7/8/2015
Training for Healthcare Professionals
Medicine
Administration
Module : Specimen
Collection
– Blood Culture
Blood Transfusion
© 2013, Wadhwani Foundation. All Rights reserved.
Learning Objectives
After completing this module, you will be able to:
•
Explain what blood transfusion is.
•
Arrange a set-up for blood transfusion.
•
Calculate the required drip rate for a unit of
blood.
© 2013, Wadhwani Foundation. All Rights reserved.
What is Blood Transfusion?
• Blood transfusion is the transfer of
whole blood or blood products such
as plasma, packed red blood cells
or platelets.
• The nurse is responsible for the
assessments before, during and
after the transfusion.
• Continual assessment is critical
because of the risk of allergic
reactions.
© 2013, Wadhwani Foundation. All Rights reserved.
1
7/8/2015
Blood Products
•
•
•
•
•
Whole blood – complete blood without
separated products, must be relatively fresh
for transfusion.
Packed red cells – used for patients
requiring increased oxygen carrying
capacity.
Plasma – used to treat clotting disorders.
Frozen plasma must be used within six
hours of thawing.
Platelets – used to assist patients with
clotting abnormalities.
Serum albumin – used to assists in
correcting hypovolemia, a state of shock
leading to decreased blood volume.
Click each image for information.
© 2013, Wadhwani Foundation. All Rights reserved.
Blood Groups and Types
•
Every person has one of the following blood types: A,
B, AB, or O.
•
Every person's blood is either Rh-positive (+ve) or
Rh-negative (-ve).
•
The donor blood type must match with the receiver’s
blood type.
•
If the Rh does not match, antibodies (proteins) in the
receiver’s blood attack the new blood and produce
adverse reactions.
•
Note: An Rh +ve blood recipients can receive Rh –
ve of the some groups of blood. E.g. An O+ve patient
can receive blood from an O-ve donor.
© 2013, Wadhwani Foundation. All Rights reserved.
Match Blood Groups – Donor and
Recipient
• People with type O blood group are called as
Universal Donors. This means that people with
type O blood group can give blood to people with
all other blood group types.
• People who have type AB blood group are called
Universal Recipients. This means that people
with type AB blood group can receive any type of
blood.
• Note: An Rh negative blood group can receive
blood only from an Rh negative group, e.g. An A –
ve can receive blood only from an A –ve or O –ve
blood group.
© 2013, Wadhwani Foundation. All Rights reserved.
2
7/8/2015
Blood Transfusion – Why?
• To replace lost blood after
surgery, trauma or
haemorrhage.
• To increase the number of red
blood cells and maintain
haemoglobin balance.
• To correct deficiencies such as
anemia and bleeding disorders.
© 2013, Wadhwani Foundation. All Rights reserved.
Blood Transfusion – When?
When patients suffer from:
• Severe blood loss - Trauma,
Surgery, Hemorrhage
• Severe anemia
• Blood disorders such as
Thalassemia
Do note, the procedure may take 1 to 4 hours, depending on how
much blood needs to be given.
© 2013, Wadhwani Foundation. All Rights reserved.
Item Checklist
1. IV fluid containing normal saline
solution.
2. A blood administration set.
3. Prescribed unit of blood or blood
product.
4. IV dressing.
5. Venepuncture set containing a 18
gauge needle or catheter (or if blood
is to be administered quickly 16
gauge needle or a larger).
6. Tape to secure tubing.
7. Sterile disposable gloves.
© 2013, Wadhwani Foundation. All Rights reserved.
3
7/8/2015
Before the Blood Transfusion
1. Take informed consent from the patient or relative.
2. Verify the physician’s prescription for type of blood
product and the amount to be infused. Collect
blood or blood products from ‘Blood Bank’, as per
prescription.
3. Double check to ensure the blood collected
matches the patient’s blood. Check the patient’s
blood record and the blood bag labelling.
4. Complete documentation as required by the blood
bank.
