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What is a blood transfusion?

A blood transfusion is the transfer of blood or blood products from one person (donor) into another person's bloodstream (recipient). This is usually done as a life saving maneuver to replace blood cells or blood products lost through severe bleeding, during surgery when blood loss occurs or to increase the blood count in an anemic patient. The following material is provided to all patients and/or their family members regarding blood transfusions and the use of blood products. Although in most situations the likelihood of a blood transfusion associated with surgery is uncommon, at times patients may require blood products. You are encouraged to discuss your particular need for transfusion as well as the risks of transfusion with your doctor. Your options may be limited by time and health factors, so it is important to begin carrying out your decision as soon as possible. For example, if friends or family members are donating blood for a patient (directed donors), their blood should be drawn several days prior to the anticipated need to allow adequate time for testing and labeling. The exact protocols are hospital and donor site specific. The safest blood product is your own, so if a transfusion is likely, this is your lowest risk choice. Unfortunately this option is usually only practical when preparing for elective surgery. In most other instances the patient can not donate their own blood due to the acute nature of the need for blood. Although you have the right to refuse a blood transfusion, this decision may hold lifethreatening consequences. If you are a parent deciding for your child, you as the parent or guardian must understand that in a life-threatening situation your doctors will act in your child's best interest to insure your child's health and well being in accordance with standards of medical care regardless of religious beliefs. Please carefully review this material and decide with your doctor which option(s) you prefer. To assure a safe transfusion make sure your healthcare provider who starts the transfusion verifies your name and matches it to the blood that is going to be transfused. Besides your name, a second personal identifier usually is used as your birthday. This assures the blood is given to the correct patient. If during the transfusion you have symptoms of shortness of breath, itching, fever or chills or just not feeling well, alert the person transfusing the blood immediately. Blood can be provided from two sources: autologous blood (using your own blood) or donor blood (using someone else's blood). Autologous blood (using your own blood) Pre-operative donation: donating your own blood before surgery. The blood bank draws your blood and stores it until you need it during or after surgery. This option is only for nonemergency (elective) surgery. It has the advantage of eliminating or minimizing the need for someone else's blood during and after surgery. The disadvantage is that it requires advanced planning which may delay surgery. Some medical conditions may prevent the pre-operative donation of blood products. Intra-operative autologous transfusion: recycling your blood during surgery. Blood lost during surgery is filtered, and put back into your body during surgery. This can be done in emergency and elective surgeries. It has the advantage of eliminating or minimizing the need for someone else's blood during surgery. Large amounts of blood can be recycled. This process cannot be used if cancer or infection is present.

Post-operative autologous transfusion: recycling your blood after surgery. Blood lost after surgery is collected, filtered and returned to your body. This can be done in emergency and elective surgeries. It has the advantage of eliminating or minimizing the need for someone else's blood during surgery. This process can't be used in patients where cancer or infection is present. Hemodilution: donating your own blood during surgery. Immediately before surgery, some of your blood is taken and replaced with IV fluids. After surgery, your blood is filtered and returned to you. This is done only for elective surgeries. This process dilutes your own blood so you lose less concentrated blood during surgery. It has the advantage of eliminating or minimizing the need for someone else's blood during surgery. The disadvantage of this process is that only a limited amount of blood can be removed, and certain medical conditions may prevent hemodilution. Apheresis: donating you own platelets and plasma. Before surgery, your platelets and plasma, which help stop bleeding, are withdrawn, filtered and returned to you when you need it later. This can be done only for elective surgeries. This process may eliminate the need for donor platelets and plasma, especially in high blood-loss procedures. The disadvantage of this process is that some medical conditions may prevent apheresis, and in actual practice it has limited applications.

