Blood Administration

Nurminie H. Ladja, BSN, RN

Blood Administration
Your patients Hgb &
HCT is 6.2 & 18.4; the
doctors orders 3 units
of packed RBCs!
What actions do you
take first?

Blood Administration
Right If you said:
Check for T&C
Verify informed consent
Insure IV access; need large
bore catheter (18-20 gauge);
smaller cause destruction of
RBCs
Gather equipment:
Y-tubing blood
administration set with filter
NS solution and pump
Prime tubing with saline.

Blood Administration
Learn:
Common blood products
Steps in blood
administration
Complications of blood
administration
*Transfusion reactions
Circulatory overload
Septicemia
Iron overload
Disease transmission

Blood Products *Know products and how to safely

administer!
Packed RBCs
From whole blood; 2/3 of plasma
removed); *most commonly used!
Inc. O2 carrying capacity
Treat anemia; replace blood volume
Use leukocyte poor red cells or
leukocyte filter if history of febrile
reaction

Whole blood:
Replace blood volume
Inc. O2 carrying capacity in
hypovolemic shock
Contains RBCs, plasma proteins,
clotting factors and plasma
Few platelets or granulocytes

Platelets:
To control, prevent bleeding in
platelet dysfunction,
thrombocytopenia

Vol. 250-300 cc
Only RBCs used (remaining platelets,
albumin, plasma used for other
purposes)
Less chance for fluid overload!
*Ordered when HGB 8-9 and HCT 24-27;
each unit inc. HGB by 1g/dl & HCT by 3
takes 4-6 hrs for lab values to chg.
No viable platelets or granulocytes
Vol. 500 cc
Danger of fluid overload and
incompatibility
Deficient in some clotting factors
Rarely used!

Vol. 30-60 cc of platelets in 1 unit

Expected inc-10,000 per/unit-each unit
Measure at 1 hr & 18-24 hr post admin.
Usually given if platelet count less than

Frozen RBCs (from RBCs)

can be frozen stored for 3 years
Infrequently used

Fresh Frozen Plasma (FFP)

Contains clotting factors
Used for DIC, liver failure patients
Improves coagulation, PT and PTT

Albumin-Plasma derivative
Prepared from plasma
Volume expander
Use for clients who are 3rd spacing
and hypovolemic (hyperosmolar
solution moves water from
extravascular space to
intravascular space)
Outcome: adequate BP and
volume

Use within 24 hours of thawing

successive washing with saline
solution removes majority of WBC/s
and plasma proteins
Vol. 200-300cc = 1 unit
Rich in clotting factors
NO platelets
Good for volume expansion to restore
clotting factors in hypovolemic shock
Available in 5% or 25% solution
Albumin 25g/100ml = to 500 ml of
plasma
Can be stored for 5 years

!
Cryprecipitates- Clotting factors VIII,
Xiii< von Willebrands factor & fibrinogen
from plasma and commercial
concentrates
Prepared from fresh frozen plasma
Store for 1 year, once thawed, must be
used.

Used to specific clotting factor

deficiencies
May cause ABO incompatibilities

Used to specific clotting factor

deficiencies

Prothrombin complex-Prothrombin,
factors Vii, IX, X and part of Xi

WBCs or Granulocytes
Improvement of infection

Rarely used except for cancer

patients, chemotherapy patients

Requires special equipment;

filters, patients own blood is
Surgery and in emergency setting
Autologous blood-collection of own blood returned
No T&C needed
prior to scheduled surgery or in
emergency situation ( blood salvage; cell if pre-donation, begin collection
within 5 weeks of transfusion date
saver)
and end at least 3 days prior to

Autotransfusion;

Cell-saver" technology
collects blood lost during
surgery, cleanses it, and
places it back in the
patient's body, all in a
continuous loop.

