Blood Products
Consists of all blood components; 450 – 500 mL/unit
Each unit raises the hemoglobin (Hgb) by 1g/dL (about 3%)
What is whole blood
may be due to ABO incompatibility. s/s: Fever, chills, Flank/back pain,
Oozing from IV site, hypotension. Occurs during transfusion or within
24 hours of transfusion completion
Acute hemolytic transfusion reaction
Severe, potentially life-threatening signs
Shortness of breath, respiratory distress Hypotension or hypertension, dec LOC;Flank or back pain; Hemoglobinuria; Oliguria/anuria
What do you do?
STOP transfusion immediately. Maintain patent IV, Assess the patient.Inform provider; Confirm the correct product was initiated. Determine type of reaction and treat as appropriate
TPN must be given through:
central line and use filter
What must be obtained prior to insertion of central line?
Consent
Whole blood with 80% of plasma removed; @300 ml/unit
Red Blood Cells (PRBC)
Most common reaction caused by release of cytokines from WBCs. Fever, chills, and/or rigor without other systemic symptoms
Febrile (non hemolytic transfusion reaction)
Antipyretics and maybe meperidine (Demerol) for rigors
Allergic rxn
How often should tubing be changed for TPN?
Q24 hours
What must be obtained prior to using a central line?
Chest xray verifying placement
Noncellular portion of blood that is separated and frozen after
donation; contains coagulation factors and proteins; 200 to 250 mL
Fresh Frozen Plasma (FFP)
Severe allergic reaction possibly due to IgA antibodies. Angioedema, wheezing and/or hypotension. Occurs during transfusion or within 4 hrs of transfusion completion
Anaphylactic transfusion rxn
Diuresis, supplemental oxygen. Ventilatory support if severe
TACO
What electrolyte must be monitored approx Q4 hours until established when giving TPN?
Blood sugars. Then once a day
What complication must you monitor for after insertion of central line?
pneumothorax
Small plasma protein prepared by fractionating pooled plasma
Albumin
Pulmonary edema due to volumeexcess or circulatory overload
• Hypertension may be present
• Occurs during transfusion or within
12 hours of transfusion completion
Transfusion associated circulatory overload (TACO)
May require intubation and mechanical ventilation
TRALI
What potential serious consequence can happen with lipids?
Lipid embolus
The site must be assessed each shift. What do you do to assess patency?
Flush Protocol: Use a 10mL syringe to avoid excessive pressure that can rupture the catheter.
Blood Return: Check for blood return before each use to ensure the line is not clotted or malfunctioning
Fragments of large bone marrow cells that help with clotting; @50 ml
Platelets
Fever, chills, respiratory distress, rales on auscultation, hypoxemia, hypotension, bilateral pulmonary edema on chest xray. Occurs during tranfusion or within 6 hours of transfusion completion
Transfusion related acute lung injury (TRALI)
Aggressive hydration and diuresis
Acute hemolytic transfusion reaction
Epinephrine, antihistamine, vasopressor
anaphylactic shock
What do you do if the line appears to be occluded?
Occlusion Handling: If a line is hard to flush, do not force it; it may require TPA/altplase to break up clots