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Blood Transfusion PP with recording — Transcript

by Trinity Pullam · 11,301 words · 1,650 segments · language en · Watch on YouTube

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0:00hi this is Miss pm and this is going to
0:02be your presentation for blood
0:06transfusion blood transfusions can be
0:09given for many reasons to for as a blood
0:12replacement as just a blood transfusion
0:15where we are exchanging um New Blood
0:18products for Old Blood products and then
0:21you may need specific blood products um
0:26for various reasons um so blood can be
0:29given as whole blood or you can give it
0:32as components and so whole blood would
0:34include everything that would be in the
0:38donor's blood whereas components they
0:40take the um components and they separate
0:42them out so for each whole blood unit
0:44you would have you know red blood cells
0:47platelets plasmas things like that that
0:50you would separate
0:52out um you can give the medication or
0:55the transfusions um as you're managing
0:58uh different hematologic diseases such
1:01as anemia um it can be given when a
1:03patient experiences trauma and bleeding
1:05and they need blood replacement or if
1:08they have blood loss during
1:10surgery it is considered a temporary
1:13support um so it is given to support the
1:17client's um circulatory needs while we
1:20are um working on resolving the
1:22underlying problem you want to avoid it
1:25unless it's absolutely necessary um
1:28because of the potential uh risk risk
1:30that come along with it um it is a very
1:33common
1:35um intervention that we will see as
1:38nurses quite frequently but it can have
1:40some very potential uh dangerous effects
1:43so that once again it needs to be
1:45avoided unless it's absolutely necessary
1:48and then once again if you for whatever
1:51the reason you're giving the blood a
1:53component therapy you're going to have
1:55different um objectives for that so it
1:57could be to increase the circulating
1:59blood volume after the surgery trauma or
2:01Hemorrhage um you could give it to
2:03increase the number of red blood cells
2:05to maintain hemoglobin levels for
2:07clients that have severe anemia um and
2:10then once you could give the different
2:11components as replacement therapy so
2:13some examples of that is plasma clotting
2:15factors for those patients that have
2:18hemophilia um those components are what
2:20they were missing and this we would be
2:22providing it through the transfusion
2:30okay so patients must be in um that are
2:33donating must be in good General Health
2:35not feeling ill on the day that they
2:37donate um they want you to maintain your
2:39iron level for donation patients must be
2:4217 years or
2:44older there are some additional
2:46requirements for our purposes 17 years
2:49um and the same thing with this weight
2:51uh patients must weigh at least 110
2:53pounds um there are some specific
2:55guidelines for those under 18 for our
2:57purposes 110 lbs is what I I need you to
3:01remember um firsttime mail donors um may
3:04be um eligible to donate if they have
3:07not had sex with another man in more
3:09than three months so um in the past any
3:13man who had sexual relationships with
3:15another man would not be eligible um so
3:18now it's related to um they they are a
3:21little bit more lenient on that and they
3:23look at the last three months and um
3:26identify if any other risk factors are
3:28present
3:30um those who
3:33um have uh oh sorry you cannot donate
3:37blood except for every 56 days so
3:40obviously if you've donated within the
3:41last 56 days you wouldn't be eligible
3:43for that you cannot have a fever so the
3:46temperature cannot exceed
3:4899.5 your blood pressure has to be
3:50relatively uh controlled so not way too
3:53high or way too low so systolic 90 to
3:55180 diastolic 50 to 100 and then you
3:59have to have hog globin levels that are
4:01adequate so 12.5 for females and 13 for
4:05males all right so there are people that
4:08are ruled out as um ineligible to donate
4:12so those who are taking anti-coagulant
4:15medications blood thinner should not
4:17donate um those who have used um uh
4:22needles to take drug steroids or any
4:24unprescribed
4:26medications um in the past 3 months
4:30um should also not donate men who have
4:33had sexual contact with other men in the
4:35past three months um anyone who has a
4:38positive test for HIV or Aids anyone who
4:41has engaged in sex for money or drugs in
4:44the past 3
4:46months um are also ineligible and then
4:49anyone who has taken a medication
4:51tegison for psoriasis which I believe is
4:53no longer on the market but if you have
4:55taken it at any point in your history um
4:59you are um asked not to donate blood
5:03because it can cause some um changes
5:06within your blood cells and then anyone
5:09who has risk factors for the crvi Jacob
5:11disease um is asked not to donate as
5:16well so um if you have um somebody who
5:21does not want to
5:23receive or cannot receive other donors
5:26blood we have um a couple of options so
5:31um autolus blood donations means that
5:34we're donating blood to give to
5:37ourself or so it's their own blood in
5:40some way so you can have um autologus
5:43blood donations that are banked in order
5:46to
5:48um prepare for upcoming transfusion
5:51typically due to a surgical need or you
5:55can have uh blood Salvage and then you
5:57have a third option which isn't really a
5:59olus but it's a designated donor so um
6:03when you give somebody their own blood
6:04which we'll talk about first you're
6:05going to reduce the risk of disease
6:07transmission because we're not going to
6:09get anything we don't already have um
6:11and then potential transfusion
6:13complications because if I receive my
6:14own blood I'm less likely to react to my
6:17own blood um than I would be to other
6:21patients
6:22blood um if I were U banking blood for
6:28a or ining my blood in preparation for
6:31upcoming transfusion I would need to
6:34start that um blood donation within five
6:38weeks of my procedure and I could donate
6:41every 3 days and I would have to end
6:44that at least 3 days before the last
6:46date of the transfusion so every 3 days
6:49gets my body to regenerate enough blood
6:51so that when I take it out again um I'm
6:54not going to cause a too too little
6:56profusion and then that five weeks
6:58before is related to the storage of the
7:01blood because the fresh of the blood we
7:03can only store it for a certain amount
7:04of time um so that's why that five we um
7:08ranges there and then of course 3 days
7:10before the transfusion because if you
7:12need a
7:13transfusion you want to give yourself
7:15time to go ahead and build back up to
7:17closer to normal levels um so that would
7:20be if you were banking Aus blood
7:22donations then there's an autologus blow
7:24donation known as blood Salvage this is
7:27done during surgical procedures so um
7:31blood can be suctioned from closed body
7:33cavities such as joint spaces or other
7:35closed body sites during surgical
7:38procedure so we're having that blood
7:40loss but we're suctioning the blood
7:42immediately um and as that blood gets
7:44suctioned there's two different ways so
7:46you can have it Go automatically
7:48reinfused into the patient or most of
7:51the time what you see is it goes through
7:53a machine and it filters filters it out
7:55makes sure that there's no uh
7:57contaminants and then it rein fuses to
7:59the patients this one in particular is
8:02going to be for a client that has t a
8:06religious
8:07um a religious uh belief where they
8:10cannot receive blood donations because
8:12they also won't receive those Bank Al
8:16autologous blood donations um but they
8:19can receive this Blood Salvage it's
8:21usually within their um beliefs um
8:24whereas you can still see it used with
8:27other clients um
8:30I think kind of the invention of It kind
8:32of came around for this reason to be
8:34able to have a an option for this
8:37reinfusion for patients that could not
8:40uh that if they lost too much blood they
8:41wouldn't re re be able to receive um
8:45blood transfusions after and then the
8:48option the designated donor so it's not
8:50a Tolus but in this uh option you would
8:53have somebody that is chosen to donate
8:55blood um this would be an option for
8:58people that have like a origin genetic
8:59disorder or genetic um what I want to