Nurses Information
The link for the slideshow..: http://nursesinformations.blogspot.com/2008/06/bloodtransfusion.html
Slideshow transcript Slide 1: Blood Transfusion Nursing Procedure Slide 2: *Whole blood transfusion replenishes the circulatories: Volume Oxygen-carrying capacity *Packed Red Blood Cells (RBCs) restores: Oxygen-carrying capacity Both treat decreased hemoglobin and hematocrit. Slide 3: Two nurses must identify the: 1. Patient 2. Blood products before administering a transfusion (to prevent errors & potentially fatal reaction) Slide 4: If a patient is a Jehovas Witness, a transfusion requires special written permission. Slide 5: Equipments needed 1. Blood recipient set (filter & tubing with drip chamber for blood, or combined set) Slide 6: Equipments needed 2. I.V. pole 3. Gloves 4. Gown 5. Face Shield Slide 7: Equipments needed 6. Multi-lead tubing Slide 8: Equipments needed 7. Whole blood or packed RBCs

Slide 9: Equipments needed 8. 250 ml of Normal Saline Solution Slide 10: Equipments needed 9. Venipuncture equipment, if necessary (should include 20G or larger catheter) Slide 11: Equipments needed 10. optional: ice bag, warm compresses Slide 12: Getting Ready Avoid obtaining either whole blood or packed RBCs until youre ready to begin the transfusion Prepare the equipment when youre ready to start the infusion. Slide 13: The Procedure Explain the procedure to the patient Make sure an informed consent has been signed Record baseline vital signs Slide 14: The Procedure Obtain whole blood or packed RBCs from the blood bank within 30 minutes of the transfusion start time. Slide 15: The Procedure Check the expiration date on the blood bag, & observe for abnormal color, RBC clumping, gas bubbles, & extraneous material. Return outdated or abnormal blood to the blood bank. Slide 16: The Procedure Compare the name & number on the patients wristband with those on the blood bag label. Slide 17: The Procedure Check the blood bag identification number, ABO blood group, and Rh compatibility. Also, compare the patients blood bank identification number, if present, with the number on the blood bag. Slide 18: The Procedure Identification of blood & blood products is performed at the patients bedside by two licensed profesionals, according to the facilitys policy. Slide 20: The Procedure Wash your hands. Put on gloves, a gown, & a face shield. Slide 21: Remove IV administration set and fluid from packaging Slide 22: Remove the cover from the selected spike and the cover from the bottle/bag of fluid. Slide 23: The Procedure Then insert the spike of the line youre using for the normal saline solution into the bag of saline solution aseptically. Slide 24: When fluid drips out of the end of the distal tubing turn off the infusion rate clamp. Slide 25: The Procedure Using a Y-type set, close all the clamps on the set.

Slide 26: The Procedure Next, open the port on the blood bag & insert the other spike. Slide 27: The Procedure Hang the bags on the I.V. pole, Slide 28: The Procedure open the clamp on the line of saline solution, Slide 29: The Procedure squeeze the drip chamber until its half full. Slide 30: The Procedure If the patient doesnt have an I.V. line in place, perform venipuncture, using a 20G or larger-diameter catheter. Slide 31: The Procedure Avoid using an existing line if the needle or catheter lumen is smaller than 20G. Ventral venous access devices also may be used for transfusion therapy. Slide 32: The Procedure If youre administering whole blood, gently invert the bag several times to mix the cells. Slide 33: The Procedure Attach the prepared blood administration set to the venipuncture device, & flush it with normal saline solution. Slide 34: The Procedure Then close the clamp to the saline solution, & open the clamp between the blood bag & the patient. Slide 35: The Procedure Adjust the flow clamp closest to the patient to deliver the blood at the calculated drip rate. Slide 36: The Procedure Remain with the patient, & watch for the signs of a tranfusion reaction, such as fever, chills, & wheezing. Slide 37: The Procedure If such sign develop, record vital signs and stop the transfusion. Slide 38: The Procedure Infuse saline solution at a moderately slow infusion rate, & notify the doctor at once. Slide 39: The Procedure If no signs of a reaction appear within 15 minutes, youll need to adjust the flow clamp to the ordered infusion rate. Slide 40: The Procedure A unit of RBCs may be given over 1-4 hours as ordered. Slide 41: The Procedure After completing the transfusion, youll need to put on gloves & remove & discard the used transfusion equipment.

