Physical Assessment Self S f-Directed Learning S SelfSeries

4. Blood & Blood Product Administration Ad i i t ti

Introduction
1. College of Nurses of Ontario: Each nurse is accountable: For his/her own conduct and practice by maintaining competence p y g p and refrain from performing activities for which he/she is not competent. To obtain knowledge, skills, and attitudes that translate into highg , , g quality nursing. To maintain competence and ensure public safety by pursuing lifelong learning as he/she is expected to have the knowledge, g g p g , skills, and judgment needed to care for his/her clients. To participate in the Reflective Practice process whereby each nurse identifies the strengths of his/her p g practice and develops a p learning plan to address areas that need development. A nurse educator is accountable: To ensure that nurses receive the appropriate education support education, and supervision when acquiring new knowledge and skills.

Introduction
2. STEGH Nursing Professional Practice Learning Partnership: Embraces the College of Nurses of Ontarios Practice Setting Consultation Program which involves employers and nurses in a joint effort to identify those elements of the workplace that support quality nursing care and those that could use improvement. p Supports and endorses the College of Nurses of Ontarios identified full scope of practice for all nurses.

Introduction
3. Incorporation of Adult Learning Principles in the development of: Self directed learning modules with RPN accountability for personal knowledge preparation for his/her skills practice in the facilitated learning laboratory setting. Specific Learning Outcomes. Learning partnership between the RPN and the Clinician within the facilitated learning laboratory environment. Teaching strategies to address the varied learning styles of participants in the facilitated learning laboratory sessions. 4. Each RPN must bring his/her own personal stethoscope to the facilitated learning laboratory.

Principles
The Physical Assessment Self-directed Learning Series acknowledges the following principles, guidelines, standards guidelines standards, and policies/procedures: Infection Control Policies & Procedures. Patient Safety. Staff Safety, Occupational Health & Safety Legislation. CNO Accountability Statements. STEGH Nursing Professional Practice. STEGH Nursing Policies & P N i P li i Procedures. d Adult Learning Principles.

Part 1: Blood, Laboratory Tests Canadian Blood T t &C di Bl d Services

Part 1: Learning Outcomes

Upon completion of Part 1 the learning will be able to: 1. Describe the function of the cellular and fluid components of blood. 2. Understand the information provided in a Complete Blood Count result. 3. 3 Understand the antibody & antigen relationship as it pertains to ABO types and Rh factor. 4. Describe the infectious disease testing that Canadian g Blood Services performs on donated blood prior to its release for transfusion.

Components of p Blood:
Blood is a mixture of cells and liquid, and each component has a specific function Blood Bl d carries nourishment, i i h t electrolytes, hormones, vitamins, antibodies, heat, and , , , oxygen to the body tissues; and carries away waste matter and carbon dioxide

Components of Blood:
Erythrocytes/Red E h /R d Blood Cells:
Hemoglobin: is the protein molecule within red blood cells that carries oxygen and gives blood its red color. Erythrocyte/Red Blood Cell membrane surrounding each cell is extremely fragile. Red blood cells make up about 40% to 45% of a person s persons blood and live for 120 days. .

Components of Blood:
Leukocytes/White blood cells :
Are part of the immune system, and the bodys main defense against infection. White blood cells make up less than 1% of a persons blood.

Components of Blood:
Thromobytes/Platelets: Thromobytes/Platelets:
Are cell fragments that control bleeding and account for <1% of blood. Figure: Platelets in clot formation over red blood cells.

Components of Blood:
Plasma: A yellowish liquid mixture of water, proteins, electrolytes, p y carbohydrates, cholesterol, hormones, and vitamins. About 55% of our blood is plasma.

Components of Blood:

Complete Blood Count:

Complete blood count is the calculation and analysis of the cellular components of blood, specifically, red blood cells, white blood cells, & platelets CBC also platelets. measures hemoglobin and gives an estimate of the volume of red blood cells in the blood (hematocrit). i th bl d (h t it) CBC can reflect problems with fluid volume such as dehydration, or loss of blood, reflect acute or chronic infection, and problems with blood clotting.