9:03say a genetic um difference in their
9:05blood where they would need a specific
9:07donor that meets those requirements so
9:09they wouldn't react or um just patients
9:12that have a fear of um receiving blood
9:17from somebody that they do not know
9:19because it's it's just anyone's blood um
9:22there's no way to identify
9:25them okay so when they get the blood and
9:28they start process in it before it comes
9:30to the patient um they take first of all
9:33they take each unit of blood so as the
9:35donor donates blood they donate it
9:37obviously in whole blood um and then
9:39that whole blood is typically going to
9:41be separated into several components
9:43although whole blood can be um given and
9:47we'll talk about that a little bit
9:48later um but typically we'll see
9:53um multiple different components like
9:56red blood cells platelets uh plasma Etc
9:59that it gets separated into um red blood
10:03cells or packed red blood cells may be
10:05stored under Refrigeration for a maximum
10:07of 42 days so that's why you see we have
10:11those kind of time limits on that um
10:13autologus donation because that means we
10:16then we can only um refrigerate it for a
10:19maximum of 42 days and then after that
10:21the blood is not viable you would have
10:23to get rid of it um potentially on some
10:26rare units of blood they have some kind
10:28of special mark marker um or they're
10:31eradicated you may see those being
10:34frozen for up to 10 years so those are
10:36those are just when you have a rare unit
10:40of some type where they may be processed
10:42and
10:43Frozen um all blood is going to be
10:45tested for um HIV Hepatitis B hepatitis
10:49C human t- cell lymphotropic virus CMV
10:52and
10:53cilis um they use nucleic acid
10:56amplification testing also known as Gat
10:59Tes testing where you're identifying uh
11:01very low levels of um viral genetic
11:05material in that DNA um so you're able
11:09to find those very early and it shortens
11:12the window between the infection or the
11:15patient being exposed and us being able
11:17to identify it in the blood um it's much
11:20shorter than the older testing where
11:23they would look for
11:25antibodies um and then they also need to
11:28identify by the patient's blood type and
11:31Rh antigen um blood type is uh related
11:35to um what you inherit whether it's a or
11:39b or a b or o and we'll talk about that
11:41a little bit lower and then the RH
11:43antigen is just a protein that's found
11:45on your um surface of your red blood
11:48cells so if you have the antigen that's
11:51present then your RH positive but then
11:53some people just don't have it and
11:55they'll be Rh
11:56negative so then um
12:00when a patient's coming into a hospital
12:02and we're trying to
12:04identify uh potential blood units that
12:07would be compatible for them they'll do
12:08what's known as a type and screen so you
12:11identify the you take the patient's
12:13blood and you identify their blood type
12:15and Rh
12:17factor and then you would screen for um
12:20blood types RH factors in the donor
12:23units that would match that patient then
12:27when the patient is um we're needing to
12:31identify a unit that we can give them
12:33specifically so when we're actually
12:34going to be transfusing you'll take the
12:37patient's blood and you'll take the
12:39donor's blood and then you will mix them
12:42of course this is in lab we don't do
12:44this as nurses but this is what's
12:45happening in a type and cross match
12:47those blood get mixed together um in
12:50small quantities and then you can they
12:52identify if any kind of um hematologic
12:55reaction happens so we're looking for
12:57the absence of that so that that blood
13:00is
13:01compatible so this is the uh the
13:05compatibility is related to that blood
13:07group um when we talk about the blood
13:11group we're talking about what blood
13:14antigens they have so A and B are blood
13:18antigens so if you
13:21have um an A B blood type you have the
13:25antigens for both A and B if you don't
13:28if you have an o blood type you have no
13:31antigens um so it determines the type of
13:34antigens and then the antibodies are
13:36determined by um the antigens as well
13:39because if you have no um antigens
13:44you're going to have antibodies against
13:46blood given to you that does have it and
13:50I
13:50think yes we talk a little bit more
13:53specific
13:54here so uh with the antigens whether
13:59it's a b or A and B these are the
14:03substance that are going to cause
14:04formation of antibodies so antigens are
14:09what does my body have if you have the
14:13antigen you can give somebody the
14:15antigen because it's going to look the
14:16same as myself so we only can give
14:19ourself self substances but if I don't
14:24have the antigen and I give it to myself
14:26that's going to look foreign so if I
14:28don't if I have type O blood and
14:31somebody gives me an a antigen that's
14:33not going to be recognized as myself
14:35it's going to look foreign to my body so
14:38then if the body recognizes this as
14:41foreign the immune response is going to
14:43produce antibodies against it so then we
14:47have these
14:48antibodies that are going to develop in
14:50response to the present of an antigen
14:53that we don't have so you can have um a
14:57natural one or you you can have an
14:59antibody that formed after um your body
15:02has um something has gained access to
15:05the body and the body formed that
15:07antibody against
15:09it
15:10so if you have an antigen on the surface
15:13of the cell and you give it to somebody
15:15that has an antibody you're going to
15:17have this series of immune response and
15:20it's going to destroy those cells um so
15:24our body is going to fight that off
15:26because it's foreign so the basic princi
15:28principle of safe transfusion therapy is
15:31to avoid transfusing any antigens to a
15:34recipient having antibodies against that
15:37antigen because all it's going to do is
15:39cause our body to attack and so we're
15:42going to have this ongoing immune
15:43response and it's very
15:47dangerous um so then one of the process
15:50that we have we would have a glutenin
15:52process where that antibody um uh
15:56attacks the antigen and causes this
15:58clumping of
15:59antigens
16:01um the most significant one are going to
16:04be our blood group and type so there are
16:06other antibodies antigens that you may
16:08see in blood which is why we do the
16:09Cross Match but the most common and most
16:12specific ones that we see are going to
16:13be the antibodies or the antigens and so
16:16our blood group and
16:19type okay so this is kind of more
16:24information or kind of going over it
16:26again because it is very important
16:29um so people in each group are going to
16:32have a
16:33glutenous antibodies to the Red Cell
16:35antigen that they lack so if you have a
16:38patient that has type A blood they're
16:41going to have an A antigen that means
16:43myself is
16:45a um people who have B blood they have a
16:49b antigen if they have a and b they have
16:51an A and B antigen but if they have o
16:54they have
16:56none so if you're in TR group a
16:59if you give someone B they're going to
17:01have an antibody against that beef so
17:05they're going to have this a glutenin
17:06that happens because B is foreign they
17:10do not have that antigen if you have
17:13someone that has a b antigen but no a
17:17and then you give them a the same thing
17:19is going to happen their body is going
17:21to attack that a
17:22antigen if you have group A and B you
17:26have all of the antib IES so this is
17:30where you'll see um group AB positive
17:34having antibodies and the r factor being
17:38called the
17:40universal recipient because I can give
17:43them a I can give them b or I could give
17:45them o and it will not have any
17:47antibodies against it but if I have
17:50group O they're going to have both the a
17:53glutenin for a and b um so if I give
17:58them a b or AB blood they're going to
18:01attack that but you can see o does not
18:05have any antigens so you can give this
18:08to any body you can give an O blood to a
18:11b AB or o and if it's negative you can
18:16give it to patients that have a positive
18:18or negative Rh factor as
18:23well so if a person that has type O
18:26blood is transfused with blood from a
18:28person with a or b blood there would be
18:31destruction of the recipient spread
