The blO<Xl type of recipicnlS must be verified os rompatib., with tbe blO<Xl type of
<lonated bkod prio< to t".",fu,ioo to pre,"nt a potenti.lly life-thr<>tening ""ute ocmol)tic r<actKon (>ee the following ""'tKon. which d=:ribe> thi, type of
""",fu.Kon re""tKon and it> treat "",n'), Thi, type of verific>1Kon i ... nti.1 w be"""""
whole bkod and PRIIC. :ue tnn.fu<ed and prefolTod ,,'hen FFP. phtol .... and
oryoprecipi~e are tnn.fu<ed."-"
Blood I}~ ref"" to k.y antigen< frond on the surf""", of the erythrocyte •. The""
.ntigens are type A. type II. 0< the inactive ""tig.n H, The i""",i,~ antigen H i.
",f.rred to '" I}'f" O.
n....
antigorur exi" in pairs, with one of .""h c""ferred g.nctically by nrh p<fooo', biological rr»lher .nd f.ther, The"'fore. there are .i, diff.",nt poMib., permutatKon' of pairs (i. ... p/>enoI)'pe». Since A and II oreequally dominant. and since 0 i. inacti .. and therefore rece"i,'e, there ore foor poMible expces<ed bkod type. (i .... geOOlype». Each p"".iblc Combin.atKon of blO<Xl type pIle_ype and g ' _ype include. the following:All PM"""IN: A ge_ype with type A bkod, AO ph<no'}p<: A ge_ype with type A bkod, BB PM"""P": II ge_ype with type II bkod, BO p/l<noI}~: II genotype "'ith type II bkod.
AB PM"""IN: All pIle_ype with type All bkod, 00 ph<no'}p<. 0 genotype with type 0 bkod."-"
II.,,,," .. type 0 blood ron"in, no octi, . . . ntigerur on the ,urface of i ..
erylhroryte>. it can he donated to patients with any blood type without r.u,ing • ocmoly'ic ", .... ion. Therefore. pati.n .. with type 0 blood are >Ornetime, ",ferred to as
u.;,,,,.al
dono,.., Con"""ly. p>tienlS with type 0 blood c.nnot reeei".Ilogeneic blood of .ny other blood type but 0 bee.u .. any type of octi ..
erylhroryte antigen ,,'oold be identified by their pl •• m. cell,., foreign .• nd they would suffer .n ""ute hemolytic "'action. On the otller hand. the plasm>. cell. for patients with type All blood are primed to ",cognize either A or II antigon type.
as nati, .. to them, Therefore. the.., pationlS are referred to .. • n" ... "al m:;pi~n"
in that they can reaive any type of blood and _ ,uffer .n ""ute bemoly.ir
",,,,,tion. lIy the
.:orne
token. OO.,e"r. they may donate blood only to I"'tien"with type All blood."-"
An additional important antigen found on the ,urface of erythrocY'e< i, .ntigen D, Thi. antigen i. ",fmed to •• the rh .. ~. factor (Rh factor). If it i, pre .. nt. it i.
'" I.V. Therapy Demystified
OOIcd .. Rh po>iti,'e. I'o,ien" wOo", ef)"hrocyte, do noI h .... ,be Rh foctor ....
",felToo to ., Rh n'ga<i;'<, "",ien" moy "'we
,or
of tbe foo. blood'YI""
.Dd .b"be Rh po.iti" or ""gati, ... Patien" "'ith Rh_positive blOC<! moy roc";",, alloge_
""ie blood of on appfOpriatoly cOfllI",;ble type lh .. i •• ither Rh po.ili,.., or Rh oegotive. HOI.'.'u. pat;en" with Rh_nepti .. blood g . . . r.olly <boul"
,,,,,,,i, ..
only .ppropri .. e blood ty",,_ of Rh_negative blood. Of lhey could form "n,ibodi ••
to the Rh factc<" that coold <au", problem< with .i,her .ulm-qu<nl ,,,,,,.fu.;,,,,.
