OBJECTIVES OF PROCEDURE
– Introduction of safe blood and blood products in the venous circulation
Preparing and checking the necessary materials
– Tray trolley for medical or treatment
– Syringes / needles, sterile gloves suitable
– Blood bag or bottle iso group , iso- Rh
– Kit transfusion ( infusion filter)
– Catheter / flexulă
– Disinfectant wipes
– Garou , tape or tape non allergic
– Oilcloth , waste collection containers
– Flannel or blanket stand
– Check the integrity infusion kit packaging , expiry date
– Check the bag of blood, durability, macroscopic appearance of blood
– Inform the patient and explain the procedure step by step ( purpose, sensations that may occur , the risk of transfusion )
– Obtain informed consent using a written informed consent
– Inform the patient of: feeling cold , itching , irritation, or abnormal symptoms
b ) Physical
– Patient position – supine
– Ensure patient privacy
– Instruct the patient not to eat at least 2 hours before or after transfusion
– Choose where to puncture intravenously – Examine the quality and condition of the veins
– Veins are the most affordable of the upper limbs , lower limbs not the ( possibility of thrombosis )
– Check the doctor’s instructions regarding the amount of blood transfusion or its derivatives , and patient identity
– Wash hands / gloves sterile
– On the day of the transfusion of blood is collected 2-4 ml sample compatibility JEANBREAU
– Submit an application point of blood transfusion include:
• name of hospital
• name of the clinic where the patient is hospitalized
• name of the patient
• the patient’s blood group
• the amount of blood required
• name of the doctor who indicated transfusion
• Name Nurse administering blood
• Day , month, year
– Warm the blood at body temperature , maintain sterility when opening kit infused sterile
– Place the blood bag or bottle with stand
– Open kit transfused
– Attach the clamp / prestubul at a distance of 2-5 cm below the room perfusor
– Close the clamp / prestubul perfusor , get off the needle cover and insert it at the entrance of the bag or bottle
– Press perfusor tighten your drain and let it fill with blood halfway
– Remove the protective cap from the other end of the tube , open the clamp / prestubul and allow blood to flow in the tube until the air bubbles are eliminated
– Keep perfusions the body height to remove air bubbles , not down
– Close the clamp / prestubul and replace the protective cap
– Select suitable (preferably elbow veins of the envelope ) and put oilcloth under the patient’s arm
– Apply tourniquet to 10 – 12 cm above the puncture site ; heads tourniquet should be directed away from the puncture
– Check that the pulse distal radial
– Advise the patient to make a fist
– Disinfect the skin ( swab ) , 60 seconds
– Place your non-dominant hand at 4-5 cm below the puncture site and thumb stretch the skin over the vein
– Remove the cap from the needle and perfusor
– Attach the needle to puncture the vein infusion
– Watch the vein and the blood returns through the needle into the vein lumen needle advanced 1-2 cm
– Untie the tourniquet and tell the patient to open his fist
– When installing transfusion central line , flyer , then secure with the index finger of the left hand exerting pressure to puncture site 3cm above
– Pull Mandrel and attach the catheter lumen cannula to the tube end perfusor
– Open the clamp / prestubul and release blood to flow
– Attach the needle ( cannula , flexure , slip ) with strips of adhesive tape or non allergic
– Start taking blood
– Make OELECKER biological sample , dispense 20-30 ml of blood and adjust the pace at 10-15 drops / min for 5 ‘ , supervised patient and if no signs of incompatibility Repeat
– Apply over the bag or bottle label indicating the time at which blood transfusion began
– If the transfusion is complete, close the clamp / prestubul
– Withdraw the needle and apply an alcohol swab or a sterile dressing
– The bag or bottle should remain approx. 5-6 ml of blood is preserved in the event of accident transfusion checks late
– Place the patient in a comfortable position and cover
– Check the vital signs every 15 minutes during the first half hour after the start of transfusion , and every half an hour or one hour after transfusion .
