ADMINISTRATION PROCEDURES

prescribed,-'" I.V. Therapy Demystified VERIFICATION PROCEDURES

f'riC4" to ini'i>ting • , .... ,fu,;"" of • pr=ribed bloOO component. !he nu"" , .. "fie<

Ihe opp<opri ... "" .. of the order.' n,. nu"" mo" ,..,rify that infonned co",.nl fo.-tr"",fu,ioo 1= be<n _ ined and ,h .. ,he !",'ie"' uOOo"W1d. ,he ;od;o>l"'''

fo.-m. , ....

,fo,;oo. its .,soci.led ri,ks.oo

""""fi".

"nd ,,·hcthe! there might be any ahern .. "'" to '".,fu,ion, ... Asking patien" "hether or 00< ,hey ha", " .. " had prlOf blood 'nn.fu,ion,""'. if 50. whether they had .ny t),pe of

oil"",,,,

^reaction

to the ,,,,,,,fu,ion i. helpful. Palients ... ho belong to a lei""" ... ', Wi, ....

<ongreg .. 'oo m>.y rd"", tr:"ufu,ion l=ed on their .. 'igioo. belier., ond thi.

dec;';"" rnu" he ""!"'CIN and OOcumen .. d per .gency or hospi .. l protocols,"

After the .. proeM"'e>, ,he n""" ""'n take. > baseli .. "'" of vi!>1 .ig ... iocluding the 1"';"0'" tempe .. '",e. blood I" .. ",ure. bean ... 'e. and ""piI>'ory "'''. and record.

,he""

d ... in ,he POI;""". recocd. It i. good pr>etice fo< the nurse to Ii.ten to the patien'"' b=lioe bean and lung >0<100. '0 de1efmi .. if ''''',e .... "ny .,,'"

"":ill

>0000 •. murmurs. crockle,. Of w~ze"

Both ,he AABB and 11>< loin' Commi"ioo "" A""redi~i"" of Heal'h Care OIganiza'ioo. (JCAHO) mandale 111.,., Ie." 'wo identifio,.. be u«"<l '0 ,orify 111>1 11>< righ' p>'ien' i, """'i"ing 1he righ' blood componen'." 1he pa'ionf, full ",me '),pically is one of lhe>e iden,ifie .. and is I""",n' 0<1 the bkod componen' product bag 000 ,be pa'ien", iden,ific>1ioo bag, lbe pa'ien' .Iso should be ",ked '0 ,,. .. hi.

0.-he, fun name,

CIt"'"

iden,ilien fruly ioclude ,he palien", dale of birth or Soci.1 SKuri'), Numbe, 0.-,be hoopi .. 1 iden,ilk.,i"" numbe" lbe pa'ien", hoopil.1! room number i. not """.idefed an .ppropriale iden,ilie,,' 1he cUlTen' SUlIIdarrb

of

Pracl;a fC4" ,he lnfu.ion Nurses Soc;")' furthe, specifies that t",o licen"'"

profo .. ioo.I, mu,t ,orify that 1he appropri ... blood component is matohed to the awropri ... p>'ient.'

CHAPTER 9 Blood Com anent Thera

' "

either compklo<l Of discontinued within 4 hours. If the ""tient requir .... ",,,,,,1 unit>

of the >am< blood coml"""'nt. then the .. me proIorol. are 'epe>1o<1 for each .u~_

quent tnn.fu.ion. .00 the unit ><Imini"''''ion ""tup i. ch.nged ><> th>t. ""w, >lerile blood ><Imini.tntion ""tup i. used.""

MONITORING FOR TRANSFUSION REACTIONS

~

..

The ,..,..., must ><=i. the ""tiem carefully fOf dinic.1 fII2IIif .... tion. of t",",fu.ion reac<ion. during ",,,,,fu.ion of blood oompon<nt>, The most commoo ", .... fu.ion reac<ions ... di","""'] in the follov.'ing 5KlionJ. The", lTIlIy include ,",ute hem<>-lytic reaction. febrile oonhemol}1ic reac<ion. tnru.fu.ion_related acute lung iniury .

• Iklllic """"ion. ' .... ume o"erloood .• nd bacteremi •.

Acute Hemolytic Reaction

An acute hemolytic reac<ion occurs ,,'hen a palient i. tnnsfused with the wrong blood typ<o C1inic.1 "","ifestati""" tend to occur very quickly, within ~_15 minute •

• fter the ",,",fu.ion com~. The>e ioclude the following;

Chills Fe, .. "

Low b>o<k ""in Tachypne.