Complete Blood Count:

White blood cell count (WBC): The number of white blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4,300 and 10,800 ll 10 800 cells per cubic millimeter. bi illi t Red cell count (RBC): The number of red blood cells in a volume of blood. Normal range varies slightly between laboratories but is generally between 4.2 - 5.9 million cells/cmm. Hemoglobin (Hgb): The amount of hemoglobin in a volume of (Hgb): blood. Hemoglobin is the protein molecule within red blood cells that carries oxygen and gives blood its red color. Normal range for hemoglobin is different between genders and is approximately 13 - 18 grams per deciliter for men and 12 - 16 for women.

Complete Blood Count:

Hematocrit (Hct): Hct): The ratio of the volume of red cells to the volume of whole blood. Normal range for hematocrit is different between the sexes and is approximately 45 - 52% for men and 37 - 48% for women. Nursing Assessment: Always compare hemoglobin, and hematyocrit when assessing a CBC.

Complete Blood Count:

Mean Cell Volume (MCV): The average volume of a red cell. This is a calculated value derived from the hematocrit and red cell count. N ll t Normal range i 86 - 98 f t lit l is femtoliters. Mean cell hemoglobin (MCH): The average amount of hemoglobin in the average red cell. This is a calculated value derived from the measurement of hemoglobin and the red cell count. Normal range is 27 - 32 picograms. Mean cell hemoglobin concentration (MCHC): The average concentration of hemoglobin in a given volume of red cells. This is a calculated volume derived from the hemoglobin measurement and the hematocrit. Normal range is 32 - 36%.

Complete Blood Count:

Red cell distribution width (RDW): A measurement of the variability of red cell size. Higher numbers indicate greater variation in size. Normal range is 11 - 15. Platelet count: The number of platelets in a volume blood. Platelets are not complete cells, but actually fragments of cytoplasm from a cell found in the bone marrow called a megakaryocyte. Platelets play a vital role in blood clotting. Normal range varies slightly between laboratories but is in the range of 150,000 - 400,000/cmm.

Differential:
WBC Differential - sorts the white blood cells into five subtypes: eosinophils, neutrophils, lymphocytes, monocytes, and basophils, Each type of white blood cell is present in different concentrations and the term differential refers to the differential process of counting the different types of white blood cells. cells

ABO Blood Type, Rh Factor & Crossmatch: C Crossmatch: t h

ABO Blood Type:

ABO blood type: A B AB or O is based on the presence or absence A, B, AB, of the A and B antigens on red blood cells: cells:. Blood Type A has only the A antigen on the red blood cell. Blood Type B has only the B antigen on the red blood cell. T pe onl cell Blood Type AB has both A and B antigens on the red blood cell. Blood Type O has neither A nor B antigens on the red blood cell. Depending on the ABO blood type the will be antibodies developed within the blood plasma - antibodies against the antigens that the red blood cells lack, that is: Blood Type A has anti-B antibodies in plasma. antiBlood Type B has anti-A antibodies in plasma. antiBlood Type AB has neither antibody in plasma. Blood Type O has both anti-A and anti-B antibodies in plasma. antiantiAlthough the distribution of each of the four ABO blood types varies between racial groups, O is the most common and AB is the least common.

ABO Blood Types (Antigens & Antibodies):

ABO Blood Types (Antigens & Antibodies):

Rh Factor:
In routine blood typing and crossmatching tests the D antigen also known as the Rh factor is tested for on red blood cells: If the D antigen is present the blood is Rh-positive present, RhIf the D antigen is absent, the blood is Rh-negative. RhThe incidence of the Rh blood types varies between racial groups, but not as widely as the ABO blood types: 85% of whites and 90% of blacks are Rh-positive; Rh-positive 15% of whites and 10% of blacks are Rh-negative. Rht a s us o s, the syste s e t po ta ce after the In transfusions, t e Rh system is next in importance a te t e ABO system. Most Rh-negative people who receive RhRhRhpositive blood will develop anti-D antibodies. A later antitransfusion of Rh-positive blood could result in a severe Rhor fatal transfusion reaction.