– Inform the patient / family to notify the nurse in case of itching , shortness of breath , dizziness, chest pain or back as they can be of transfusion reactions
– Instruct the patient to notify nurse if pain or redness at the site of venipuncture appear because they are indicative of infiltration
– Room temperature 1 to 2 ° higher
– Provide patient warm liquids and cover with blanket
REORGANIZATION OF WORK
– Collect waste in special containers according PU
– Remove gloves
– Wash hands
MAKING NOTES PROCEEDING
Note the care plan :
– Management of transfusion
– Number written on the bag or bottle of blood transfusion time of beginning , the time over the possible reactions of the patient
EFFECTIVENESS EVALUATION PROCEDURE
Expected / desired :
– Assess patient’s response to the administration of blood
– Vital signs are normal
– No chills, itching , hives or irritation
– Laboratory tests within normal limits
– Colored pink mucous membranes and skin , the patient understand the purpose and risks of transfusion
Results unwanted / Do you:
– Pulmonary embolism – manifested by agitation, cyanosis , chest pain , coughing, painful , hemoptysis
– Intravascular hemolysis with renal failure , transfusion shock , metabolic acidosis , cardiac arrest with hypothermia – unheated blood may occur due
• Warm blood before it Infuse
• Monitor patient
• Tell your doctor
• Discontinue infusion
– Hemolytic shock – incompatibility group – chills , tachycardia , dyspnea, cyanosis, pain, retrosternal , malaise
• Tell your doctor
– Perfusor and needle clogging clots – perfusions and needle changes
• Heat the patient by increasing the number of blankets, hot water application buiote
– Do not heat the blood in warm water, or over heat sources , avoid shaking the bag / bottle
– If any transfusion reactions return bag / vial of blood transfusions point
– Maintain asepsis
– Do not fill with blood perfusor room – no longer follow the pace of flow
– If the needle is not clogged permeable needle through pressure
PATIENT MONITORING THE EFFECTS REATII transfusion
OBJECTIVES OF PROCEDURE
• Prevent adverse transfusion during and after transfusion .
• Establish measures to reduce transfusion reactions .
– Side effects may occur within the first 15 min of transfusion after transfusion.
– Are systemic reactions to the administration of blood and blood derivatives , incompatible with the beneficiary , containing allergens or contaminated with bacteria
– General adverse reactions may have symptoms ranging from fever, chills , urticaria , hypotension and cardiac arrest . Other possible side effects that may result from transfusion therapy include circulatory overload and the transmission of diseases : hepatitis , cytomegalovirus and human immunodeficiency virus ( HIV).
– Acute haemolytic reaction – ABO incompatibility , Rh and occurs within 5-15 ‘ of the establishment transfusion. It begins with the rise in temperature , heart rate , warmth and pain along the vein in which the blood is transfused , chills , headache , grace, chest and back pain , dyspnea , hypotension, homoglobinemie , haemoglobinuria . Stop the transfusion .
– Delayed hemolytic reaction – developed by the recipient immune response against non donor ABO antigens . Fever is unexplained , inexplicable decrease Hb, Ht , Coombs test is positive. Stop the transfusion .
– Febrile reaction nonhemolitică – 1% of transfusions , a possible receiver sensitivity to donor leukocytes and platelets in the blood . This occurs at 30 ‘ after the initiation of the transfusion and 6 h after transfusion . it
manifested by fever greater than 1 ° , flushing , chills, headache.
– Allergic reaction ( mild to moderate ) caused by allergy to proteins in plasma donor recipient . It occurs during transfusion and 1 h after transfusion . Appear local erythema , rash , urticaria .
– Severe allergic reaction – caused by allergy recipient to donor antigen (usually IgA ) . Agglutination of red cells obstruct capillaries and block blood flow , causing major symptoms at all major organ system . This occurs during the first 5 to 15 ‘ from the start of transfusion . Cough, nausea, vomiting, respiratory distress , hipotenshinea , possible unconsciousness and cardiac arrest . This is a life-threatening reaction . The Make it stop transfusion , intravenous line is maintained , inform doctor prescribed medication is administered ( antihistamines , corticosteroids, epinephrine , antipyretics ) . Measure vital signs every 5 to 15 ‘ and initiate cardiopulmonary resuscitation if necessary.
– Circulatory overload – can lead to pulmonary edema and occurs due to excessive volume or fast pace of transfusion. This can happen at any time , or 1 -2h after transfusion. Shortness of breath , cough, tachypnea , tachycardia , increased central venous pressure . Observe 2-4ml/kg/h rhythm management . Special attention is paid rate and volume management in elderly patients . It slows or stops the transfusion , your doctor tells administered diuretics , oxygen and morphine .
– Bacterial Sepsis – due to bacterial contamination of transfused product . This occurs during the 2 h after transfusion and transfusion. It is characterized by fever, chills , abdominal cramps, vomiting , diarrhea , hypotension .
Apply appropriate care . Stop the transfusion and keep the intravenous line , inform doctor to monitor vital signs, blood culture is harvested . Medical indication is given IV fluids , antibiotics
broad spectrum antimicrobial , vasopressors and steroids.