18:33blood cells since that A and B anti-a
18:37anti-b A glutenin would react with the A
18:40and the B and the donor cells so then we
18:42would start attacking those cells
18:44because it's now foreign so that's why
18:47once again AB Universal recipients o
18:50Universal
18:52donors so we're going back to the Rh
18:54factor because we kind of opened up with
18:57that but
18:59um we've already looked at blood Factor
19:01so a b AB if you have it then itself if
19:07you don't it's forign it's the same
19:09thing with the Rh factor so it's an
19:12antigenic substant in the red blood
19:13cells it's it's most common that you do
19:16have it but you can have a patient um
19:19that is negative where they don't have
19:20the factor so if they have it on their
19:22red blood cell it's positive if they
19:24don't it's negative if the blood is
19:27given to an RH negative were there RH
19:30positive we can see that red blood cell
19:33destruction and anemia happening um so
19:37if we're negative that RH is considered
19:40foreign so our body is going to attack
19:42that and so that's why you could only
19:45give positive to another positive client
19:48or you can give negative to a positive
19:50or negative
19:53client this is another compatibility
19:56chart this is super important that you
19:59understand how this works and you'll be
20:00able to identify this um once you know
20:03this is just another way of putting it
20:05where it's just charted
20:08out so here are some different blood
20:11components that you may see and why
20:13they're being used um packed red blood
20:15cells are the most common um thing that
20:19you'll be seeing use on the floor um is
20:22for symptomatic anemia or acute and
20:24chronic blood
20:26loss um fresh frozen plasma if you have
20:29a patient that has um a deficiency of
20:31the plasma coagulation factors or if you
20:34have a patient that's getting massive
20:36transfusions and we want to make sure
20:38that we're clotting um and then if you
20:40have patients that have a PT and INR
20:42that's way too high you may give ffp to
20:45decrease that and then we'll see it used
20:47in um DIC as well Granulos sites are
20:53given to patients that have
20:55neutropenia um with infections so that
20:58you they have um increased white blood
21:01cells in order to fight off the
21:03infections um so patients that have
21:06neutropenic illnesses or um are
21:10neutropenic related to other treatments
21:12such as chemotherapy may be receiving
21:14that um so
21:16abuin um may be given to expand the
21:19volume um because it can pull fluid in
21:23um to the um vascular space as well so
21:29when a crystalloid solution are just not
21:31AC adequate to expand the volume because
21:33we need to pull more fluid in you may
21:35see something like alumin used um there
21:38are albumin blood components there are
21:40actually um what I want to say
21:45um synthetic albumens that are available
21:48as well okay so now we're getting into
21:51the actual administration of the blood
21:53transfusions themselves so before you
21:57can administer blood the patient must
21:59have consented and there needs to be a
22:01signed informed consent on the chart um
22:05and then you also need to have
22:07documentation somewhere in the chart
22:09that indicates the transfusion purposes
22:11the reason you know if they have um if
22:14they're getting packed red blood cells
22:16what is their hemog globe and
22:17hematocrite level do we have that
22:19information
22:21available um you want to make sure that
22:24uh you assess the client's understanding
22:25of the procedure for instance if
22:27somebody has had multiple blood
22:29transfusion um you're not starting from
22:31square one if it's a brand new one they
22:33may not understand the purpose or
22:35anything that's happening so you may
22:37have to um you know be a little bit
22:42more I don't want to say more
22:44informative but you may have to provide
22:45more detailed instruction and you know
22:47make sure that they understand it um as
22:50well so you need to let the patient know
22:53about the procedure what components
22:55they're receiving what's the time
22:56involved what's the expected out outcome
22:59um and we talked about knowing the
23:01previous transfusions uh also did they
23:03have any potential symptoms or
23:05transfusion reactions because if they
23:07had a previous transfusion reaction
23:10they're going to be um at increased risk
23:12for having those reactions in the future
23:15also if they've had multiple
23:16transfusions that also increases the
23:19risk because if you think about the way
23:20that we get exposed to foreign
23:23substances in the
23:24antibodies our body can form those
23:27antibodies that can increase
23:28overexposure so that's also going to
23:30increase their risk you want to ensure
23:34the patient knows to report any unusual
23:36symptoms
23:39immediately um prior to starting the
23:43transfusion you need to have Baseline
23:45vitals taken and you're going to be
23:47obsessing obsessing assessing for any
23:49pre-transfusion abnormalities that could
23:51be confused to a reaction uh with a
23:54reaction so um if a patient's febrile we
23:58want to try to avoid transfusions with
24:00them if at all possible however
24:03sometimes we just have to transfuse them
24:07related to you know their um assessment
24:11and what's going on with the patient but
24:13um if a fever is over 10.4 we do try to
24:16avoid that because the fever can mask
24:19the symptoms um of an adverse reaction
24:22and it can also interfere with the
24:23desired effect of of the component
24:25itself because of that immune response
24:27that's happening
24:29um however it's not an absolute Contra
24:32indication for the needed transfusion
24:34because if the patient needs a
24:36transfusion um fever
24:39itself um is not going to is typically
24:42not going to stop us but will typically
24:45uh monitor that closely you want to
24:47premedicate clients um that
24:50need potential premedications
24:53prophylactic medications um with Tylenol
24:56if they have febr reactions padil if
24:59they have allergic reactions a lot of
25:00times you'll see a mix of both um and uh
25:05you want to make sure that you give it
25:06in plenty of time for it to uh take
25:08action before you start the transfusion
25:10you don't want to give it at the time
25:12you start the transfusion because it
25:13wouldn't be in the system yet so you
25:15want to give it a minimum of 30 minutes
25:18um and usually like a maximum of an
25:22hour
25:24so you need to start an IV if necessary
25:28Neary and this needs to be done before
25:31we get our blood because there'll be
25:33some specific details about how long we
25:35can have blood so that IV needs to be
25:38started before we go to get our blood um
25:40we'll have normal saline hung as the
25:43backup
25:44fluid that's the only fluid that can go
25:47in directly with blood components
25:49because other medications uh or other
25:52fluids may cause utenation or hysis or
25:55other unwanted effects um you'll see
25:57here D W can cause hemolysis um LR can
26:01cause some um blood clotting to
26:06occur okay so we talked about you need
26:08to get an IV started before you go and
26:11get your blood um but what size IV is um
26:16sometimes it's facility policy but as
26:18far as like the national guidelines go
26:21um 20 gauges often recommended an 18
26:24gauge or larger needs to be used if
26:26you're giving rapid transfusion
26:29and 22 gauge can be used uh if you can't
26:33obtain a larger um size of access um you
26:38will have a lot of facilities that don't
26:40allow 22 gauge access for blood
26:42transfusion but it isn't against um
26:45National recommendations but you would
26:47want to typically give the blood on a
26:49slower on the slower side because as it
26:53goes through you would have less damage
26:56or less risk of damage because of that
26:57small Gap gauge you want to have it
26:59slower um pediatric patients may have a
27:0223 gauge scalp um
27:06access and then anytime we're giving any
27:08other we need to give other medications
27:11at the same time we're giving the
27:12transfusion we're going to start another
27:15um IV site because you don't want to
27:17delay the blood or the other medications
27:21so most of the time when we're talking
27:23about the tubing and how you start it
27:25we're really kind of focusing on packed
27:27red blood cells because that's what