ABO Blood Type & Rh Factor: yp

Figure: Blood Type is AB positive because the red blood cell surface antigens present are A antigen, B antigen and Rh (D) antigen Also note that there are no antibodies in antigen. the surrounding plasma.

ABO Blood Type & Crossmatch: Crossmatch:

Blood typing is a laboratory test done to determine a person's blood type. Crossmatch is completed if a blood transfusion is required to ensure that the donor blood is compatible with the recipients blood type & Rh f t t factor. In an emergency, when there is not enough time for blood typing and crossmatching, Blood Type O, Rh-negative may be given as Rhthis blood type is known as the universal donor because it has no ABO antigens for a patient's antibodies to attack. In contrast, Blood Type AB, Rh-positive known as the universal Rhrecipient because it has no ABO antibodies to attack the antigens on transfused red blood cells.

Canadian Blood Services:

Canadian Blood Services separates the collected blood into different components: Red blood cells: used for accident victims, surgery patients, and people who have anemia. p p Plasma: used to treat people with deficiency in clotting factors, burn victims and shock. Cryoprecipitate: derived from frozen plasma and used as a source of fibrinogen for patients with hemophilia. Platelets: used to aid blood clotting such as in patients with thrombocytopenia. thrombocytopenia White blood cells: used to help fight infection and protect the body. Patients who require transfusion only receive the blood component(s) that they need.

Canadian Blood Services:

Canadian Blood Services:

Before blood is issued to hospitals for transfusions it is tested for infectious diseases: Syphilis Hepatitis B (Anti HBc) Hepatitis C HIV-1 & HIV-2 Human T-cell lymphotropic virus HTLV-I & HTLVII (viruses that can cause a rare form of leukemia in adults & chronic nervous system disease) disease). West Nile Virus (WNV).

Part 1: Review
Reflect on the Part 1 Learning Outcomes and ask Learning yourself: Have I achieved the identified Learning Outcomes? If your answer is yes then continue on to the next section. section If your answer is no then: g 1. Review the Part 1 slides again. 2. Look for other resources to assist you in the area that you have concerns with (e.g. Clinical Nursing Skills & Techniques, P T h i Perry & P tt ) Potter). 3. Seek out dialogue and clarification with peers, Unit , p g Leader, clinician related to the specific learning outcome in question.

Part 2: Nursing/Patient Assessment Before, During, and Post Transfusion

Part 2: Learning Outcomes

Upon completion of Part 2 the learning will be able to: 1. Describe the importance of a complete Nursing/Patient Assessment prior to, during and following the administration of a blood/blood product transfusion. 2. Describe the fluid shift expected upon the administration of a hypertonic blood product to a patient. 3. Identify the gauge of IV catheter that is required for the administration of packed red blood cells.

Nursing/Patient Assessment:
Admitting diagnosis & health history. Auscultation of lung fields before , during, and post transfusion, and advocate for diuretic therapy if required. Peripheral Assessment mucous membrane check Assessment, check, nail beds & capillary refill. Baseline vital signs: IV administration of hypertonic blood products increases intravascular fluid volume and may elevate blood pressure pressure. Some patients may not tolerate the intravascular volume load and may develop fluid volume excess, leading to markedly elevated blood pressure, tachycardia, tachycardia pulmonary edema, or cardiac failure. edema failure

Nursing/Patient Assessment:
Known allergies Complete Blood Count pre and post transfusion. Blood type & crossmatch, Bl d t t h Electrolytes: When blood is stored, there is continual destruction of RBCs which releases RBC s potassium from the cells into the plasma. If blood is transfused rapidly, there may be transient hyperkalemia before the potassium is reabsorbed. reabsorbed Understand the indications for and the goal of the transfusion therapy for the p py patient. This will assist in the evaluation of the patient outcome(s) and assessment of the need far further therapy.