Tachycardia Hypoten.ion

Pain.oo flu.hing at the infu.ion .ite

When the wrong type of blood <Oml"""'nt i. tnn.fuoOO. the tnn.fuoOO erythrocyte. are recognized by ,he recipient'. pl,ml'l' cell. as foreign, ond

t.o.t

>Jltibodi . .. "ad ,he .. cell •. c.u.ing r2pKl el)'throcyte de,true,ion Of hemolysi •.

lIy_prodocts of "'pid el)'throcyte de,truc1ion clog the ren>.1 tubule •. resul'ing in 10,,' b>o<k pain. hematuri>. ond ",ute renal failure. In iOddition. bee.u"" the recipiem".

immun< .y>lem moon" .n >rute .)'<tomic re>pO<l"'. the ""tient mou"'s. f .. "r .00 . . hibit> signs comi>len' with >hock,· "

Febrile No nhemolytic Reaction

Febrile ooohemolytio (FNH) re><1ion. ocrur when the recipie"'". pl»mo cells fonn

>Jltibodi . . '0 HLA. frond on 'nn,fuoOO leukocyte. Of plal<lc", The likelihood th>1 the", r . . c,ion. "'ill OC<"ll! inc",,,,,,. with lengthi .. tran.fu,ion time • .00 with

, .. I.V. Therapy Demystified

r<p<>100 bloc<l".",fu.ions. 1herefore. guKklioe, fof "'''lOfu,ing whole blood or f'RBCs '",""ify Ill .. eorh unil infuse within 4 OOuB to de<reasc the hkelihcod th ..

FNH ",,,,,,ions occur. Pa,ion" ,,'ith a

J>rior

hiSlOf)' of lUI FNH ",""tioo 0< who are at i"",.,ased ri,k for.n FNH ",,,,,,ion llK.u .. 'bey h . . e tu.d mulliJ>le '",,,,fu.ioru may be c.ndidate, fo.-J>I'OPIlylacric lnI . . fu,ions of leukocyte-reduced PRBC •. In addi,;oo. the .. p>uonts may """"fit if.n IUItipyreli< such .. orel>minopben "

administered immedi.tely prior to rommeocem<n' of the '''' .. [u.;oo ... , Clinical manif", .. ,ions of an FNH react;oo m.y i""lude the foUov.'ing:

Olill.

Hca<brhe Myalgi ...

N,u",.

a.. ..

I"'o .. "

Transfusion-Related Acute Lung InJury

1he p>'hop/ly.ioIogi< mech2ni.m ""pon.ible for """"fu.;oo_ ... I>1OO aruto lung iniury (ffi.ALl) is ,imil., to !hOI fouod in FNH ",,,,!ion. in that the reei";'n", immu"" .ySlem form. "",ibOOie. to .Ilogoneic.lly doo .. od leukocyte>. For "' ...

that are _ enli",]y cleu.

"""'CW!.

^{,he ~} in 1lI.AU teod> to be much qude.

than that frond in FNH ro",,'ions and tend. to oause "",u'e ""P\""orr fail"", fol""'ro by. type of "",ute re.piratory distress .yodrome, n..". p>ti<nts"'oo to respond .... 11 to .arly rerognition. aggre"ive rTIlIn.gement of

"""te

"'spiratOf)' foil"re ... I.V, odmini .. ""ion of oonico>",roids,"-"

Allergic Reactions

M"'t .11e'!lie ",,,,,,ion. '0 .lIog<""ie.lly t",,,,fused blood are mild ond occur ....

result of immunoglobulin Ii (lgE)-«g"lo,oJ sen.itivity to the donatoo blood", pi ... protein •. Thi. 'lpe of ..,oction typi<a1ly i, del.yed .00 oc<un either toward the <00 of the tr.illlSfu,ion 0< ... ithin • couple of he."., .fler the ",,,,,fu,ion i,

«,mp""oo, Oinical rtWlif .. ~iOllS include

• Flu'hing

• Unico'" (i,e. hi,..,.)

• h<hing. panieularly of the polm. of the h ... nd

..,1<.

of the f .... t

Palients ... ith • prio< hi"Of)' of • ,..ne.y of other aI o"gies are panic"larly .uocepIibie to tIri. tlpe of unicaial r.oction to • blood Ir.U15fusion. I':o,;'n" ... ith knov.'n prior

CHAPTER 9 Blood Com anent Thera

'"

hi.tories of urticari:iJ al""F;ic ",actions to blood tr.u15fu.ioru l1IlIy l><oeIit from administr3:ioo of diphmhy<hmine (BenadtyIJ immedialely pcio< to comm<"",",e,\t of

"'h>eG""'"

t"""fusions to mitigate tb< .. :iJ1e1gi< f1I2IIife>tations.""

Infrequ<ntly, allergic "'''''tions to .lIogeneic.lly t",",fu.oo blood <an I>< IgE-medi.ted ond thu. «hibit ., lUI .naph)'lactic t),pe of «action. Thi, type of "'actioo t),pic.lly ocrurs earl)' during the fin' f ... · minute, of tbe tr,nsfu,ion. and the potient

~dly dcterionte. into >n2phylactic .hock unl ... "'pid inte,,'ention. are t»;en.

TIte.e clinicall1lllnife,tion. include the .. me .ign,.nd .ymptom> that are ron.i"ent with an .lIe'llic ",action plu, the following:

Wheezing with ",,,,i"'tO<)' dis ...

ss.

followed by

.trim

ond laryngosp1Sms N.u", •.• lxIomin.1 poin •.•• " ..

"e

<",",ping

Tachycardi.

Hypoten.ion ,,'ith n.rrowed pulse I"""ure"'"