5. Ensure transfusion starts within 30 min of blood
being taken out of storage.
© 2013, Wadhwani Foundation. All Rights reserved.
Before the Blood Transfusion (Cont’d)
5. Verify the following information with another
nurse or a physician:
• Patient’s name and identification number.
• Blood component blood type and Rh factor.
• Expiration date of blood.
6. Obtain vital signs of the patient before the
transfusion begins. In case of abnormal results,
notify the doctor before the transfusion.
 The Right Blood
 The Right Patient
7. Explain the entire procedure to the patient and  The Right Time
ask him/her to report any alterations felt during
transfusion.
8. Put on gloves and provide for privacy.
© 2013, Wadhwani Foundation. All Rights reserved.
How is the Procedure Done?
1. Remove the blood administration set from
the package. Label the tubing with the
date and time of transfusion.
2. Close all the clamps on the tube.
3. Remove the protective covers from the
saline solution container.
4. Place the blood administration set into
the port of the blood bag and open the
roller clamp closest to the blood bag.
5. Compress the drip chamber of the
administration set and allow it to fill up
half way.
6. Inspect the tubing for air. If air bubbles
remain in the tubing, flick the tubing with
a fingernail to remove the bubbles.
© 2013, Wadhwani Foundation. All Rights reserved.
4
7/8/2015
How is the Procedure Done?
7. Gently move the blood bag several
times to mix blood components.
Remember to close the clamp before
moving the blood bag.
8. Hang the blood product container on
the IV pole. Slowly open the roller
clamp closest to the blood product.
9. Aseptically attach blood administration
set to cannula connected to the
patient. (see Venepuncture)
10. If the blood is very thick, you can hang
the normal saline solution attached
with IV administration set (which is
connected with 3 way stopcock) and
run it slowly along with the blood.
© 2013, Wadhwani Foundation. All Rights reserved.
How is the Procedure Done?
11. Adjust the drip rate, as prescribed. (Note: blood
administration sets have a drip factor of 10 -15
gtts(drops)/min).
12. Remain with the patient during the first 15 minutes of
transfusion and then take vital signs.
13. After the unit is empty, close the roller clamp closest to
the blood product container and open the roller clamp
closest to the normal saline solution to flush the
administration set with normal saline solution.
14. Close the saline roller clamp and then disconnect the
blood administration set from the IV catheter.
15. If at the same time, more units of blood are required for
a patient, the same administration set can be used.
16. Discard the empty blood container and administration
set in the proper waste bin according to hospital policy.
© 2013, Wadhwani Foundation. All Rights reserved.
Calculating Drip Rate
•
Drip Rate (gtt/min) = [Volume (ml) x Drop Factor
(gtt/ml)]/Time(Min)]
•
The drop factor is written on the packaging.
•
1 unit of blood is approximately 400ml in volume.
© 2013, Wadhwani Foundation. All Rights reserved.
5
7/8/2015
Alert - Stop Transfusion and Immediately
Report!
• Anxiety
• Chest or back pain
• Trouble breathing
• Fever, chills, flushing, and
sticky/sweaty skin
• A quick pulse or low blood pressure
• Nausea (feeling sick in the stomach)
© 2013, Wadhwani Foundation. All Rights reserved.
Documentation
• Patient blood details.
• Start time of transfusion.
• Units of blood given.
• Drip rate for each unit.
• Any adverse reactions, if occurred, and
reported to physician.
• Date and time of completion of transfusion.
© 2013, Wadhwani Foundation. All Rights reserved.
Points to Remember!
• Start transfusion within 30 minutes of blood
being removed from storage.
• If you have any doubt, do not start the
transfusion, speak to your senior immediately.
• Obtain first voided urine specimen after a
transfusion reaction and send to lab.
• Give saline (100ml+) before transfusion to
keep cannula ‘open’ and after transfused units
to ‘wash through’ the line.