Nursing/Patient Assessment:
Provide the patient or significant other with blood and blood product information and risk forms. Verify the patient s patients understanding of the procedure and its rationale, and answer patient questions. Obtain a signed consent from the patient. Obtain patients transfusion history have they experienced a reaction in the past, & anticipate a similar reaction. reaction Fluid Balance intake & output measurement. Ensure that the patients IV cannula is intact, and that patient s the insertion site is patent. An IV cannula of 16 or 18 gauge is recommended for RBC transfusion.

Part 2: Review
Reflect on the Part 2 Learning Outcomes and ask Learning yourself: Have I achieved the identified Learning Outcomes? If your answer is yes then continue on to the next section. section If your answer is no then: g 1. Review the Part 2 slides again. 2. Look for other resources to assist you in the area that you have concerns with (e.g. Clinical Nursing Skills & Techniques, P T h i Perry & P tt ) Potter). 3. Seek out dialogue and clarification with peers, Unit , p g Leader, clinician related to the specific learning outcome in question.

Part 3: Type of Blood Product Transfusion and Supplies & Equipment Preparation

Part 3: Learning Outcomes

Upon completion of Part 3 the learning will be able to: 1. State the expected rise in a patients hemoglobin and hematocrit following the administration of a unit of packed RBCs. 2. State the expected rise in a patients platelet count following the administration of a unit of platelets platelets. 3. Understand the rationale for the administration of the various blood products to patients. 4. Describe the importance of the in-line blood filter being covered with fluid.

Packed RBC Transfusion:

Volume 300 t 350 ml. V l to l Transfusion time: < 4 hours. Red cell transfusions raise a patient's hematocrit and hemoglobin values. These transfusions go to patients with chronic anemia caused by a variety of ailments, including kidney failure, cancer, failure cancer and gastrointestinal bleeding Red bleeding. cells are also used to correct significant blood loss in acute illness situations, like surgery or severe trauma. tra ma Each transfused unit of RBCs should raise hemoglobin 1 g/100 ml. and hematocrit by 3% in g g ml. y non hemorrhaging adult patient.

Packed RBCs:

Fresh Frozen Plasma:

Volume: 200 to 250 ml. Infusion time: < 4 hours. Replaces plasma without red blood cells or platelets; contains most coagulation factors and complement. FFP may be given to patients for the control of g p g bleeding where replacement of coagulation factors is needed, e.g. DIC (Disemminated Intravascular Coagulopathy).

Fresh Frozen Plasma:

Platelets:
Platelets from single donor, Volume: 200 to 500 ml. Platelets from multiple donors (pooled), Volume: 40 to 70 ml/unit; 1 unit/10 kg body weight. Infusion time: < 4 hours. For patients with thrombocytopenia. Single-donor platelets are most useful in immunologically refractory patients when given as HLA matched with f t ti t h i t h d ith recipient. Each transfused unit expected to raise platelet count by 5000 to 10,000/ml in a 70 kg patient.

Platelets:

Albumins (Colloid Components): ( )

1. Albumin 5% (pooled) is an Isotonic Solution:
Volume: 250 to 500 ml. Infusion Time: 1 to 10 ml/min. Albumin: This major protein constituent of blood is often given to individuals t t t h ft i t i di id l to treat hypoproteinemia i t i i in burns and hypoalbuminemia in shock and ARDS; used to support blood pressure in dialysis and acute liver failure. IV administration set is supplied by Blood Band with the product product.

Albumins (Colloid Components):

2. Albumin 25% (Pooled) is a hypertonic solution:
Volume: 50 to 100 ml. Infusion time: 0.2 to 0.4 ml/min. Albumin: This major protein constituent of blood is used to increase circulating blood volume by increasing intravascular osmotic pressure. IV administration set is supplied by Blood Band with the product.