Slide 42: The Procedure Then remember to reconnect the original I.V. fluid, if necessary, or disconnect the I.V. infusion. Slide 43: The Procedure Return the empty blood bag to the blood bank, & discard the tubing & filter. Slide 44: The Procedure Record the patients vital signs. Slide 45: Practice Pointers Although some microaggregate filters can be used for up to 10 units of blood, always replace the filter & tubing if more than 1 hour elapses between transfusions. Slide 46: Practice Pointers When administering multiple units of blood, use blood warmer to avoid hypothermia. Slide 47: Practice Pointers For rapid blood replacement, know that you may need to use a pressure bag. Slide 48: Practice Pointers If youre administering packed RBCs with Y-type set, you can add saline solution to the bag to dilute the cells by closing the clamp between the patient & the drip chamber & opening the clamp from the blood Slide 49: Practice Pointers Then lower the blood bag below the saline solution container & let 30-50ml of saline solution flow into the packed cells. Slide 50: Practice Pointers Finally, close the clamp to the blood bag, rehang the bag, rotate it gently to mix the cells & saline container Slide 51: Documenting Blood Transfusion In your notes, record: Date & time of the transfusion. Type & amount of transfusion product. Patients vital signs. Your check of all identification data. Transfusion reaction & nursing actions taken. Slide 52: Nurses Informations

Blood Transfusion(medical procedure)


The procedure for transfusing blood is simple and straightforward. About 450 millilitres (one pint) or more of blood is withdrawn from a donors arm vein by means of a hypodermic syringe and is passed through a plastic tube to a collection bag or bottle to which sodium citrate has been added in order to prevent the blood from clotting. In transfusing blood into the recipient, donor blood of the appropriate type is passed by gravity from a container down through a plastic tube and into a vein of the recipients arm. The procedure is accomplished slowly, and two hours may be needed to infuse 450 millilitres of blood into the recipient. The use of sterile containers,

tubing, and needles helps ensure that transfused or stored blood is not exposed to disease-causing microorganisms. Blood can be kept in a state satisfactory for use in transfusion by the addition of special preservatives and refrigeration. Methods of fractionating the blood have allowed its use in specialized forms: Whole blood, which is used to treat acute blood loss. Packed red blood cells (erythrocytes), which are used for chronic anemia. Washed red cells, to combat allergies that have been induced in frequently transfused patients by other elements in the blood. Platelets, for bleeding caused by platelet deficiency. White blood cells (leukocytes), for low white-cell count in patients with infections. Plasma, for shock without blood loss. Fresh-frozen plasma, freshly drawn plasma, or concentrates of the antihemophilic globulin (factor VIII) of plasma, for bleeding in hemophilia. Serum albumin, concentrated from the plasma, for shock or for chronic low-albumin disorders and malnutrition. Immune globulin, the antibody component of the plasma, concentrated for prevention of viral hepatitis and protection against or modification of measles after exposure. Fibrinogen, an important clotting factor in the blood, easily concentrated for bleeding conditions caused by deficiency or absence of fibrinogen.

Exchange transfusion, in which all or most of the patients blood is removed while new blood is simultaneously transfused, is of use in treating erythroblastosis fetalis and leukemia and in removing certain poisons from the body. Blood Transfusion(nursing Procedure)
Nursing Intervention a.Pre Procedure 1.Obtain patients base line data before the transfusion. Asses base line data: Temp, Pulse, Respiration and Blood Pressure. Determine any known allergies or previous adverse reaction to blood. Note specific signs related to the client's pathology and reason for transfusion (e.g. an anemic client, note the hemoglobin level less than 10g/L). 2.Obtain the correct blood component for the patient. Check the physician's order with the requisition. See that doctor check and write to start. Check the requisition form and the blood bag label with a specially check the patient name, identification number, blood type and Rh group the blood donor number, and the expiration date of blood. Ensure that doctors counter check and sign With another nurse (RN) compare the laboratory blood type round with : The client's name and identification number. Ask the patient to state the full name as a double check.