27:28you're going to see the most frequently
27:31um so I'm just going to kind of say um
27:33albumin or other components may have
27:35specialty filters or specialty sets that
27:38are a little bit different but by and
27:40far the sets that we're talking about um
27:43are what we see most commonly um so um
27:47all of our blood our PID blood cells are
27:49going to be um
27:51infused um in a IV set that includes an
27:55inline blood filter you don't need to
27:57know the pore size but it's going to be
27:59able to uh retain any clots that may
28:02have formed in the blood or any other
28:04debris that could be there to keep it
28:05from reaching the client so typically
28:07what we see is a Y type uh transfusion
28:11set and so you have one end that is um
28:14the normal saline which once again
28:16remember that's the only fluid that can
28:17be given with with or in the blood
28:20tubing um so on one side you have the
28:24normal sailing bag and then on the other
28:26side is where the blood train
28:28um blood component is going to be um
28:31straight lines when you have a patient
28:34that has like a major traumatic event
28:36you may see that straight line is being
28:38used for blood um if that's the only
28:42thing to be infused I have not seen this
28:45it's it's very uncommon but um I'm sure
28:48people that work ICU ER may be seeing
28:51this um more frequently um specialty
28:54sets we talked about that you may have
28:57for your different components you may
28:58have a a specialty set just for that
29:00component as
29:02well so this is what a y tubing would
29:05look like so um and you guys won't
29:08actually get to transfuse blood in
29:10nursing school but you'll get to see it
29:11transfused by nurses I'm sure at some
29:14point um so and you can assist and help
29:17you just can't be the person that's
29:19actually um responsible and and
29:22providing the the
29:24transfusion so first as you prime your
29:27tubing you're going to Prime first with
29:29your saline and you're going to make
29:32sure that you cover your um blood filter
29:35completely with that saling and then the
29:37saline will be then primed to the end of
29:40the tubing once you get your blood bag
29:44later um you're going to take that blood
29:47and you're going to prime it the same
29:48way so you're going to prime it all the
29:50way through make sure we cover the
29:51filter and go to the end of the um
29:54tubing so when we start the blood
29:56transfusion on the client we're starting
29:59with the blood actually going so we can
30:01watch for um you know how they
30:05respond and this up here will tell you
30:07um the things that you'll see on the
30:09blood bag by the way um you'll have the
30:11blood bag you'll have the RH type what
30:13what blood group they are there'll be an
30:15expiration day and then they'll have an
30:17ID number as
30:21well okay so there are some special
30:24devices that are sometimes used with
30:26blood um this up here the electrome
30:28mechanical infusion device that's a
30:30fancy way of saying a pump um an IV pump
30:33or transfusion pump um typically all of
30:36your IV pumps um are can be used um for
30:42transfusion they have to be approved by
30:45the manufacturer for blood transfusion
30:47and it needs to be documented somewhere
30:48which is typically just in the user
30:50manual um and then we also have an
30:53external pressure infusion cuff um and
30:56what this is is just for giving blood
30:59more rapidly so this Blood sits in this
31:02kind of like little pouch it kind of
31:04sits in there and then on the other side
31:06of the pouch you have this bag that
31:09fills with air and pushes on the blood
31:12um bag itself so it can squeeze it more
31:15quickly and you can give the blood more
31:18rapidly you only want to use cuffs that
31:20are designed for the blood transfusion
31:22so you don't want to wrap a blood
31:24pressure cuff around it or squeeze it
31:25with your hands you want to use the the
31:28cuff that's approved for that and then
31:30once you once again we're looking at
31:32rapidly so when we're using a rapid
31:35infusion remember that 18 or larger
31:38gauge needs to be
31:40used um also blood at sometimes may need
31:44to be warmed before it gets to the
31:47client Um this can decrease the risk of
31:50dysrhythmia and cardiac rest that can
31:52happen with rapid uh massive infusions
31:55of Cold Blood components
31:58uh neonates
32:00um have uh can have exchange transfusion
32:03and clo glutenin disease um if they're
32:07given um blood that's cold um it can
32:10prevent hypothermia and this is going to
32:12be the very young very old are going to
32:15be at greater risk for that of course um
32:18and then when you're administering
32:19several units of blood that's going to
32:21put patients at increased risk of
32:23hypothermia and these other risk factors
32:25that occur
32:28so uh blood is warmed in an improved
32:30inline warmer only so we're not warming
32:33the bag we're warming the line so as the
32:35blood moves through in this line it gets
32:38warmed up um so it's kind of like just
32:41the line fits in the certain area and it
32:44Heats it up as it moves through so kind
32:46of think of um oh the hot water heaters
32:50that are like the instant hot water
32:51heaters how those work is as the water
32:54moves through at a certain point it
32:55Heats it up and so it's the same way
32:57with blood it's just um a different type
33:01of device to do it um of course you only
33:04want to use the approved inline warmers
33:07so never hold the blood bag under hot
33:09water don't put them in a microwave
33:10don't put them in a hot water bath where
33:13you're trying to warm it up um if you
33:16have warmed blood and not used it it
33:18needs to be discarded honestly if you
33:20get to the point where you're in an
33:22inline blood warmer um you're going to
33:25need to discard it anyways cuz it's
33:27already going to be spiked
33:30um and then uh because of the rate that
33:35it can warm the blood you may have to
33:37give the blood itself at a slower rate
33:40in order to keep it
33:44warm if you have multiple blood
33:47components ordered so you know it may
33:51be two ffps and three prbcs it could
33:56have more or less
33:58um your physician should give you the
34:01order or you have to go by your
34:04institutional policy but if he doesn't
34:06give you the order you don't have a
34:07policy then that's something that you
34:09would clarify with your Physicians so
34:11they're responsible for deciding what
34:13order they want us to give them
34:17in okay so now we're ready to administer
34:21we've started RV we've primed it with
34:24normal saling uh we you know the
34:27patients already been typed and cross
34:28matched we have the order we've gotten
34:31the um originally we went ahead and got
34:35the
34:36um consent so that the client actually
34:40has consented before we we decide we're
34:42going to get blood so now we're at this
34:44point where we're like okay we need to
34:46go and get our blood
34:48so when you go to get your blood you
34:50want to double check with the person
34:51that issues the blood um whether it's
34:54the blood bank or the lab whoever is
34:57responsible for it that there needs to
34:58be the client's name the person who
35:01issued the blood is available uh the
35:03person who got the blood so that would
35:05be you if you're receiving it the date
35:07and the time that it was issued any
35:10verification numbers will be checked at
35:12that time so your patient identification
35:14versus um the patient that it's meant
35:18for versus um the identifications on the
35:20blood
35:21bag and there'll be a
35:23transfusion me uh copy that's issued by
35:26the bloodbank so you'll get actual
35:28paperwork with your blood tubing um
35:30whereas most of our things are kind of
35:32leaning electronic blood transfusions
35:35are almost always paper copies still you
35:38want to take that bag you want to look
35:40at it and make sure that there's no
35:42leaks that the color is appropriate you
35:44don't see cloudiness um you don't see
35:46any clots in the bag or any abnormal
35:48amounts of air if you do see those you
35:51need to be bringing it to the attention
35:53of the people in the blood bank before
35:55you accept the blood um you want to
35:58check the expiration date and time on
36:01the bag if you don't have a time on it
36:03it's it's midnight on the expiration
36:05date that's