Albumin:

Cryoprecipitate (multiple donors, pooled): l d)

Volume: 5 to 20 ml/unit; 1 unit/10 kg body weight. Infusion ti I f i time: 1 to 2 ml/min. t l/ i Cryoprecipitate is used to replace factors VIII, XIII, VIII XIII von Willebrands factor, and fibrinogen.

Cryoprecipitate:

Rh Immune Globulin (Rh G /RhIG) RhoGam/RhIG): RhoGam RhIG) ):

Rh Immune Globulin is used to suppress immune response of nonsensitized Rh (D) negative individuals who are exposed to Rh (D) positive red blood cells either by: o Fetal maternal hemorrhage during the delivery of an Rh positive infant oAbortion (spontaneous or induced) oFollowing anmiocentesis, abdominal trauma, or accidental transfusion of Rh (D) positive cells. Administration Ad i i t ti prevents an i t immune response with ith subsequent anti-Rh (D) antibody formation.

Rh Immune Globulin (RhoGam/RhIG): (RhoGam/RhIG):

Immune Globulin (Human):

Purpose: Prevent or attenuate a wide variety of infectious diseases. Treat Idiopathic Thrombocytopenic Purpura (ITP) when a rapid rise in platelet count is needed to control bleeding; or preoperatively in Rh negative p patients to modulate immune response. p Decrease risk/number of infection(s) in acquired immune deficiency and hereditary immune disorders. di d

Immune Globulin (Human):

Process: Blood Bank must special order this product from Canadian Bl d S i C di Blood Services and requires a 24 h d i hour advance notice. If an IV set does not come with the product, use a standard vented administration set and ensure vent is open. Precautions: P ti Administer IV ONLY. Compatible with D5%W only only. Incompatible with 0.9% saline.

Supplies & Equipment:

(packed RBC s, FFP cryoprecipitate, platelets) RBCs FFP, cryoprecipitate Administration via Horizon Nxt IV Pump: B-Braun Y t BB Y-type Blood S t ( ith inline filt ) f Bl d Set (with i li filter) for Horizon Pump #US 3120. 500 ml bag of normal saline (Na Cl 0.9%). Horizon Nxt IV Pump. Gloves Administration via Gravity: Same tubing can be used B-Braun Y-type Blood Set (with inline filter) for Horizon P Bl d S t ( ith i li filt ) f H i Pump # US 3120. Drip Factor: 10 drops/ml. gloves

Priming/Flushing Blood Tubing:

Normal Saline (0.9% saline) should be used to prime the IV tubing before blood/blood product administration, and t clear th li post d i i t ti d to l the line t administration. Exception: Immune Globulin (Human) is administered with 5% Dextrose (D5W).

InIn-Line Blood Filter: It is imperative that Filter:

the in-line blood filter be completely covered inwith solution. Membranes surrounding red blood cells are extremely fragile and prone to rupture, therefore the blood drops should land in solution and never be allowed to drop onto the exposed filter.

InIn-Line Blood Filter: Completely covered

with solution allowing the blood drops to land in ith l ti ll i th bl d d t l di solution and not on the exposed filter.

Part 3: Review
Reflect on the Part 3 Learning Outcomes and ask Learning yourself: Have I achieved the identified Learning Outcomes? If your answer is yes then continue on to the next section. If your answer is no then: 1. Review the Part 3 slides again. 2. Look for other resources to assist you in the area that you have concerns with (e.g. Clinical Nursing Skills & Techniques, Perry & Potter). 3. Seek out dialogue and clarification with peers, Unit Leader, clinician related to the specific learning outcome in question. t i ti

Part 4: Verification Procedure

Part 4: Learning Outcomes

Upon completion of Part 4 the learning will be able to: 1. Describe the required verification procedure in preparation for the safe administration of blood/blood products to patients.