Evaluation of patients
– Observe the patient for fever with or without chills . Fever may indicate the onset of an acute hemolytic reactions , febrile reactions nonhemolitice or bacterial sepsis
– Observe the patient for tachycardia and / or tachypnea and dyspnea . This could indicate acute hemolytic reaction or circulatory overload . These symptoms may be accompanied by coughing in case of circulatory overload .
– Observe the patient for hives or rash . These may be early signs of an allergic reaction , anaphylaxis occurring after transfusion.
– Observe the patient for flushing. Flushing may be present in an acute hemolytic reaction , or rectum nonhemolitică .
– Observe the patient for gastrointestinal symptoms . Nausea and vomiting may be present in acute hemolytic transfusion reactions , anaphylaxis , or sepsis.
– Observe the patient for lowering BP . Hypotension can be an acute hemolytic reaction , anaphylactic , or sepsis.
– Observe the patient for wheezing , chest pain and cardiac arrest . These are all anaphylactic reactions.
– Pay attention to patient complaints of headaches or muscle pain in the presence of fever. Both can be signs of nonhemolitice febrile reactions .
– Monitor patient for disseminating intravascular coagulation , renal failure . , Hemoglobin / haemoglobinuria . All these are signs of late acute hemolytic reaction .
– Monitor laboratory values for anemia refractory to transfusion therapy . This could mean a delayed hemolytic reaction .
– Observe patients receiving massive transfusions of blood for mild hypothermia , cardiac arrhythmias , hipoteosiune and hypocalcemia, hyperkalemia .
Cold blood products may affect cardiac conduction system resulting in ventricular disaritmii . Other disaritmii heart and tingling may indicate hypocalcemia hypotension , which occur when citrate (used as a preservative
blood products ) is combined with calcium patient. Hyperkalemia leads to intestinal colic , diarrhea , oliguria , muscle spasms, changes in ECG , bradycardia preceding cardiac arrest.
WHAT WE DO IN CASE OF REACTIONS TO TRANSFUSION ?
– Stopping transfusion. The severity of reactions is the load placed .
– Change perfusions containing blood clots and replace it with a new one , unless it is only slightly allergic reaction ..
– Tell your doctor . Transfusion reactions require immediate medical intervention . In case of a mild allergic reactions , transfusion should be stopped and antihistamine at doctor . Transfusion may be resumed .
– Keep the intravenous line for administration of drugs and solutions needed.
– Write blood and blood products , which occurred during the transfusion reactions , and interventions nurses .
– Collect blood simple. A sample of blood before transfusion compatibility test . A second sample ( if necessary ) are collected from the opposite arm transfusion and check the serum -free hemoglobin , indicating
hemolysis and bilirubin levels should be checked also .
– Brought back to the blood transfusion bag , removing a few ml of blood , for verification if it is severe postransfuzionale reactions occur .
– Monitor vital signs every 15 ‘ or more frequently if necessary. Maintain continuous assessment of the patient’s cardiopulmonary status .
– Administer prescribed medication according to the type and severity of transfusion reaction :
• antihistamines – reduces some aspects of allergic response by blocking histamine receptors . In some cases pretransfuzional can be administered at doctor
• antipyretic / analgesic – is given to lower the fever and diconfortul : acute hemolytic reactions , febrile nonhemolitice , bacterial sepsis
• corticosteroids – stabilizes cell membranes , decrease histamine release , it administers the severe allergic reactions
• Fluids – rapid administration of iv fluids can help counteract some of the symptoms of anaphylactic shock
• diuretics / morphine – circulatory overload can be managed to reduce intravascular volume
• antibiotic – is given when it is suspected bacterial contamination
• a heart attack – is initiated cardiopulmonary resuscitation
• First collected urine sample – may occur due to hemoglobinuria hemolytic reactions . The deterioration of the kidneys is affected by urinary pH and urinary excretion rate . If kidney damage is severe , it is recommended dialysis
– The patient will have pink mucous . Tissue perfusion is improved
– Cardiac output returns to baseline values . Intravascular volume is restored
– TA will remain stable . Intravascular volume is restored. The absence of transfusion reactions .
– The patient will be calm and express comfort. Nursing care are properly applied to maintain the safety and patient comfort.
– The patient maintains normal body temperature
– The patient will remove urine from 0.5 to 1 ml / kg / h – reflects the state of the fluid optimal .
– The patient will maintain oxygen saturation greater than 95 %