36:09listed all right so you've gotten the
36:11blood you've checked it it looks good on
36:14that end and you want to come back in be
36:18before you start the blood you want to
36:20double check that Physician's order
36:21again you want to compare the blood
36:24group and the RH type from the patient
36:27um um into the bag you want to have
36:30another licensed person so another um
36:34nurse needs to look at the blood with
36:36you um and verify the patient
36:39identification and the
36:41documentation now if you have not
36:44personally checked blood even if every
36:46single nurse on the floor has seen that
36:49blood bag and checked it you do not want
36:51to hang it until you go through and
36:53check
36:54it you want to compare the name and the
36:56ID number on the bag to those on the ID
36:59band The Blood band for the
37:03patient um the transfusion form stays in
37:07the client's room the entire time
37:08they're receiving the uh transfusion and
37:12all the information on that form must be
37:14the same as what's on the blood bag and
37:18on the uh the
37:20blood the ID number on their band should
37:23be the same as on the transfusion form
37:25and then you also once again you want
37:27the patient to tell you their name
37:29you're not asking if they're Mr Smith
37:30it's the name and date of birth
37:34process so most of your transfusion
37:37reactions are going to be a result of
37:39errors in the client or component
37:42identification
37:44so this is going to be mean that maybe
37:48the lab identified the client in
37:51correctly they could have mixed up their
37:54blood when they went and they drew um
37:57two different people's blood at the same
37:59time and mix that up or maybe the blood
38:03bank identified something in correctly
38:07or you as the nurse did not identify
38:10something correctly so there's three
38:12different steps in this process for us
38:14all to identify it unfortunately if one
38:16of these areas breaks down it can cause
38:19problems for the rest of it but most of
38:21the times that we have like a severe
38:23transfusion reaction there's been an
38:25error somewhere somebody did not check
38:27something
38:31appropriately okay so something I should
38:33have mentioned earlier um you only have
38:3630 minutes from the time that you
38:37actually pick up the blood from the lab
38:40Blood Bank wherever you're getting it or
38:42they send it to you until the time that
38:45you can hang and administer it so that's
38:48a pretty short period of time um in
38:51nursing because so many things can
38:52happen that's why we want to have things
38:54prep before we go in the room you have
38:56the the saline hanging the TU being hung
39:00um prepped with the saline you've uh got
39:04the IV already started before we left so
39:06all these things are in place so that we
39:08can just start the blood when we get it
39:11um should have mentioned that early what
39:12I mentioned now 30 minutes from the time
39:14you get the blood until you can start
39:16the blood or else the the blood is no
39:18longer
39:19viable um when we're going through all
39:23the process before we administer it once
39:25again everything must match exact if it
39:28doesn't match exactly you cannot start
39:30the transfusion you need to contact the
39:32transfusion service immediately with
39:35those discrepancies so that we can
39:37identify um the issues as well um you
39:41want to uh sign that transfusion form
39:44and the person that verified the
39:45information with you must sign it as
39:47well and then when you go to start it
39:49within 30 minutes of getting it from the
39:51blood bank you need to document the date
39:53and time that you're starting it all the
39:56identification remains attached to the
39:58blood container until you are uh have
40:01completed the transfusion so all that
40:02stuff that you bring in stays in that
40:04patient room the whole time that they're
40:06receiving
40:07transfusion um the blood
40:10filter um and blood tubing can only stay
40:14up for either 4 hours or two units of
40:17blood whichever one comes sooner so if
40:19you are giving blood over 4 hours then
40:23the second unit you need a new tubing if
40:25you're giving blood over an hour a piece
40:28you would still need new tubing on the
40:30third unit even though it's only been up
40:31for 2 hours um blood itself each unit of
40:36blood cannot be hung for more than 4
40:39hours this includes that 30 minute time
40:41frame from getting the getting it from
40:43the blood bank so 4 hours from the time
40:47it leaves the blood bank's controlled
40:49temperature it must be transfused by
40:52that
40:53point um you do not want uh any
40:58medications added to the blood
41:00components or infused through the same
41:02line as the blood components the only
41:04thing that can go through the same line
41:05or come in contact with that is normal
41:08saline um and then um never ever hang
41:12anything that you've not personally
41:13checked I feel like we talked about that
41:15earlier but it's so important to
41:17remember that despite other people
41:19checking it we need to be the individual
41:21that does that because you will be the
41:22individual that's signing and
41:24responsible for saying it's been checked
41:31okay so um Administration guidelines uh
41:34as we're actually transfusing it we're
41:37going to initially start the transfusion
41:40um very slowly so about 2 Millers a
41:43minute for the F first 15 minutes um
41:46some people go a little bit faster it
41:48may be a little different with your
41:50organization but slow um because we're
41:54going to watch them for transfusion
41:56reactions and we're going to sit in
41:58their room for the first 15 minutes and
42:00watch them very closely and that is when
42:05most of our severe reactions are going
42:07to occur when we receive less than 50 Ms
42:11of
42:12blood so if we were to recognize a
42:16severe reaction or signs of a reaction
42:19we would be able to stop the blood and
42:21decrease the amount of blood that has
42:23actually gotten into the receivers um
42:27system so we're going to have a less or
42:31a um a decreased response because less
42:33blood to cause the response less blood
42:36to see the response um so you want to
42:39sit with them and it it's not like a law
42:42it's just a policy that I've never seen
42:44any other way you always want to sit
42:45with the client for the first 15 minutes
42:47of a transfusion um you're going to
42:49monitor them very closely during that
42:52first 15 minutes for any signs or
42:54symptoms of a reaction you're going to
42:57then take another set of vitals after 15
42:59minutes and compare it to the initial
43:01and you're going to observe them very
43:03closely throughout the
43:05transfusion
43:06um
43:10itself so you'll have a lot of different
43:12Vital Signs uh you have to repeat the
43:14vital signs very frequently and you'll
43:16compare each of those to the Baseline um
43:19each facility is a little bit different
43:21there's almost always after 15 minutes
43:24um often you'll have 15 minutes for the
43:26first hour or 15 minutes time 2 and then
43:29q30 so it really just depends on your
43:31facility and the policy that they have
43:33in place um if we that initial uh Vital
43:37sign is fine you'll go ahead and adjust
43:39the flow to whatever the prescribed rate
43:41is um and then as you continue you
43:44follow those guidelines for your
43:46facility and you record it in the
43:48appropriate place on the permanent
43:49record so you'll be recording their
43:52vital signs for the um transfusion on
43:56paper but you can also so put them in
43:58the um electronic record as well after
44:01the transfusion is done you want to
44:03discard empty blood containers um as
44:06Guided by the facility usually it's just
44:08a hazard um trash um or some facilities
44:12have you return it to the blood
44:15bank um blood products can be stored in
44:17the refrigerators or freezers only those
44:20that are monitored by the transfusion
44:22service once you get those blood
44:24products you are not going to be able to
44:27refrigerate them or keep them
44:29um um from becoming um non-usable you
44:34have to transfuse it within the 30
44:36minutes that you get it and it needs to
44:38be completed within 4 hours of that
44:42time so never store the components in
44:45the nursing unit or any unmonitored
44:47refrigerator do not keep the blood out
44:49of that monitored refrigerator for more