Verification Procedure:

Verification Procedure:
At the patients bedside, the health care professional administering the blood product and an RN, RPN, pregraduate clinical nursing student &/or physician must check the following for patient identification & accuracy: Patient s Patients armband Cross match information on the blood/blood component bag/bottle Blood Product Administration tag issued with the product from the Blood Bank. Physicians d Ph i i order.

Verification Procedure:
Ensure th t all th f ll i i f E that ll the following information i correct: ti is t Patients first and last name on armband, and have patient state his/her name if able. Patients E number. Donor unit number. Patients ABO and Rh group. Donor ABO and Rh group. Check expiry date on the blood product bag/bottle.

Following verification, both parties are to sign in th i the appropriate space on the Blood Product i t th Bl d P d t Administration tag and Blood Product Transfusion Record Record.

Review: Part 4
Reflect on the Part 4 Learning Outcomes and ask Learning yourself: Have I achieved th id tifi d L H hi d the identified Learning O t i Outcomes? ? If your answer is yes then continue on to the next section. If your answer is no then: 1. Review the Part 4 slides again. 2. Look for other resources to assist you in the area that you have concerns with (e.g. Clinical Nursing Skills & Techniques Perry & Potter) Techniques, Potter). 3. Seek out dialogue and clarification with peers, Unit Leader, clinician related to the specific learning outcome in question.

Part 5: Patient Safety Guidelines & Patient Assessment During Transfusion:

Part 5: Learning Outcomes g

Upon completion of Part 5 the learning will be able to: 1. Understand the rationale and importance of the patient safety guidelines related to blood/blood product transfusions. 2. 2 Locate the STEGH Blood Product Transfusion STEGH Record, and describe the importance of the stated patient assessment as outlined on the form, and for use as a guide and resource f safe nursing practice. id d for f i ti 3. Describe the potential transfusion reactions that patients may experience during blood/blood product administration.

Patient Safety Guidelines:

Gently rotate blood component bag to equally distribute cells throughout - NEVER shake/agitate the bag. Blood products should NOT be piggybacked into a main line that has been used for any solution other than normal saline. Whenever possible, administer blood products as the main line. Do NOT add any medications directly to any blood product or via piggyback into the blood administration line. All blood products MUST be infused within 4 HOURS of distribution from the Blood Bank.

Patient Safety Guidelines:

All blood products and fractionation products, if NOT used MUST be returned to Blood Band within 30 minutes of i i t f issue. P d t returned after this Products t d ft thi time frame will be DISCARDED by Blood Bank. To reduce bacterial contamination, a blood tubing set with filter will be used for a MAXIMUM of 2 units of bl d/bl d products. f blood/blood d t Tubing & filter MUST be flushed well with normal saline before administration of second unit of blood.

Nursing/Patient Assessment During Blood Transfusion:

Ensure that a STEGH - Blood Product Transfusion Record is at the patients bedside. Compete Nursing/patient assessment (including vital signs) as outlined on the record: Baseline 15 minutes: During the first 15 minutes of the infusion, remain with the patient, infuse blood at a slower rate (10 to 15 ggts/min) monitor and observe closely for evidence of ggts/min) transfusion reaction. Most severe reactions will occur within the first 15 minutes of the infusion. 30 minutes 1 hour 2 hours 3 hours 4 hours

Transfusion Reaction:
Transfusion Reaction Acute Hemolytic Cause ABO or Rh incompatibility. Rare and potentially fatal Assessment & Nursing Action -Usually occurs within 10 to 15 minutes of infusion. -Antigen antibody reaction with hemolysis. -Lumbar/flank pain, hypotension, tachycardia, d t h di dyspnea, n/v, fever, / f chills, facial flushing, anxiety. -Stop transfusion, maintain IV Stop access, change IV tubing & infuse , g g 0.0% Saline TKVO. -VS, Code Blue cart ready, oxygen, notify physician. -recheck the verification process process. -Notify Blood Bank & lab & to draw blood for transfusion reaction & return blood unit & tubing to lab. -Obtain urine sample to lab, transfusion reaction.