The number on the blood bag label The patients blood group and label, amount of blood, calculate and adjust. Check blood for any abnormalities, gas bubles dark color or cloudiness, clots and excess air Make sure that the blood is left at room temperature for no more than 30 minutes before starting the transfusion. RBCs deteriorate and lose their effectiveness after 2 hours at room temperature. Agencies may designate different times at which the blood must be returned to the blood bank if it has not been started. As blood component warm, the risk of bacterial growth also increases. Rational : If the patients Clinical status permits, delay transfusion if baseline temperature is greater than 38.50 C b.Procedure 1.Wash and dry hands 2.If any pre medication order, give before transfusion 3.Prepare the patient Identify the patient and explain the procedure and its purpose to the patient such as blood product to be transfused, approximate length of time, and desired outcome of transfusion. 4.Assemble the equipment and bring to the patient 5.Wear gloves. 6.Positioning the patient comfortably 7.Prime the tubing with saline solution. Establish the saline infusion See that the set used in appropriate, as sometimes attached filteris not suitable for some product 8.If the patient has an intravenous solution infusing check whether the needle and solution are appropriate to administer blood. The needle should be no. 18 gauge or larger and the solution must be saline. If solution is not compatible remove it and dispose of it according to hospital policy. Dextrose which causes lysis of RBCs, Ringer's Solution, medication and other additives and hyper alimentation solution are incompatible. 9.If patient does not have an intravenous solution infusing, in the case you will need to perform veni puncture on a suitable vein. Select a large vein that allows patient some degree of mobility and place bed protector under the site. Start the prescribed intravenous infusion 10.Establish the blood transfusion. Invert the blood bag gently several times to mix the cell within the plasme 11.Start infusion slowly at 2 ml/mnt. Remain at bed side for 5-30 minutes. If there are not sign of circulatory overloading, the infusion rate may be increased 12.Observe the patient closely for chilling, nausea, vomiting, skin rashes tachycardia as they early sign and symptom reaction and check vital sign at least hourly until 1 hour post transfusion. Report sign and symptoms of reaction immediately to physician to minimize consequences. Acute reaction may occur at anytime during the transfusion.If any reaction: close clamp & run normal saline, report to doctor, save urine and observe.

Rational : The majority of acute fatal transfusion reaction are caused by clerical errors. Patient and product verification is the single most important fucntion of the nurse. It is strongly recommended that two qualified individuals perform this task. Do not proceed with the transfusion if there is any discrepancy. Contact the blood bank immediately cPost procedure Obtain vital sign and compare with base line assessment. Document procedure in patient's medical record including: Product , blood type Rh, volume transfused, rate, site infused. Product identification number Name of individual verifying, patient ID, name of person starting and ending transfusion. Patient assessment findings and tolerance to procedure. Monitor patient for response to and effectiveness of the procedure. Terminate the transfusion Discard administration set according to policy procedure. (i.e. If any reaction, save the set for further investigations)

nebulization [nebylzshn] Etymology: L, nebula, cloud; Gk, izein, to cause a method of administering a drug by spraying it into the respiratory passages of the patient. The medication may be given with or without oxygen to help carry it into the lungs.

nebulization (neby lzsh n), n a technique of administering medication by spraying it into the respiratory tract. Oxygen may or may not be used to assist carrying the medication into the lungs

Explaining the Usefulness of Nebulization


Turning Liquid Medicines into a Mist
Nebulization involves the process of transforming liquid medications into fasteracting inhaled mists. This aerosolizing is accomplished by a nebulizer machine equipped with a compressor and a mouthpiece or face mask. Nebulization is used to treat respiratory conditions, such as asthma or cystic fibrosis. Nebulizers effectively deliver medicine directly into an individual's respiratory tract so that it can reach the lungs quickly. Since the device's mouthpiece or mask are easy to use and require little coordination, nebulizers are well suited for the treatment of children. Many health insurers will help pay for the costs of at-home nebulization treatments prescribed by a physician.

Different Types
There are different types of nebulizers, which have been nicknamed breathing machines. Jet nebulizers are the most common. They use compressed air to turn liquid medicine into an aerosol that passes through tubing to the face mask or mouthpiece. Ultrasonic nebulizers produce sound waves to create aerosolized droplets. Bronchodilators and corticosteroids are among the medications selected more frequently for nebulization. Delivering these agents into the respiratory tract can lead to speedy relief of breathing difficulties associated with asthma.

Advice for Parents


Parents of asthmatic children who require nebulizer treatments can try the following tips to make the process easier. To overcome a child's apprehension, use a "brave" stuffed animal to demonstrate how the nebulizer mouthpiece of mask works. Do treatments at the same time each day so they become part of the child's normal routine. Provide a book, video, crayons, stickers or toys to entertain the child during treatments.