44:52than 30 minutes before you start the
44:54transfusion only monit or only warm
44:56blood in a an approved blood warmer
45:01nothing like an un monitored sink or
45:03microwave do not administer any blood
45:05components without a blood
45:08filter this is just um kind of a list of
45:12the procedure steps pre-procedure
45:14procedure itself the post-procedure um
45:17and this is actually provided to you a
45:18little bit differently in another
45:20document in your material as
45:23well okay so there are several
45:25transfusion reactions that you need to
45:26watch out for if you administering um
45:30blood um one that's very common is a
45:32febril non-hemolytic reaction um this is
45:36just an immune response that happens um
45:39due to cytokines in donor's blood so
45:42you're going to start seeing signs of
45:44immune response and one of those
45:46responses are going to be um
45:49fever um an acute hemolytic reaction is
45:52going to be typically we see this if we
45:55have a Inc ability in the um blood
45:59types so you're going to see the
46:01recipient blood attacking the donor
46:03blood um but there can be other um anti
46:08antibody antigen mismatches that occur
46:11as well but uh the most common by far is
46:13the
46:14incompatibility you can have a simple
46:16allergic reaction where you have um a
46:19hypers sensitivity to protein in the
46:21donor's blood and then that can go as
46:24far as an anaphylactic reaction where
46:26you have
46:27basically just that but much more severe
46:30where we see the signs of
46:32anaphylaxis um you can have a
46:34transfusion Associated C circulatory
46:37overload or taco this can happen when
46:39you get um too much blood in your body
46:43um so it's similar to heart failure
46:46where you're going to see that our body
46:48is just not able to handle this
46:49increased circulation or circulatory
46:52load um so the blood is kind of um
46:55causing the ad and this inability for
46:58our heart to pump effectively into to
47:01rid of the excess um
47:05fluid um it can happen relatively slowly
47:09um a lot of times you'll have patients
47:11that are going to be predisposed to this
47:13related to their past history for
47:15example if they have heart failure um
47:18but it can happen several hours after
47:19the transfusion stops because it just
47:22happens due to our body's inability to
47:25handle the extra volume
47:27you can have a bacterial contamination
47:30which can lead to bacteria and sepsis um
47:33because you you've given them
47:34contaminated blood and straight into
47:36their Venus system um you can have a
47:40transfusion related acute lung injury or
47:43a trle related to uh just kind of this
47:47um quick immune reaction that happens in
47:50our pulmonary tissue um due to some um
47:56reaction to the donor's antibodies um
48:00and then it would cause like this um
48:02pretty rapid onset of pulmonary
48:05congestion and and
48:07dmia you can have what's known as a
48:09delayed hemolytic reaction um which can
48:12happen when there is an antigen um or
48:15foreign substance that gets reintroduced
48:18into um blood this is going to be more
48:20common in
48:23um like patients that have had uh more
48:26more frequent um blood transfusion there
48:29are some some slides that are following
48:31that will have a little bit more
48:32specific information to know about the
48:34transfusions but there are things that
48:36you need to know um kind of overall what
48:40happens when you have any suspected
48:42transfusion reaction so the very first
48:44thing with any single type of
48:46transfusion reaction is you stop the
48:48transfusion you stop the transfusion
48:51you're going to take the tubing that the
48:55patient has for the blood tubing you're
48:58going to take that away and you're going
49:00to change to a Brand New Bag and line
49:04and you're going to piggy back normal
49:05sailing into that line so you're going
49:07to keep that normal sailing going so we
49:09keep a port um open and available for
49:14us um you're going to report those
49:17reactions to both the physician and
49:19transfusion Services you're going to go
49:23through and do more clerical checks and
49:25making sure that everything match the
49:27numbers at the bedside the the blood bag
49:29all the stuff gets checked again just
49:31like it did at the beginning um you're
49:34going to treat any kind of symptoms per
49:36the physician order you're going to
49:37monitor them very closely Vital Signs
49:40and their uh hematological status as
49:43well respiratory status as well you're
49:45going to send the blood bag and any
49:48Administration set and labels to the
49:50transfusion services so that they have
49:52the blood um there to um
49:57view you're also going to collect a
49:59blood and urine sample and send that to
50:01lab which reminds me that I did not
50:03mention before you start a blood
50:05transfusion you want to make sure the
50:06patient urinates because then when we
50:09collect the blood and urine sample it's
50:11it's fresh blood from after the
50:13transfusion
50:15um what labs need to be done will be
50:18specific to each facility in their
50:20policy and then you want to document
50:22completely on the transfusion reaction
50:24form and you want to document in the
50:26patient's
50:29chart so here are a little bit more of
50:32the information for the different types
50:34of reaction so with the FBR we have this
50:38um cyto release from the um donor's
50:42blood it causes this immune
50:45response so the one thing that I really
50:48need you to remember um is that they're
50:51going to have an increase in temperature
50:53so 1° C it's 1 8 F but um just remember
50:59two for me and you will be fine um so 1
51:02Celsius 2 fenhe and you are going to be
51:04good uh typically you're going to see
51:07this happen after they've had the
51:09transfusion going for a while so that
51:12timing can be kind of important so
51:14you'll see a couple hours later is when
51:17you actually start seeing um the
51:19increase in the fever and then they have
51:21things that kind of go along with the
51:23fever so they may have chills headache
51:25Flushing anx xiety and muscle pain kind
51:28of some things that are present with
51:29fevers but that temperature is what's
51:32important
51:35so most of the time you're not going to
51:38restart the transfusion
51:40and if you follow the recommendations
51:43not starting the transfusion is what we
51:45typically see um you're going to treat
51:49the symptoms give
51:50antipyretics um you're going to avoid of
51:53course aspirin if they're
51:54thrombocytopenic but
51:57I want you to know that in practice this
51:59of this sometimes does get restarted it
52:02may be in the case of those patients
52:04that we expect to see increased fevers
52:06in such as pneumonia or um cellulitis or
52:11somebody that has another infection
52:13going on where they have been febr there
52:16have been times where you will see the
52:18physician go ahead and order the
52:21restart um you don't have to worry about
52:24the prevention on this
52:26okay so for the acute
52:28hemolytic uh reaction once again the
52:30most common cause of this is going to be
52:32an incompatibility so we've given a
52:35patient blood with an antigen that they
52:37don't have which made them uh form
52:39antibodies and then they start attacking
52:42the blood so then they lose the blood
52:44they get rid of the blood in their
52:46system attack it and then we start
52:47seeing this uh vascular collapse and
52:50decreased blood um and other issues that
52:53are occurring so the patient can have
52:55Tac card
52:57um because they have less blood
52:58hypotension vascular collapse can occur
53:02um you can see um fever and chills in
53:05these patients as well low back pain heo
53:09hemoglobin Nua because of the breakdown
53:11of the blood you start seeing that in
53:12the urine um which is one of the reasons
53:14why we would test
53:16urine um patients can have bleeding
53:19acute renal failure shock cardiac arrest
53:22and death um so the you can kind of see
53:26how these symptoms can go from bad to
53:29worse so if we have less blood in the
53:32system we're going to have less severe
53:35responses so that's one of those reasons
53:37why we got to watch so closely so um our
53:40management for this we're really going
53:42to be treating those
53:44um symptoms and you also want to make
53:48sure that you're not giving any blood