Transfusion Reaction:
Transfusion Reaction Febrile Cause Assessment & Nursing Action White cell antibodies -Fever above baseline occurring within or platelet 2 hours of transfusion initiation. antibodies. antibodies -Tachycardia, chills rigors, facial Tachycardia chills, rigors flushing, headache, myalgias, light headedness, n/v. -Treat with antipyretics ( y (as ordered). -Notify physician. ________________ ______________________________ -Variable local urticarial syptoms such as erythema, hives, itching, pruritus. -Stop transfusion and infuse 0.9% saline TKVO. -Notify physician & administer antihistamines (as ordered). Notify type. -Notify Blood Bank of reaction type

______________

Allergic, urticarial Recipient sensitive to plasma protein in donors blood initiating antibody response to donor plasma proteins.

Transfusion Reaction:
Transfusion Reaction Allergic Anaphylaxis Cause Potentially life threatening antibody to donor plasma proteins Assessment & Nursing Action -Usually occurs within 5 to 15 minutes of initiation of transfusion. -Severe respiratory & cardiovascular collapse. -Severe GI disturbances. Brochospasm/coughing, dyspnea, -Brochospasm/coughing dyspnea respiratory distress, hypotension, loss of consciousness, local edema, anxiety. -Stop transfusion & change IV tubing, &i f infuse 0 9% saline TKVO 0.9% li TKVO. -Support airway, oxygen PRN, Code Blue cart accessible. Assess -Assess VS q5 to 15 min. Reverse Trendelenburg position if hypotensive. -Notify physician, notify Blood Bank related to type of reaction, product # & interventions required. Return blood i t ti i d R t bl d product & tubing to Blood Bank.

Transfusion Reaction:
Transfusion Reaction Circulatory Overload Cause Volume overload due to rate of infusion too rapid for patient to tolerate. Assessment & Nursing Action -Cough, crackles at lung mid & lower lobes, SOB, dyspnea, respiratory distress, cough, cyanosis. -Tachycardia, headache, -Tachycardia headache constriction of chest. -Stop infusion and maintain 0.9% saline TKVO. -Support airway, position patient, oxygen prn. -Notify physician -Monitor fluid balance. Monitor -Diuretics (as ordered). -Transfusion may resume post treatment (as ordered).

Transfusion Reaction:
Transfusion Reaction Bacterial Contamination Cause Contamination may occur at any time during donation or processing of blood bl d product. d t Most often seen in platelet transfusions. ____________ Air or cellular debris entering IV bag/tubing. bag/tubing Faulty technique in g g changing equipment/bag. Assessment & Nursing Action -Fever, chills, hypotension, sepsis -Stop transfusion and infuse 0.9% Stop 0 9% saline TKVO. Notify physician. Notify Blood Bank of type of reaction, donor product #. d d t# Complete Blood Product tag & return any un-transfused blood products to Blood Bank. _______________________________ -SOB, chest pain, acute cyanosis, pain, cough, hypotension, cardiac arrhythmia, cardiac arrest arrest. -Stop transfusion and maintain IV 0.9% saline TKVO. p -Turn patient on left side, head down, & legs elevated above chest & head. -Code Blue cart at bedside.

______________ Embolism

Transfusion Reaction:
Transfusion Reaction Septicemia Cause Infectious agents in blood leading to systemic response. Blood/blood product hanging too long. Assessment & Nursing Action -Fever, chills, vomiting, diarrhea, hypotension, sudden shock, flushing of skin, hemoglobinuria, oliguria. -Disseminated Intravascular Disseminated coagulopathy. -Stop transfusion and maintain IV 0.9% saline TKVO. -Notify physician. N tif h i i Manage symptoms & treat septicemia as ordered. -Inform Blood Bank. -Blood cultures as ordered.

