LB
What signs and symptoms was LB exhibiting that would indicate low hemoglobin?
Pale, weak, fatigue, dizziness w/ position changes
What size IV should the patient have prior to transfusion?
18 or 20 g (or larger) depending on hospital protocol
The doctor ordered 2 units for LB, can I use the same IV tubing?
No, start over!
What signs and symptoms first indicated the patient was having a transfusion reaction?
What is the most common reason for a transfusion reaction?
What chronic and acute conditions require transfusion?
Acute bleeding, post-surgical transfusion, cancers, kidney disease
If pt needs anything IV during transfusion (like abx, pain meds), second IV is required. Nothing can be run with the blood.
How do you dispose of the tubing and empty unit of blood?
Biohazard bag
What kind of transfusion reaction did he have?
Hemolytic
Hemolytic
pt’s blood and donor’s blood are not compatible, immune system attacking, can lead to DIC, renal failure, and death; s/sx: back pain, bloody urine, chills, fainting, dizziness, fever, flank pain, flushing of skin
After starting the transfusion, what should the nurse do?
Stay with the patient for the first 15 minutes, assess vitals
How long do I have to transfuse one unit?
4 hours (may vary depending on hospital protocol)
What medication is run with the blood (on the Y)?
NS
What are the immediate priorities/nursing interventions when a transfusion reaction occurs?
STOP, disconnect, flush with NS, notify MD, notify blood bank, stay with patient, frequent vital signs
Allergic
recipient's immune system reacts to the proteins from the donor’s blood (rashes, hives, itching and can lead to anaphylaxis)
What education should you give the patient prior to administration?
Notify RN if you feel sweating, chills, chest pain, itching/hives, SOB, headache, backache, N/V
When the blood arrives on the unit, how long do I have to spike the blood and start the transfusion?
About 30 minutes (may vary based on hospital protocol)
How do you prime your tubing?
Prime with NS, then start blood. Transfusion time begins when blood has reached pt's IV.
What labs are typically ordered after a transfusion reaction?
clotting factors, BMP to assess for electrolytes and renal function, urine
Febrile (non-hemolytic)
recipients WBC’s reacting with donor’s WBCs, body develops antibodies, increase in temperature (1 degree C or 1.8 degree F from baseline); Most common transfusion reaction, especially in pt’s that have received transfusions in the past bc their body develops antibodies over time
Prior to blood administration, what assessments of the blood product and the patient are required to promote safe delivery and lessen potential complications?
Type and crossmatch; Blood band; Informed consent; education; verify allergies; assess understanding; previous blood transfusions; baseline vital signs; check order, verify consent, patient’s identification and blood bank ID, pt’s blood type, donor’s type, expiration date
If there is a transfusion reaction, how do you dispose of the blood product and tubing?
Put in biohazard bag and send to blood bank for further testing
When the blood unit bag is empty, what is the next step for the nurse?
Flush the line with NS drip
What medications could be ordered after a patient has a blood transfusion reaction?
fluids, corticosteroids, antihistamines, vasopressors
Graft vs host disease
(days to weeks after blood transfusion) - rare and deadly; donor’s T lymphocytes cause an immune response in the recipient by engrafting in the marrow of the recipient and attacks recipient’s tissues; fever, rash all over body; GI issues diarrhea, nausea, liver inflammation