Blood Transfusions
Once consent is signed, how long is the consent valid?
The entire admission
Should you clamp a chest tube when the patient goes to CT or any procedure?
NO! This will give them a pneumothorax and/or harm your patient.
What lab value do we use to titrate Heparin drips?
PTT
Whose responsibility is it to call the family post code/rapid response when patient transfers to a higher level of care?
The transferring unit from the lower level of care.
Can you transfuse ANY medication/drip/fluid through the same IV site while giving blood products?
NOOOOO
Once a type and screen is drawn, how long are the results valid?
72 hours (can be extended to 14 days per blood bank depending on the patient and situation)
Name two conditions or reason a patient would need a chest tube
Pneumothorax, Hemothorax, pleural effusion, post operatively
Once we titrate the Heparin drip per the protocol, when do we recheck the PTT?
6 hours
You are questioning weather or not to call a rapid response on a patient. What do you do?
Call a rapid
Can you renew restraint orders via telephone because the physician told you to?
NOOOO, the physician has to renew them. You can place the initial order, just not the renewal.
Do you have to physically stay with the patient for the first 15 minutes of the transfusion?
Yes, Absolutely
When receiving report from IR, the RN states the patient has a left chest tube to -20 water seal suction. How should you respond?
Clarify if the chest tube is -20 suction OR to water seal. The chest tube is either TO suction or NO suction (water seal).
After titrating the Heparin, do we let pharmacy know? If so, how?
Yes. Orders, any order, PHA heparin rate change- message to pharmacy
A patient is not responsive to sternal rub, you feel for a pulse, there isn't one, what do you do next?
Push the code blue button and start compressions.
How long are EMS IV's and I.O. IV's good for?
24 hours, once access is established via PIV or PICC/Midline, those accesses are to be discontinued immediately. We are to NEVER use foot/leg IV's without an order.
How many times do vital signs need to be documented to transfuse one unit of blood?
3 times
Before transfusion starts, after 15 minutes, and the end
What are the tiny "rice crispy" bubbles found on the chest, neck, back called when a patient has a pneumothorax?
Crepitus
At 0800 the PTT was too high. We held the Heparin drip for two hours and restarted the drip at 1000 per the protocol. When is the next PTT?
1600 (4pm)
Where do you place the pads on a patient's chest during a code blue?
Upper right chest and left lower lateral phlebostatic axis
What IVF do we hang with any blood product?
Normal Saline ONLY
If there is a suspected transfusion reaction, what do you do with the blood product after stopping the infusion?
Send entire blood product, normal saline, all tubing, and paperwork back to lab.
Can you remove a chest tube if a physician tells you to?
NOOOOO you cannot remove a chest tube unless you have been checked off on this (CVICU). If you assist a physician with this at the bedside, they will need a suture removal kit, Vaseline impregnated gauze, 4X4 gauze, and tape.
While on Heparin drip therapy, the patient suddenly develops Hemoptosis, Hematuria, and black tarry stools. The BP is 78/42, HR 133 What do you do?
STOP THE HEPARIN! Call a rapid response! Likely there is an active bleed, and the Heparin drip will be discontinued, the patient will receive aggressive IVF therapy, potential transfer to higher level of care, and blood products.
What is the first medication to be given IV during a code blue?
Epinephrine
A patient has chest pain, as a nursing measure during our rapid, you do an EKG, it reads STEMI. What is your next step?
If they have cardiology, notify that cardiologist. If no cardiology, page the on-call STEMI physician. The on-call cardiologist will determine if a STEMI alert should be called or not. Once it is called you cannot cancel it.