Transfusion Reaction:
Transfusion Reaction Citrate Toxicity Cause Citrate binds with serum calcium resulting in hypocalcemia. May M occur when h large volumes of Fresh Frozen Plasma administration. Assessment & Nursing Action -Numbness around mouth and in arms Numbness and legs. -Assess VS (Hypocalcemia can interfere with cardiac function). Notify h i i N tif physician.

Review: Part 5
Reflect on the Part 5 Learning Outcomes and ask Learning yourself: Have I achieved the identified Learning Outcomes? If your answer is yes then continue on to the next section. section If your answer is no then: g 1. Review the Part 5 slides again. 2. Look for other resources to assist you in the area that you have concerns with (e.g. Clinical Nursing Skills Techniques, P Skill & T h i Perry & P tt ) Potter). 3. Seek out dialogue and clarification with peers, Unit , p g Leader, clinician related to the specific learning outcome in question.

You have successfully Completed the Blood/Blood Product Administration Self-Directed Learning Series SelfModule. Next Steps: 1. Complete the remaining 3 modules in the Self-Directed Learning Series. 2. Ensure that you have purchased a stethoscope. 3. Book a facilitated learning session with a clinician in the Learning Laboratory by calling extension 2891.

References
1. Perry, A & Potter, P (2006) Cli i l Nursing Skills & 1 P A., P tt P. (2006). Clinical N i Skill Techniques. St. Louis: Mosby Inc. 2. Jarvis, C. (2000). Physical Examination and Health Assessment, Third Edition. Philadelphia: W. B. Sanders Co. 3. St. Thomas Elgin General Hospital (2005), Blood and Blood Products Transfusion Therapy Nursing Policies and Procedures. St. Thomas, Ontario. 4. Blood Components. Viewed March 2008 from www.wikimedia.org 5. Human Blood Cells. Viewed March 2008 from www.healthcare.utah.edu 6. Red Blood Cells and Hemoglobin. Viewed March 2008 form www.nlminig.gov

References
7. White Blood Cells. Viewed March 2008 from www.lymphomation.org 8. Platelets. Viewed March 2008 from www.astrographics.com 9. Plasma. Viewed March 2008 from www.bloodservices.ca 10. Complete Blood Count. Viewed March 2008 fro www.hghclinique.com q 11. Hematocrit. Viewed March 2008 from www.pezcyclingnews.com 12. Complete Blood Count with Differential. Viewed March 2008 from www.rnceus.com www rnceus com 13. ABO Blood Type & Rh Factor. Viewed March 2008 from www.answers.com 14. Crossmatch. 14 Crossmatch Viewed March 2008 from www wikimedia org www.wikimedia.org 15. BBO Blood Types (Antigens & Antibodies). Viewed March 2008 from www.algeria.com 16. Canadian Bl d S i 16 C di Blood Services. Vi Viewed M h 2008 f d March from www.canada.com

References
17. Patient Assessment. Viewed March 2008 from at e t ssess e t e ed a c 008 o www.saintjosephhealthcare.org 18. Blood Product Transfusion. Viewed March 2008 from www.istockphoto.com p 19. Packed Red Blood Cells. Viewed March 2008 form www.ams.cmu.acth.com 20. 20 Fresh Frozen Plasma Viewed March 2008 from Plasma. www.gambrobct.com 21. Platelets. Viewed March 2008 from www.gambrobct.com 22. Albumin. 22 Albumin Viewed March 2008 from www kmhk kmu ed tw com www.kmhk.kmu.ed.tw.com 23. Cryoprecipitate. Viewed March 2008 from www.ams.cmu.ac.th.com 24. Blood Bag Label. Viewed M h 2008 f 24 Bl d B L b l Vi d March from www.primerahealthcare.com 25. Patient Assessment During Blood Transfusion. Viewed March 2008 f from www.mariecurie.org.uk i i k 26.