provide access for possible IV drug infusion. Send the blood bag and tubing to the blood bank for repeat typing and cultur e. Draw another blood sample for plasma hemoglobin, culture, and retyping. Collect a urine sample as soon as possible for hemoglobin determination. Ñ
1. The patient maintains normal breathing pattern. 2. The patient demonstrates adequate cardiac output. 3. The patient reports minimal or no discomfort. 4. The patient maintains good fluid balance. 5. The patient remains normothermic. 6. The patient remains free of infection. 7. The patient maintains good skin integrity, with no lesions or pruritus. 8. The patient maintains or returns to normal electrolyte and blood chemistry values.
Postural Drainage Therapy
PDT 1.0 PROCEDURE: Postural drainage therapy (PDT) is a component of bronchial hygiene therapy. It consists of postural drainage, positioning, and turning and is sometimes accompanied by chest percussion and/or vibration. Cough or airway clearance techniques are essential components of therapy when postural drainage is intended to mobilize secretio ns. Postural drainage therapy is often used in conjunction with aerosol administration and other respiratory care procedures. This procedure has be en commonly referred to a chest physiotherapy, chest physical therapy, postural drainage and percussion, and percussion and vibration. PDT 2.0 DESCRIPTION/DE FINITION: Postural drainage therapy is designed to improve the mobilization of bronchi al secretions and the matching of ve ntilation and perfusion, and to normalize functional r esidual capacity (FRC) based on the effects of gravity and external manipulation of the thorax. This includes turning, postural drainage, percussion, vibration, and cough. 2.1 Turning Turning is the rotation of the body around the longitudinal axis to promote unilateral or bilateral lung expansion and improve arterial oxygenation. Regular turning can be to either side or the prone position, with the bed at any degree of inclination (as indicated and tolerated). Patients may turn themselves or they may turn by the caregiver or by a special bed or device. 2.2 Postural Drainage Postural drainage is the drainage of secretions, by the effect of gravity, from one or more lung segments to the central airways (where they can be removed by cough or mechanical aspiration). Each position consists of placing the target lung segment(s) superior to the carina. Positions should generally be held for 3 to 15 minutes (longer in special situati ons). Standard positions are modified as the patient's condition and tolerance warrant. 2.3 External Manipulation of the Thorax 2.3.1 Percussion Percussion is also referred to as cupping, clapping, and tapotement. The purpose of percussion is to intermittently apply kinetic energy to the chest wall and lung. This is accomplished by rhythmically striking the tho rax with cupped hand or mechanical device directly over the lung segment(s) being drained. No convincing evidence demonstrates the superiority of one me thod over the other. 2.3.2 Vibration Vibration involves the application of a fine tremorous action (manu ally performed by pressing in the direction that the ribs and soft tissue of the chest move during expiration) over the draining area. No conclusive evidence supports the efficacy of vibration, the superiority of either manual or mechanical methods, or an optimum frequency. PDT 3.0 SETTING: Although PDT can be used with neonates, infants, childrens, and adults, this Guideline applies primarily to older children and adults. PDT can be performed in a wide variety of settings. 3.1 Critical care 3.2 In-patient acute care 3.3 Extended care and skilled nursing facility care 3.4 Home care 3.5 Outpatient/ambulatory care 3.6 Pulmonary diagnostic (bronchoscopy) laboratory PDT 4.0 INDICATIONS: 4.1 Turning 4.1.1 inability or reluctance of patient to change body position. (eg, mechanical ventilation, neuromuscular disease, drug -induced paralysis) 4.1.2 poor oxygenation associated with position(eg, unilateral lung disease) 4.1.3 potential for or p resence of atelectasis 4.1.4 presence of artificial airway 4.2 Postural Drainage 4.2.1 evidence or suggestion of difficulty with secretion clearance 4.2.1.1 difficulty clearing secretions with expectorated sputum production greater than 25-30 mL/day (adult) 4.2.1.2 evidence or sugges tion of re-tained secretions in the presence of an artificial airway 4.2.2 presence of atelectasis caused by or suspected of being caused by mucus plugging 4.2.3 diagnosis of diseases such as cystic fibrosis, bronchiectasis, or cavitating lung disease 4.2.4 presence of foreign body in airway 4.3 External Manipulation of the Thorax 4.3.1 sputum volume or consistency suggesting a need for additional manipulation (eg, percussion and/or vibration) to assist movement of secretions by gravity, in a patient receiv ing postural drainage PDT 5.0 CONTRAINDICATIONS: The decision to use postural drainage therapy requires assessment of potential benefits versus potential risks. Therapy should be provided for no longer than necessary to obtain the desired therapeutic resul ts.
5.1 Positioning 5.1.1 All positions are contraindicated for 5.1.1.1 intracranial pressure (ICP) > 20 mm Hg(59,60) 5.1.1.2 head and neck injury until stabilized (A) 5.1.1.3 active hemorrhage with hemodynamic instability (A) 5.1.1.4 recent spinal surgery (eg, laminectomy) or acute spinal injury 5.1.1.5 acute spinal injury or active hemoptysis 5.1.1.6 empyema 5.1.1.7 bronchopleural fistula 5.1.1.8 pulmonary edema associated with congestive heart failure 5.1.1.9 large pleural effusions 5.1.1.10 pulmonary embolism 5.1.1.11 aged, confused, or anxious patients who do not tolerate position changes 5.1.1.12 rib fracture, with or without flail chest 5.1.1.13 surgical wound or healing tissue 5.1.2 Trendelenburg position is contraindicated for 5.1.2.1 intracranial pressure (ICP) > 20 mm Hg(59,60) 5.1.2.2 patients in whom increased intracranial pressure is to be avoided (eg, neurosurgery, aneurysms, eye surgery) 5.1.2.3 uncontrolled hypertension 5.1.2.4 distended abdome 5.1.2.5 esophageal surgerY 5.1.2.6 recent gross hemoptysis re-lated to recent lung carcinoma treated surgically or with radiation therapy(59) 5.1.2.7 uncontrolled airway at risk for aspiration (tube feeding or recent meal) 5.1.3 Reverse Trendelenburg is contraindicated in the presence of hypotension or vasoactive medication 5.2 External Manipulation of the Thorax In addition to contraindications previously listed 5.2.1subcutaneous emphysema 5.2.2 recent epidural spinal infusion or spinal anesthesia 5.2.3 recent skin grafts, or flaps, on the thorax 5.2.4 burns, open wounds, and skin infections of the thorax 5.2.5 recently placed transvenous pacemaker or subcutaneous pacemaker (particularly if mechanical devices are to be used) 5.2.6 suspected pulmonary tuberculosis 5.2.7 lung contusion 5.2.8 bronchospasm 5.2.9 osteomyelitis of the ribs 5.2.10 osteoporosis 5.2.11 coagulopathy 5.2.12 complaint of chest-wall pain