53:49until they've done a complete new um
53:52check on the patient and made sure that
53:54everything is correct so so you would
53:56never want to administer another um
53:59blood product without redoing everything
54:03CU at this point they're may have been
54:04that error in the system that we talked
54:06about um so a lot of it is going to be
54:09maintaining urine flow maintaining their
54:11um
54:13vascular
54:15um not structure maintaining uh V volume
54:19maintaining their
54:24volume so you can have allergies you can
54:27have the mild allergies which is just
54:28going to be that sensitivity due to a
54:31protein in the the donor and this is
54:33going to be what you think of when you
54:34have an allergic reaction so flushing
54:36itching ticaria or hives um in these
54:40patients sometimes you would go ahead
54:42and restart these transfusions if their
54:45symptoms are mild enough after you give
54:47them um an
54:49antihistamine um if they're
54:51mild you just have to give them that
54:53give that time to set in and you restart
54:55it slowly
54:57um you have to get it over that 4 hours
54:59but um you don't want to go quickly if
55:03the patient can have a potential severe
55:05allergic reaction um if patients have
55:08had reactions in the past prophylactic
55:10treatments are often
55:14given um and then anif flaxes this it's
55:16going to be that and just much more
55:19severe so it's going to be like that
55:20severe allergic reaction and we're it's
55:22in our blood um you're going to start
55:24seeing the the signs of the aniflex so
55:27these patients are going to have
55:29breathing problems wheezing anxiety
55:32cyanosis um they're going to have that
55:35itching and stuff that they would have
55:36with um the regular reactions maybe have
55:39hives as well um and this could progress
55:42to shock and cardiac arrest so with
55:44these patients an aaxis remember that's
55:47very severe and a lot of times we're
55:48looking at starting CPR and obviously
55:51never restart those transfusions
55:56um here's the taco or the transfusion
55:59Associated circulatory overload so it's
56:02just a fluid overload that happens
56:03because of
56:05transfusion and this is one of those
56:07things that can happen up to six hours
56:10after the transfusion so you could give
56:13their unit or two units of blood and
56:15then not see this for several hours so
56:17you would have to kind of connect that
56:18it is that fluid volume overload a lot
56:21of times you'll have uh Physicians that
56:23will prevent this by um either giving
56:26smaller um they can give them a smaller
56:30amounts uh separate the units into
56:33smaller units or they'll give them like
56:35a diuretic um after each unit or between
56:38units just depending on the patient so
56:40these patients are going to have what
56:42looks like circulatory overload so they
56:44have the cough the disia they'll have
56:46some crackles and Pulmonary congestion
56:48um headache hypertension tacac cardia
56:51distended neck vein so it's all that
56:53sign of that increased fluid um so when
56:56we treat it it's going to treat it like
56:58fluid overload so you're going to want
56:59the patient
57:00position uh head a bed elevated give
57:03them diuretics as needed to help get rid
57:05of the excess fluid oxygen morphine can
57:08be used especially if you're having any
57:10kind of um cardiac chest pain that's
57:12really good for
57:14that uh bacterial
57:16contamination the blood's contaminated
57:18so if you're going to give um a patient
57:21blood that has that bacterial
57:23contamination you're going to start
57:24seeing these uh manifestations of
57:26infection in in possibly sepsis where
57:29you have the patient have chills fever
57:32um moving into vomiting diarrhea um
57:35marked hypotension and shock as they
57:37move into sepsis um of course you guys
57:40would want to or we would be sending the
57:42blood bag anyways but we would expect a
57:44culture uh to be taken and you would
57:46treat it um just as you would other
57:49infections so you'd have to give
57:50antibiotics fluid vasopressors um
57:53whatever medications to decrease or to
57:55get rid of the um invading
58:00organism um and then try so this is like
58:03fluid volume overload but specifically
58:05to our lungs and it's quick um so you'll
58:09have the uh reaction that occurs that
58:13causes this edema on our lungs it's very
58:15abrupt the patient will suddenly have
58:18severe dmia we can see hypoxia or
58:21hypoxemia um hypotension because the
58:24fluid is moving into the pulmonary space
58:26and then the pulmonary edema so it's um
58:30it's like some of the things you will
58:33see kind of be similar to the fluid
58:35overload itself but it's very abrupt and
58:38it's pulmonary um centered uh so
58:42aggressive support therapy oxygenation
58:44ventilation head of bed all your
58:46respiratory interventions are going to
58:48be important
58:50here so uh the delayed hemolytic uh can
58:54happen
58:563 to 14 days after a transfusion it's
59:00just a delayed reaction um because of an
59:04antibodies um Can attack uh donor blood
59:09that's circulating um it's not as severe
59:12as a an acute hinic reaction because we
59:15won't have those circulating um blood
59:17units as much um but because of the
59:20breakdown of the blood we may see some
59:22jaundice and decreased hematocrit and
59:25then because it's causing that
59:26inflammatory response we may see fever
59:29as well um most of the time uh you're
59:32just really watching them closely and um
59:35making sure that they may not need
59:37another transfusion and making sure that
59:39they recover from it and then here are
59:42the um some infectious things Hepatitis
59:44B and hepatitis C and I think there
59:46might be more in the next slide but the
59:48whole point of those are you know
59:51they're there they are risk so if a
59:53patient scared of this you can't say
59:55there's no risk R of these diseases
59:57being transmitted um but they do check
1:00:00for all of these infections and they use
1:00:02that Gat testing which is very good at
1:00:04identifying any small um viral uh DNA
1:00:09that would be
1:00:12present yes so here's some more um that
1:00:15we're not really looking into but it's
1:00:17just there for your
1:00:18information so other risk that we might
1:00:21see with patients that receive blood
1:00:23transfusions um one thing that we see is
1:00:25hyper IIA um blood the older the blood
1:00:28is the the higher the risk because as
1:00:30blood sits in is stored you're going to
1:00:32see this breakdown of some of the cells
1:00:34and as the cells break down because the
1:00:36potassium's inside of the cells it's
1:00:38going to release potassium out into the
1:00:41plasma um and you can see here where it
1:00:44says one day old we would see seven uh
1:00:48mil equivalent per liter is where you
1:00:49would see your uh potassium level
1:00:52expected to be but if it's 21 days you
1:00:54can have 2 3 mil equivalent per liter so
1:00:58it's like giving patients some a little
1:01:00bit of dose of potassium if we get high
1:01:03so especially if you're going to have
1:01:04multiple units that potassium level is
1:01:06going to increase and the older the
1:01:09blood itself itself is is the increase
1:01:12risk as well um so if they're receiving
1:01:14several units you need to measure their
1:01:16potassium levels
1:01:19frequently um you can also have
1:01:22hypocalcemia um with patients especially
1:01:24those receiving masses transfus fusions
1:01:26because of the citrated blood can
1:01:28combine with ionized calcium um and then
1:01:32we will have hypocalcemia occurring um
1:01:36if this actually should I believe be
1:01:39five units so calcium gluconate is
1:01:41frequently U ordered to be administered
1:01:43every we'll say four to five units of
1:01:46Bank blood you don't have to remember
1:01:47the exact number but know that that's a
1:01:49risk factor that hypocalcemia and
1:01:52calcium gluconate may be ordered
1:01:56um okay so now we're going the whole
1:01:58component of red blood cells uh this is
1:02:02whole blood so it includes all the red
1:02:04blood cells the plasma um including the
1:02:07plasma proteins clotting factor and then
1:02:10they usually add an anti-coagulant
1:02:12preservative to it um the volume is very
1:02:15high where you will see this most
1:02:19frequently or really almost always is
1:02:21going to be when they have to expand the
