Pre-Transfusion
Name 1 thing you need to check (in the medical record) prior to administering blood products? (Before you release blood product.)
ABO compatibility (type & screen), Consent for blood products, Orders from MD, Previous reactions?, any premedications
What tubing do you prime blood with?
Blood tubing!
Where do you get a blood warmer?
At SMH, as of July 2024, we can borrow from another unit like ICU or SMED
True/False: I have to have a second RN check the blood product with me prior to transfusing.
True! Check the blood product itself (no tears, leaks or abnormal appearance to the bag) and compare the label that comes with the product to the electronic medical record.
You just started a transfusion, your patient starts coughing and then goes silent with a dark red face, grabbing at their neck, what medication do you anticipate giving STAT?
Epi!
What should a complete blood order look like?
Per policy: Type of blood product (and any special needs ie: CMV negative, irradiated), volume (or # of units), instructions on the rate (max of 4 hours), date/time.
How long is this tubing and blood product good for once opened?
4 hours!
True/False: I'm in a rush. I can just heat up the unit of blood in a basin with warm water or put it in the blanket warmer.
False!! You can overheat, destroy the cells, cause clotting, introduce bacteria. Use the warmer!
You are transfusing platelets. What color should your unit be?
Off-white, yellow, light green (did you know, if the donor is taking hormonal birth control pills, their platelets may have a green hue to them?)
Your patient is dizzy & hypotensive. You are 15mins into a transfusion. What do you do?
Stop the infusion, maintain line with NS TKO, notify MD, lie patient supine or in reverse Trendelenburg. Anticipate transfusion reaction workup
What do you need to read off the blood product, matching with what is scanned/written in Epic?
-Patient name, MRN, DOB (2 pt identifiers)
-Type of blood product (with any special considerations, ie: CMV negative, irradiated, leukocyte reduced)
-Patient blood type & the unit's type (& "Crossmatch Compatible")
-Unit # (usually starting with "W"); Part # (if receiving partial unit)
-Donor ID Number
-Unit expiration date
Where do you place the empty/used blood product tubing & bag?
Red biohazard bag in soiled utility
If you're using a blood warmer, how long is the blood tubing good for?
4 hours!
When do you take vitals?
Per Policy: At the start of infusion (baseline)
At 15mins
Per clinical judgement (any time you feel worried about patient!) / if you notice acute changes
Completion
What vital signs can indicate a transfusion reaction?
Temperature elevation (generally, 1.1C or higher than baseline); new hypo/hyper-tension, tachycardia (general rule of thumb, baseline x 1.25=your max HR; similarly, BP x 0.75=your low BP), increased respiratory rate & desaturations
What medications might be used to premedicate a patient who has had past transfusion reactions?
Tylenol, Benadryl, possibly Pepcid or a steroid depending on the patient
Why do we use blood tubing?
There is a filter in place for any clotted blood product or precipitates. (Did you know we shouldn't squeeze the filter chamber and instead invert it while priming the line to prevent cracks? Hold the chamber upside down with the clamp open until you have enough in chamber, then invert and prime as normal)
What is the max temperature a blood warmer should be set to?
Blood warmer should be set 37-41C.
42C = no no number!! -Tag as broken, do NOT use, call Clinical Engineering
Your patient was admitted with a Hgb of 4.2, having a work-up for cancer. Do you anticipate rapid transfusion of a unit of PRBCs?
No! This can cause TACO or TRALI. Expect small aliquot infusions at first to prevent circulatory overload. Run infusions over the max time- 4 hours- unless MD orders otherwise. Remember, this patient has probably lived with low hemoglobin for a while and their body has compensated to live with a low hemoglobin.
Hepatitis B (<1 in 200k-500k).
followed by Hep C (1 in 1-2mil), HIV (~1 in 2mil), Human T-Cell lymphotropic virus (<1 in 2mil), West Nile Virus (1 in 4.57mil)
My pediatric patient is a Jehovah's Witness but needs PRBC's (life threatening necessity). What might I do to help the patient and/or family cope with this situation?
Chaplain consult; Offer to allow parents to leave room during transfusion (a volunteer or CCP/RN may stay with patient if needed); cover the product with a pillowcase while transfusing; arrange nighttime transfusions if possible.
True/False: I released the blood, I have it in my hands & I forgot I have an hour long antibiotic running. I can store the blood in the medication fridge as long as I transfuse within 4 hours.
FALSE. Blood has to be stored in a special cooler; if not ready for immediate use, return to blood bank
What is a clinical indication to use a fluid/blood warmer? (multiple answers accepted)
Presence of Cold Agglutinin antibodies; Exchange transfusion; Massive transfusions (ie: trauma); Intraoperatively to prevent/treat hypothermia; hypothermia
Your 12yo patient's pre-transfusion VS are as follows: Temp 36.9C, HR 100, BP 100/50, Resp Rate 20, and sats are 99%. They call you back in the room asking for a warm blanket and to adjust the temp. While in the room, they tell you their IV burns. You check the IV, it flushes fine. The room is already on 90F and quite warm, so you decide to check VS. They are now: Temp 38C, HR 110, BP 73/37. You don't get a chance to count respirations as the patient asks for a bedpan right away. Their urine is red. What do you do?
Stop transfusion, keep PIV TKO to saline, page MD to inform of possible transfusion reaction. Anticipate a bolus of crystalloid fluids, repeating VS, UA, labs including coags to assess for DIC. The patient may also require diuretic like lasix depending on MD & signs of renal failure. This could indicate an immune, acute hemolytic reaction (usually caused by clerical error, transfusing incompatible blood types). This can result in shock, death, DIC, renal failure.
Your patient's transfusion is flushing through the line, you're happy to be done finally. You're disconnecting the tubing, when you look up and your patient is blue. They aren't responding & don't seem to be breathing. What do you do first?
Call for help (#36, a shout out the door, or pulling the code blue button). ....CPR. Whew. close call.