How To Perform Nebulization


When you have someone in the family who has asthma and it is more of a hassle to go to the hospital to have the nebulization done, the next practical step is to actually have your own nebulizer machine at home. Of course, along with the medication that the doctor has given, you have to follow some basic instructions on how to perform a nebulization.

Prepare the machine. There are actually different instructions on how to set up your nebulizer, because there are some variations in nebulizers depending on the manufacturer. So make sure that you have your manual with you when it's your first time to set it up for use. Also, check the mask or mouthpiece for dirt and clean it before using it or letting someone else use it. But even if these are the most important parts, make sure that the tube and the machine itself are clean. Place the medication. Some doctors give a medication of two types of liquid to be placed in the nebulizer although some only give one. Make sure to read your doctor's instructions, along with the instructions from the home nebulizer manual. There is a specified cup where you can place the medicine so make sure it is sealed in before you turn on the machine. Take note that a pediatric nebulizer would have different requirements to that of an adult's, so extra care must be performed in placing the medication. The doctor may have indicated the need of applying only a small volume of the medication instead of the full dose. Again, refer to your doctor's instructions and the nebulizer manual. Secure the mouthpiece or mask. Make sure that you are biting the mouth piece properly and that you can breathe through it comfortably. If you are using a mask, make sure that none of the mist gets out through any side of it, so you can get the full benefits of the medicine placed there. Occasionally tap the cup of medication so it can be misted because there may be a tendency that they are all kept to one side. Sit comfortably. Once the mouthpiece or mask is in place, turn on the machine and inhale and exhale at a regular pace. This allows the medication to settle in your respiratory tract. You can try holding your breath for at most ten seconds before exhaling to get most of the medication in your airways. Monitor. Nebulizer treatments must be monitored carefully because this type of therapy will not be quite as effective if the mask is not properly put on or the medication was not put properly placed. You have to check for the connections before you turn it on and during the nebulization process. More often than not, the medication will be completely misted in 15 to 20 minutes. The machine will give a sound when the medicine has been fully consumed.

Performing nebulization is not as difficult as you may think. But proper care must be observed before, during and after the procedure to secure your health or the health of the person using the nebulizer. Remember to wash the mouthpiece or mask with warm water after every use and dry it before being stored in a dry place for the next use.

RESPIRATORY MANAGEMENT IN SPINAL CORD INJURY: BREATHING AND THE RESPIRATORY SYSTEM IN SCI: TREATMENTS FOR RESPIRATORY TRACT

COMPLICATIONS: RESPIRATORY TREATMENTS WITH A NEBULIZER


If respiratory medication needs to be delivered directly to the lungs, this can be accomplished with a nebulizer, if prescribed by your physician. Indications for this treatment are: Tightness in chest Increased or thick secretions Pneumonia (congestion) and/or Atelectasis Increased blood pressure (autonomic hyperreflexia) Increased pulse History of adverse reaction to the medication. Nebulizer Compressor oxygen tank (to drive nebulizer) Oxygen tubing Respiratory medication Normal saline (cc vials) Remove cup portion of the nebulizer Draw up prescribed amount of the mediation in the eye dropper Place medication in the medicine cup with 3cc normal saline Return cup to the nebulizer Place oxygen tubing on the nipple on the nebulizer and attach other end to the compressor or oxygen tank Turn on the compressor or tank until mist is seen coming out of the mouthpiece. Check pulse Place the mouthpiece in your mouth and take slow, deep breaths. If on a ventilator, the nebulizer can be placed in line in the ventilator circuit. To do this, remove the mouthpiece and connect the nebulizer between the dead space tubing and the exhalation valve assembly. During the treatment, monitor the pulse. If the pulse increases to more than 20 beats a minute, discontinue the treatment. Otherwise, continue until the medication is used up. Following the treatment, use postural drainage, percussion, assisted coughing and/or suctioning, as appropriate.

Reasons to avoid the treatment include:

The following equipment is needed for respiratory treatments with a nebulizer:

Following is the procedure for treatments with a nebulizer:

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