• Vulnerable patients should be monitored
closely and often for adverse reactions since
patient may be unable to communicate if
problems.
© 2013, Wadhwani Foundation. All Rights reserved.
6
7/8/2015
Activity – Blood Transfusion
Time Required (suggested): 20 min
Items Needed: Dummy, see item checklist
Form Groups
Divide yourselves
into groups based
on the number of
items sets
• Select a leader to
direct activity.
Initial Demo
Each group selects one
volunteer to be a
“nurse” and dummy to
be the patient.
• Nurse demonstrates
procedure to
transfuse blood
using shown
procedure.
Feedback
Rest of the
group gives
feedback to
Nurse on
what he/she
did right or
wrong.
Repeat Demo
A second set of
volunteers are
selected.
Nurse
demonstrates
procedure to
transfuse blood
using shown
procedure.
Class Demo
If time permits,
one set of
volunteers does
the demo in
front of entire
class.
© 2013, Wadhwani Foundation. All Rights reserved.
Remember to Complete Your Documentation!
Patient Name
Patient ID
Date & Time
Blood Group
Amount Transfused
* Add any other information that you may need to document as per your
hospital policy.
© 2013, Wadhwani
Foundation.
All Rights
reserved.
Copyright
© 2013 Wadhwani
Foundation|
All rights
reserved.
Check Your Learning – 1
A 71 year old man is receiving a blood transfusion after a surgery. The
nurse is using a giving set of 20 gtt/ml. The unit of blood (400ml) is
prescribed for 4 hours as he has grade 1 heart failure. Calculate the
transfusion rate.
1 – 33 gtt/min
2 – 43 gtt/min
3 – 10 gtt/min
4 – 1000 gtt/min
Select one option and click Submit.
© 2013, Wadhwani Foundation. All Rights reserved.
7
7/8/2015
Check Your Learning – 2
Sr. Maya has been asked to bring blood products from the blood
bank. Which of the following should she pick up?
Drag and drop the correct blood products in the bag and click
Submit.
1.
2.
3.
4.
5.
6.
Plasma
Red blood cells
Platelets
Serum albumin
Cytotoxin
Haemoglobin
© 2013, Wadhwani Foundation. All Rights reserved.
Check Your Learning – 3
Mr. Guna has a blood group of AB -ve. Which of the following blood
types can he receive?
1.
2.
3.
4.
AAB +
O+
O-
Select all correct options and click Submit.
© 2013, Wadhwani Foundation. All Rights reserved.
Check Your Learning – 4
Label the missing parts.
Drag and drop the correct label in the blank tile and click Submit.
© 2013, Wadhwani Foundation. All Rights reserved.
8
7/8/2015
Check Your Learning – 5
State True or False:
Plasma is used to treat clotting disorders.
•
•
True
False
© 2013, Wadhwani Foundation. All Rights reserved.
Now You Can…
Please rank your comfort level for
the learning objectives:
Yes
•
Explain what blood transfusion is.
•
Arrange a set-up for blood
transfusion.
•
Calculate the required drip rate for
a unit of blood.
Need More Practice
No
© 2013, Wadhwani Foundation. All Rights reserved.
Resources
For further references, please see:
• http://perawat.blogspot.in/2006/06/nursing-procedure-bloodtransfusion.html
• http://www.transfusion.com.au
• www.classes.kumc.edu/son/nurs420/CalculatingDrugDosages.html
• https://www.pathology.med.umich.edu/bloodbank/manual/bbch_6/index.h
tml
• http://www.nlm.nih.gov/medlineplus/bloodtransfusionanddonation.html
• https://www.youtube.com/watch?v=WJuqiTEc2tk
© 2013, Wadhwani Foundation. All Rights reserved.
9
7/8/2015
Acknowledgement and Credits
We gratefully acknowledge the following sources of information and content:
Authors: Deepali Ghosh, Pooja Kale, Piyush Goel
© 2013, Wadhwani Foundation. All Rights reserved.
10