1:02:24volume and the um blood they need the
1:02:27blood components quickly so you're
1:02:29seeing in things like um severe trauma
1:02:32and so forth because of the the volume
1:02:35of it it's going to put patients at
1:02:36higher risk for fluid volume overload so
1:02:38you don't want to give it to patients
1:02:39with like CHF um or other fluid overload
1:02:44problems so pack red blood cells like I
1:02:47said this is the one that we're going to
1:02:48most commonly see um and given the
1:02:52most so they take the red blood cells
1:02:55from the um whole blood after the
1:03:00donation um and this is going to uh
1:03:03restore and maintain adequate organ
1:03:04oxygenation you're going to see the
1:03:06increase of hemoglobin and
1:03:08hematocrit um it can be indicated for
1:03:11anemia or anything that affects spread
1:03:13blood cell production CLE cell anemia
1:03:16blood loss um trauma or surgical blood
1:03:19loss um and then sometimes we'll see in
1:03:22chemotherapy because our body is not
1:03:23producing the red blood cells um as
1:03:26quickly or really it's dying off because
1:03:28of the chemotherapy effects you'll see
1:03:31that they need some pack red blood cells
1:03:33to get their levels up um 42 days is how
1:03:37long it can stay refrigerated and viable
1:03:40unless it's one of those rare um blood
1:03:42units that we see for up to 10 years
1:03:44Frozen in a nonbleeding adult um one
1:03:48unit of packed red blood cell should
1:03:50increase the hematocrit by 3% and the
1:03:53hemoglobin by 1 so if I had a hemoglobin
1:03:57of 10 and I got four units of blood my
1:04:00expected hemoglobin level would be 14
1:04:03and you know there's going to always be
1:04:05factors involved in that but that's what
1:04:07you would expect to see
1:04:11um we would see
1:04:15um the transfusion would be given to
1:04:19patients that are under a hemoglobin of
1:04:21seven so the the number is very low now
1:04:25so you have to get under seven um
1:04:27hemoglobin level to get blood if we're
1:04:31not looking at symptomatic you can see
1:04:33it's um given in patients that are
1:04:36symptomatic at an earlier time um under
1:04:40eight is sometimes given for patients
1:04:42that have certain chronic issues or
1:04:44they're um receiving surgical but in
1:04:47general if we're looking at no other
1:04:50issues under seven we would expect a
1:04:52transfusion
1:04:57um uh fresh frozen plasma so fresh
1:05:00frozen plasma is just really 91% water
1:05:037% protein 2% carbohydrate it's frozen
1:05:07when fresh which is why it's called
1:05:09Fresh Frozen plasma within the 6 hours
1:05:11of collection um you can use this to
1:05:14incre CL increase clotting factors with
1:05:16patients with a deficiency so if we're
1:05:19looking at
1:05:21um PT INR levels if they're very high
1:05:24you can give them in
1:05:27factors if they're over um
1:05:31one oh if the if the pro time and PTT
1:05:34are under 1.5 times normal ffp is
1:05:37usually not indicated so they need to be
1:05:39more elevated than that you do not want
1:05:42to transfuse these for volume expansion
1:05:46or nutrition or
1:05:48prophylactically um for blood
1:05:50transfusion or cabbage you're going to
1:05:52give it when it's indicated which is
1:05:54related to
1:05:56um insufficient uh clotting factors elev
1:06:01and elevated P T ptti and R
1:06:05levels um so when you were given this
1:06:08you would expect that the coagulation
1:06:09function would be um improved and you
1:06:12would be measuring it by PT PT or INR or
1:06:16by a specific Factor assay if you were
1:06:18looking at a missing clotting Factor um
1:06:21you would Infuse this within two hours
1:06:23of thawing
1:06:25and over 30 to 60 minutes so it goes
1:06:28quite a bit faster than a blood
1:06:29transfusion usually
1:06:31does platelets um are our next things
1:06:34that we're looking at that's about 50 to
1:06:3770 mls in each uh transfusion of
1:06:40platelet rid plasma that came from that
1:06:42when they got the fresh whole blood this
1:06:44is um the plasma aspect um it is used to
1:06:48control or prevent bleeding associated
1:06:50with deficiencies in uh platelet numbers
1:06:53or function and I believe that the
1:06:56number for that is under
1:06:5810,000 um if you if we're not looking at
1:07:01symptomatic under
1:07:0310, is where we would expect to see the
1:07:06ffp um
1:07:08administered um you may see it if we're
1:07:11symptomatic much earlier than that and
1:07:13you may see it if you see the signs of
1:07:15bleeding like ptii gum bleeding ecosis
1:07:19blood in the urine stool or once again
1:07:22that low platelet count um would would
1:07:25need to
1:07:26be it would need to be low even if the
1:07:29platelet even if we're bleeding
1:07:31elsewhere
1:07:35um once you uh have the blood the
1:07:39platelets that are being processed you
1:07:41need to use it within 4
1:07:45hours so there are other components that
1:07:48you may see um you don't see them quite
1:07:50as often but they are components that
1:07:54have been given
1:07:55cryoprecipitate especially for factor 8
1:07:58for
1:07:59hemophilia um then you can have blood
1:08:02products that are modified in one way or
1:08:05another so like luccy por or radiated uh
1:08:08red blood cells where you can reduce the
1:08:10lucaites this would help a patient that
1:08:13has um reactions because of um the donor
1:08:18blood in their lucaites you can have
1:08:22colloid Solutions uh albumin once again
1:08:25you have the um human albumen or you can
1:08:28have the synthetic albumen um now plasma
1:08:31protein factors um you would use those
1:08:34to provide
1:08:37um volume expansion when we're not able
1:08:40to get adequate volume expansion with
1:08:42other with our IV fluids um so our whole
1:08:45point of that would be to maintain the
1:08:46blood pressure and the fluid volume in
1:08:49order to maintain our U perfusion you
1:08:52can have immune serum globulins that are
1:08:54us used in a variety of different
1:08:56treatments where uh we have
1:09:00a concentrated aquous of gamma
1:09:03globulin um containing a higher tighter
1:09:07of antibodies so you're really providing
1:09:10passive immune protections for clients
1:09:13this was used a lot during the uh
1:09:14covid-19 where you have the immune
1:09:17globuline
1:09:18infusions um and you can also treat
1:09:21hypog gagl globin nmia
1:09:26so really the most common issue that
1:09:30comes up with blood transfusion has been
1:09:34uh patients that don't want blood
1:09:35transfusion for um one reason or the
1:09:38other so the most common reason that
1:09:40patients will refuse the blood
1:09:42transfusion is it is against the
1:09:44religious beliefs and the most common
1:09:46time that we see that is a patient that
1:09:47is a Jehovah's Witness because they do
1:09:50not believe that they can receive blood
1:09:52from um anyone other than from anyone
1:09:57and still get into heaven so this this
1:09:59is
1:10:00um one of those things where you will
1:10:04see some people refuse the uh
1:10:07transfusion despite the fact that it may
1:10:09be necessary uh for life-saving reasons
1:10:13um but they have the right to refuse
1:10:15that transfusion for themsel um they
1:10:18just need to be completely educated on
1:10:21the risk and benefits and um what would
1:10:24happen if they War to take the
1:10:26transfusion I will say some people tend
1:10:28to change their minds when they realize
1:10:30that um you know just how severe their
1:10:32anemia has to be before they can get the
1:10:35transfusion and then some patients you
1:10:37know will kind of stand firm and then uh
1:10:40they will look for alternate treatments
1:10:42as well um and there'll be other things
1:10:44that will come up um some patients
1:10:47during the um or even now probably did
1:10:52not want to take blood from donors if
1:10:54they did not know whether they had or
1:10:56hadn't had an immunization for covid um
1:11:00and you know just regardless of your um
1:11:04personal beliefs on that they do have
1:11:06the right to refuse we just have to be
1:11:09um you know we have to listen to them
1:11:12understand that where they're coming
1:11:14from and then provide them with all of
1:11:16the facts that they need to make an
1:11:18actual informed decision and then you
1:11:20know in in the end that's that's their
1:11:23own decision to make and I think that's
1:11:26all I have for you

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