BLOOD

ADMINISTRATION

NRS 108
ESSEC COUNTY COLLEGE
Majuvy L. Sulse MSN, RN,CCRN
Objectives:
Use safe accurate techniques and apply the nursing
process when caring for clients who are receiving blood and
blood products.
Definition of terms
 Antigen-substance that elicits an immune
response; mostly proteins (can also be
lipoproteins, polysaccharides and nucleic acids.
 Antibody-substances produced by the plasma
(300 molecules/sec) secreted into the blood &
other extracellular fluids
 Agglutination-a clumping like antibody action that
results from an antibody molecules having at least
two antigen binding sites
Definition of terms cont’d

 Lysis-cell membrane destruction, occurs

because of antibody binding to membrane-
bound antigens of some invaders.

 Blood transfusion- are actual transplantation of tissue

from one person to another. Donor and recipient must be
checked for compatibility to prevent lethal reactions.
Blood Transfusion cont’d

 Compatibility is determined by 2 different types of

antigen systems (Cell surface proteins) ABO system
antigen & the Rh antigen (membrane surface of the
RBCs)

 RBC antigens are inherited and maybe one of the

following:
A antigen (type A blood)
B antigen (type B blood)
Both A & B antigen (type AB blood)
No antigen (type O blood)
Compatibility Chart for Red Blood Cell Transfusion

Recipient
___________________________________
Donor_______A______B______ AB_____0_
A X X
B X X
AB X
O X X X X
Rh Compatibility
 An Rh negative person is born without the
antigen and does not form antibodies unless
he or she is spefically sensitized to it.
Sensitization can occur with RBC transfusions
from an Rh positive person or exposure during
pregnancy and birth.
 An Rh positive person can receive an RBC
transfusion from an Rh negative donor
 Rh negative people MUST NEVER receive Rh
positive blood.
Blood Product Components & Indications
for Usage
 Red Blood Cell (RBC)-
administered to
 replace erythrocytes lost
from trauma
 Erythrocytes lost from

surgical intervention
 clinical conditions that result

in destruction or abnormal
maturation of RBCs
 Hgb less than 6 g/dL or 6-

10 g/dL if clinical symptoms

are present.
Blood Product Components & Indications
for Usage-cont’d

 Platelet Transfusions are administered

 Platelet counts below 20,000 mm3

 Thrombocytopenic patients actively bleeding

or going for an invasive procedure

Blood Product Components & Indications
for Usage-cont’d
 Cryoprecipitate-
 product derived from plasma. Clotting factors (Vlll,

Xlll), fibronectin, and fibrinogen are precipitated from

pooled plasma.
 Clients with fibrinogen level less than 100 mg/dL or

clotting factor disorder at a volume of 10-15 ml/unit

usually IV push within 3 minutes
Blood Components continued
 Plasma
 Replaces blood volume.

 Used for clients with clotting disorders.

 Actively bleeding with PT or PTT greater than 1.5

times than normal.

 ABO compatibility is required for transfusion of

plasma products.
 FFP volume is about 200 cc is given as rapidly as
the pt. can tolerate while the clotting factors are
viable generally over a 30-60 minute period. Use a
regular Y set or straight filtered tubing.
Nurses responsibilities when Initiating, Maintaining & terminating
A Blood transfusion Therapy

1. Assess lab values

2. Verify medical order

3. Send blood specimen for type & cross-matching

4. Obtain blood consent from client or next of kin if

unable/incompetent to sign

5. Assess VS, urine output, skin color, and history of

transfusion reactions
 6. Obtain venous access- large bore needle g.19

7.Obtain blood product from the blood bank

8. With another RN, verify client’s name, & number,
blood compatibility and note expiration time.

9. Administer blood using appropriate filtered tubing as
soon as possible

 10 Use only normal saline for priming the tubing or for

dilution
Nurses responsibilities when Initiating, Maintaining &
terminating A Blood transfusion Therapy

 11.Infuse slowly at about 2 ml/min during the 1st 15

minutes then adjust at ordered rate

 12.Remain with the client for the first 15-30 minutes of

infusion

 13. Take VS and record as per facility’s policy


14.Upon completion of transfusion, discontinue infusion
& dispose of bag & tubing properly.

 15. Document.
Transfusion Reactions

 An adverse reaction to blood transfusion therapy

ranging from mild to life threatening condition. If
this occurs:
 Stop the transfusion

 Maintain a patent IV line with Normal saline

 Notify the healthcare provider & blood bank

 Recheck identifying tags & numbers

 Monitor VS and urine output

Transfusion Reactions

 Treat symptoms per physicians order

 Save blood bag and tubing and send to
blood bank for exam
 Complete transfusion reaction reports
 Collect required blood and urine
specimen at intervals per hospital policy
to evaluate for hemolysis
 Document on transfusion reaction form
and patient chart
Acute Transfusion Reactions
 Acute Hemolytic Reaction-
 Cause by ABO or Rh incompatibility

 Clinical signs
 Mild reaction with fever and chills or life threatening
like DIC & circulatory collapse
 Apprehension

 Headache

 Chest pain

 low back pain

 Tachycardia/tachypnea

 Hypotension

 Hemoglobinuria
Acute Reactions cont’d.

 Febrile Reactions
 Caused by leukocyte incompatibility

 Prevented by using leukocyte filter tubing

 Clinical signs
 Sensation of cold

 Tachycardia

 Fever

 Hypotension

 Tachypnea
Acute Reactions cont’d

 Allergic reactions
 Results from sensitivity to plasma proteins of the donor
or history of allergy
 Antihistamines ( Epinephrine/corticosteroids) are used to
prevent reaction
 Washed RBCs are given for those with history of allergy

 Signs:
 Urticaria
 Itching
 Bronchospasm or anaphylactic reactions
Acute Reactions cont’d
 Circulatory overload
 Occurs when blood product is administered too
quickly
 Cardiac or renal insufficiency and older population
at risk
 Signs:
 Hypertension

 Bounding pulse

 Distended jugular veins

 Dyspnea

 Restlessness

 confusion
Acute Reactions cont’d
 Bacterial transfusions reactions (Sepsis)
 Blood products infected from improper handling and
storage
 May cause bacteremia or septic shock

 Massive transfusion reactions-due to large volume of

transfusions and can cause:
 Hypothermia

 Cardiac arrythmias

 Citrate toxicity

 Hypocalcemia

 Hyperkalemia
Delayed transfusion Reactions

 Delayed hemolytic reactions

 Hep B
 Hep C
 HIV
 Iron overload
 Graft versus host disease