Heparin
Heparin is used in the treatment of...(list 2)
What are... DVT, A-fib, PE, MI
When two nurses verify an order, medication, and rate this is called
What is double verification
What does leukoreduced mean in regard to blood products?
What is... removal of as many white blood cells (leuko) as possible from the unit to be transfused, in order to prevent febrile non-hemolytic reactions.
15 minutes into your patient's blood transfusion, she complains of chills and back pain. You note blood in her foley bag and on assessment, you find BP 90/52, T100.7 F. What kind of reaction is she having?
What is.... acute hemolytic transfusion reaction
How long do you have to start blood product transfusion after picking the unit up from the Blood Bank?
What is... 30 minutes
Heparin can be administered via these routes
What are IV and subQ
The steps of independent dual verification (for blood, heparin gtt, PCAs) are...
1) Two nurses verify correct med based on orders, labs, weight.
2) The 1st nurse calculates the dose and prepares pump independently.
3) The 2nd nurse also calculates the dose and checks pump independently with no input from the other nurse.
1) The threshold hemoglobin for blood transfusion is...
2) The threshold for platelets?
1) Transfuse RBC if <7
2) Transfuse plt if <10
Toward the end of the blood transfusion, your patient begins to complain of chills, headache, and flushing. Her temp is now 101 F. What kind of reaction is she having?
What is.... febrile non-hemolytic transfusion reaction
Can you pick up more than one unit of a blood product at a time from the Blood Bank?
No, unless it is an emergency such as active hemorrhaging
The antidote for heparin is...
What is protamine sulfate
An independent double-check is completed at these points during heparin gtt administration (3)
What are... initiation, new bag, and rate change
What is the lowest platelet count tolerable for a patient to undergo lumbar puncture?
What is... 50
10 minutes into his platelet transfusion, your patient becomes short of breath and expresses difficulty breathing. You find he is hypotensive, and determine he is having an anaphylactic transfusion reaction. What are your interventions?
What are.... stopping the transfusion immediately, opening a clean saline line, calling a rapid response, and giving epinephrine
You should change transfusion tubing this often
What is... every 4hrs or after 2 blood products consecutively, whichever comes first.
After two consecutive therapeutic results, the frequency for PTT draws can be changed to
True or false... independent dual verification is required prior to blood transfusion?
Bonus 100pts: When do you get vitals with blood transfusion?
What is... true.
Bonus answer: prior to starting transfusion, after 15 mins, 30 mins, 60 mins, and every hour until completion.
What is the lowest platelet count tolerable for Lovenox or heparin injection?
What is.... 50
Your patient received a blood transfusion earlier this afternoon and tolerated it well. You notice facial flushing as he is scratching his chest. On assessment, you find hives. What type of reaction is he having, and what is your intervention?
What is... mild allergic reaction. Administer antihistamines.
What are the 8 components that must be dual-verified prior to blood product transfusion?
What are... patient's name, DOB, MRN, pt blood type, donor blood type, unit #, expiration date, and any special phenotypes/considerations such as leukoreduced/irradiated/HLA-matched
This is the most serious adverse effect of heparin
HIT (heparin-induced thrombocytopenia)
Your co-worker has asked you to verify a rate change for the heparin drip and says it should be increased by 4 mL. What do you do next?
What is... re-calculate according to UNITS. Heparin protocol does not adjust by mL, but by units.
These are two types of thrombocytopenia for which platelet transfusion is absolutely contraindicated
What are... HIT (heparin-induced thrombocytopenia) and TTP (thrombocytopenic thrombotic purpura)
(plt transfusion can fuel the underlying disease process and increase risk for thrombotic events.)
Your patient with sickle-cell anemia presents to the hospital 10 days after a transfusion. She complains of dark-colored urine and appears pale but with yellow sclera. The patient is wondering, could this be related to the transfusion 10 days ago or something else? If it is a reaction, which kind?
What is.... yes, this could be a delayed hemolytic transfusion reaction.
Why might we irradiate blood products?
What is... to prevent Transfusion-Associated Graft-vs-Host Disease (TA-GVHD). This is rare, but can occur in immunocompromised pts or those who have had stem cell transplants.