Megan non-sterile material from coming into contact with

Megan Matthews



Professor Sarah Connolly

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and Transfusion Reactions

of blood are a tricky business and only the qualified personnel should handle
such products. During a transfusion, blood goes from a donor bag, into a
patient who has either: a lot of blood loss, low Hematocrit, and Hemoglobin, or
a combination of either. In this paper I will discuss transfusions, the risks,
benefits, and reactions that may happen as well as those who are qualified to
administer them.

blood is the process by which blood or blood products, including plasma and
platelets, are administered via an intravenous catheter (I.V.). Most commonly a
transfusion is obtained from an unrelated donor. These products are
administered using an aseptic technique that utilize measures to prevent any
non-sterile material from coming into contact with the sterile material going
into the patient” (Blood Transfusion: Administering — an Overview, 2017). This is most commonly done in an acute care
setting, or if further therapy is needed it can be done in a “physician’s office,
outpatient clinics, and ambulatory care settings” (Blood Transfusion: Administering — an
Overview, 2017).

transfusions can be administered by a Physician, emergency responders, and
licensed RN’s who have the proper education in their facilities procedures and
is trained to look for adverse reactions.  A licensed vocational nurse (LVN) is allowed
to witness and cosign blood but is ultimately not responsible for anything
there after. The nurse is the person who deals with the after effects of
administration, if any should occur. Other assistive personnel are allowed to
monitor for adverse reactions such as “itching, swelling, redness, or in a
worst case scenario, an anaphylactic reaction, but again are not responsible
for intervening and identifying such” (Blood Transfusion: Administering — an
Overview, 2017). Properly trained personnel should notify
the nurse if any reaction should occur. The desired outcome of transfusions is
the replacement of lost material without complications (Blood Transfusion: Administering — an
Overview, 2017).

are many benefits to receiving transfusions. “Currently, there are no
oxygen-carrying blood substitutes that have been approved by the U.S. FDA.

Blood serves a number of critical life functions, including, cellular support, delivery of oxygen, nutrients (e.g., glucose,
amino acids, fatty acids) to body cells, transport of waste products
(i.e., carbon dioxide, urea, lactic acid) from the cells, immune support (e.g., delivery
of granulocytes to an infection site), coagulation support, regulation of body pH, transportation of hormones, and regulation of core body
temperature” (Blood Transfusion: Administering — an Overview, 2017).

Transfusions are used to correct low levels of blood from different

However, prior to
the administration the nurse must be familiar with what is in whole blood, or
what makes it up (Blood Transfusion: Administering — an Overview, 2017). “The primary component of blood is plasma
(about 55% of total volume). The remaining components are Red Blood Cells,
White Blood Cells, and platelets. The typical whole volume of a unit of blood
equals 550 mL. Typically, due to age and processing, there are no functional
platelets or neutrophils in whole blood, so therapeutically, a unit of whole
blood is the equivalent to a unit of RBC’s and a unit of plasma” (Blood
Transfusion: Administering — an Overview, 2017).

plasma is another way to administer blood products into the body. “Transfusion
of fresh frozen plasma, is the administration of all it contains such as clotting
factors, proteins, platelets and plasma. The storage time is limited to 5 days
in a temperature controlled station and is agitated during that time”. This is
because if it stays longer or gets warmer, there is an increased risk of
bacterial growth which may cause a reaction to the patient (Blood
Transfusion: Administering Fresh Frozen Plasma, 2017). Looking at the blood bag for
any abnormalities such as free floating organisms or a change in color are
grounds to have the infusion postponed, and the product be sent back down to
the lab (Blood Transfusion: Administering — an Overview, 2017).

            In order to infuse blood there is a correct manner in
which to follow to prevent any mistakes. First, you perform proper hand hygiene
and don gloves, while introducing yourself to the patient. Secondly, ask the
patient the name, date of birth, and any known allergies. Then, once you have obtained
the blood from the blood bank, record the time it left the blood bank, and the
time it was infused. This is because you can wait no longer than 30 minutes between
this time period. The transfusion can go on for no longer than 4 hours (Blood
Transfusion: Administering — an Overview, 2017).

After, at the bedside, confirm with another nurse that this is the
correct person, place, time, route, and the right type of blood. Ask the
patient one more time their name and date of birth, and any known allergies. It
doesn’t hurt to double check. Immediately before setting up the transfusion you
are to obtain accurate vital signs. This includes blood pressure, temperature,
respirations, heart rate, and pulse ox. This is so you have a baseline if
anything should happen to the patient. If all are within company policy, then
you can begin to set up the transfusion to the patient (Blood
Transfusion: Administering — an Overview, 2017). Follow your Company’s policy
for setting up the transfusion as it may differ in some facilities, always
using aseptic technique.

            Adverse reactions can range from a wide variety of
symptoms. Those symptoms include fever and hives to more serious complications
like “anaphylaxis and vascular collapse, AKI, and hemolysis, or the bursting of
blood cells. The allergic reaction manifests as as a flushed face, itching,
wheezing, and can progress to swelling of the larynx” (Blood
Transfusion: Administering — an Overview, 2017). Another risk is a
blood-borne infection called bacterial sepsis which comes from contaminated
blood products and presents itself as fever, chills, and shock. Bacterial
sepsis can also lead to death (Blood Transfusion: Administering — an
Overview, 2017). Careful monitoring of the patient for any reaction can
help prevent what could be a fatal reaction.

can be treated by medicating the patients with antihistamines like Benedryl, Claritin,
and Zyrtec, which are the common brand names. These are to be administered
prior to the transfusion, and the worst case involves epinephrine for the
anaphylactic reactions (Blood Transfusion: Administering — an Overview, 2017). The risk for immune reactions can be reduced by “using
irradiated or leukocyte-depleted blood components” (Blood
Transfusion: Administering — an Overview, 2017). This means that there
are less leukocytes in the transfusion that are able to react with the patients
already existing blood low in the body. The radiation will cause the white
blood cells in the transfusion to become inactive. Other components that cause
reaction can be reduced with removal from the RBC’s and platelets with a wash
down of saline solution. (Blood Transfusion: Administering — an
Overview, 2017). If a reaction is noticed, the infusion should be
immediately stopped and all the proper health care providers notified
immediately, and all unused blood products be sent back to the blood bank.

are a few things you can expect after administering a blood transfusion which
include: the “components will be administered without complication, and any
signs and symptoms of a reaction will be promptly identified and treated” (Blood
Transfusion: Administering — an Overview, 2017).

family and patient should also be taught some key points about this administration.

Explaining the reason for the product is essential. If the patient has no idea
why they are getting this, take the time to sit with them and explain with
phrases that are easy for them to understand. Medical jargon can be
overwhelming. Include the benefits and risks as well. “If further testing is
required, explain why they are ordered and what they can tell you” (Blood
Transfusion: Administering — an Overview, 2017). Also, educate the
patient to notify of any adverse reactions such as those listed above. Discuss
the measures and steps that will be taken to keep the patient safe throughout
the transfusion as well as any associated complications and assuring them that they
will be closely monitored and measures will be initiated should a reaction
occur (Blood Transfusion: Administering — an Overview, 2017).

conclusion, only qualified personnel who are trained in the art of
administering blood, can do so. There are many risks and fatalities that can
arise from improper technique and ignorance. Making sure the patient knows
these as well as any other personnel taking care of said patient can be
beneficial in early detection of a reaction, but ultimately the nurse is