I'le! in lif. or. in the case, of p<cgn.n, Rh_negati,', ,",'o"",n. acut. hemol)1i< ... ..,.
tion. in tbei. ""00>1",,"'-"
INTRAVENOUS DElIVERY SYSTEM
Blood compone"ts ore "ore" in bko:l Nnb uc.der ooodition. thai. main!>in the .. rely .00 quality of the products .. dictated by polieie, .00 guideli.." advocated by the Americ.n A»oci .. K>ti of Blood Bank. (AABB).
me.-
toobuirung pre""ribed blood prn:locts from the blood Nnl. the mIR" ,boold en ... that the patien' ba, a pa'ent in""",n.,,," (lV,) lioe in place th>t can delive, ,he Mood romponen' that i. ordered safely and effecti",ly. Thi. i. imponant bee.u", tr2ru;fu.ions of "'hole blood 0.-PR8C. must rom"",,,,,e "'ithin JO minu,os after ""'y are obuioed from "'"blood bank. 0.-they mu,' be re,urned to ,he blood brl .00 not used. Other blood
oom~'" have simil", lime re.tric!;o.u, It is preferred ... "'" "',..,.,. access C."""Of be 18 gauge or Ie .. , .I,hoogh. 2O-gauge catheler may be <free,i"". IIoth periphe",1 .00 centr:al '..,nollS """" .i'e, are occepubie 10 ,,,, .. fuse blood
com~"', The lV, line can_ be used fo.- .ny <>!he, purpose. dwing lhe blood tr2ru;fu.ion. bov.'CW>". If"'" pa'ient doe> DOl ba", • patonllV. Ii".. doe> DOl ha, ... n lV, line wilh at Ie .. ,. 2U-g ... ge "'DOllS occe .. c.theto" 0.-<loes not ha"" .n lV. Ii""
thol C2/l be use<! only forlhe blood tr2ru;fu.ion. then IiI\ lV. line must be .urted th>t can """"",modate these criloria, In addilion to this. the nur>< must ... ,rify thol the patient', informed ""m.nl W2S obuined. Othef equipment thol shouk! be gathered before the blood oompon<nl unil i. obuined include the following;
A sterile .ingle_u", blood administralion .. , "'ilh filte, (Fig, 9_ I) lV. bag ofO,<}% .. line 10 u'" as the only compatible ~u.h ",Iution Equipmenl for taking ,'itol .igns. including '1elhoscope. blood pre"u"
cuff. and thermome1<r
Any connectors bel,.. .. n lV. Ii .... mu" he of lhe Lue,_locl lype. occording 10 the Srandards
of
Prucr;« promulgated by the Infu,ion Nurse. Sociely,- A<ldiliooal equipment that mighl be uoed cook! include blood w",m ... , pco"ure device. weh .. pre"ure bags 0.-fast infu<ef'S. and 'peci,liz.ed filters, Blood compon<n" thol areCHAPTER 9 Blood Component Therap
'"
• "
"lgul"< ~I Bk .. , admioi"'''ion ... A. On< roll« clamp. dripch_ ""illl IN-,...
b _ fil ... >lid di ... l_ffid inje<1ioo port. B. Y_!)'!'" ""illllhreo roll« CWnp', dlip ,1WTftr
""ilh 170-"", blood hi ... >nd <li""-I-""" injoct"'" ,"",. (COIIn..y of B. BrnIII. _ "
C.~.200~.)
Ir2n>fusOO ",1 .. i,,,ly quidly m.y oeed 10 be ,,':umed so lh .. !be palienl doe> DOl become h)'poIbenn"',
n.e
DIlly "PI'"'.ed melhOO '0 W>rnl blcol i. by u,in~ .n AABB_"ppnwN blcol ,,'.rmer lh>' i. properly m.intaiDNl ..-.d deemed r<li.bl. bybiomed",oIen~i"""ring prof""i"""I . .. lbe spoosorin~ insti,u,ion, Other me'hods for ,,'.nning blood. ioclooing immenion of ,he bog in ,,"2rJJIe<l ,,'.ler. m"'row"",.
e«" are forbidden. If
1"""''''
dev""" or f"" infu""" .re used. 'imil:u-ty they must be AABB~.ed dev",e, thatha,,, •
pre""'" g""~ • ..-.d ",on unifOfm """,ure agoin" 011 parts of ,he bloOO rornpon<flt bag. Leukocyte ..-.d m",""'Uregote filters 0150 mu" meet industry ,.fely .nd qu.lily ,,:md:u-ds if ,hey oreprescribed,-'" 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 ofoil"",,,,
reactionto 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' SUlIIdarrbof
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.'