Preparation for Blood Administration

Physicians order
Obtain IV access; large bore catheter (18-20 gauge); 2 lines if
possible
T&C done? Blood on hold?
* Get client ready for transfusion prior to getting blood from
the lab
* Staff signs and obtains blood (only one client a time!)
Verify informed consent
Routine compatibility testing takes about 1 hour to identify
recipient ABO and Rh type; in emergency O-negative RBCs can
be safely given to most clients without serologic testing.
Why can O-neg blood be safely given?
*Universal RBC donor is O negative; universal recipient is AB
positive

Compatibility Chart

Recipient
Donor
A B AB
A
X
X
B
X X
AB
X
O
X X X X

O- universal donor, AB+ universal recipient

Initiation of
Transfusion
Verify informed consent for blood
Check physicians orders
ID patient, draw blood for T&C in red top tube;
start 18-20 gauge IV (if not already done), place
blood band and label tube. Blood tubing & 0.9NS
IV fluid ready!
T&C to lab!

Obtain blood from blood bank (2 persons verify)

Blood to unit for administration: 2 RNs check unit
of blood with lab slip, patients chart; forms to
include patients name, hospital #, and blood type
Expiration date of unit of blood
Pts ID #, blood band (Fenward) and state name
Blood band #- blood armband, issue transfusion
card
Blood component, donor #, expiration date, gp and
Rh factor
If blood not to be given, must be returned to blood
bank within 20 minutes; CANNOT be kept in unit
refrigerator (requires special refrigeration)!

Cont***

Verify identification!

Compare all labels second time

Check vital signs and record
IV 18-20 gauge adult, 23-child
0.9% Sodium Chloride(NS) only!!!
Invert unit to mix cells
Prime Y-type blood tubing with NS
Spike blood bag, clamp off NS
Cover blood filter with blood

Use appropriate filters

Use blood administration set
no more than 4 hours infusion
must be complete in 4 hours
Check facility policy re: #
units per administration set
May give blood on a pumpuse pump tubing

Blood to cover filter

Example of filters
Use appropriate
filters

For intraoperatively salvaged

washed blood.
Reduces leukocytes
Decreases fat globules
Reduces microaggregates

Platelet filter:
Patient protection against
leukocyte-related transfusion
complications
Primes directly with platelets
quickly and conveniently
High platelet recovery achieved
without saline flush

Critical Points
Client identification and blood compatibility!
Drip rate no higher than 2 cc per minute X 15
minutes (25-50 cc)
Remain with pt for first 15 minutes
*Vital signs prior to administration, in 15 minutes,
then q 30 minutes, until transfusion complete--then X
2
No meds or fluid other than NS to be given in line
with blood (Saline ONLY)!!!

 *Monitor for signs of transfusion reaction

Infuse over period specified (2-4 hours)

Blood cannot be out of blood bank refrigerator more than 30

minutes prior to administration-PLAN ahead!

*Do not allow blood to hang no longer than 4 hours (longer time,
greater chance of bacterial contamination/septicemia)
If multiple units being given for rapid blood loss; may have to
give under pressure and warm blood prior to administration (only
agency approved warming devices)

How would you manage

this?
Client to receive a unit of packed red blood

1.
cells.unable to initiate an IV access. What actions
should you take?

Ask An
Expert
Return
Double
Click to blood bank within 20 minutes if left out
longer run risk of bacterial growth and sepsis; get
help with starting IV (should have started IV before
requestingplan ahead) blood)

How would you manage this?

2. In addition to transfusion reaction; what is a major
risk related to administration of whole blood?

Ask An Expert
Double Click

Circulatory overload due to volume; whole

blood is typically 500cc and would cause fluid
overload, especially in at risk client.

How would you manage

this?
Your client receives a unit of RBCswhat response to

3.
this unit of blood is anticipated?

Ask An Expert
Double Click

Recall that 1 unit of PRBCs increases the Hgb

by 1g/dl and Hct by 2-3%-result > Hgb 9 &
Hct 24

Transfusion
Reactions/Complications
Febrile (most common)
Sensitization to donor WBC,
platelets, plasma proteins
Bacterial (pyrogenic or sepsis) (not in
text)
Transfusion of bacterially infected
components

Allergic (hypersensitivity to donor

plasma proteins)
Mild allergic to severe
Hemolytic (life-threatening!)
Acute hemolytic: ABO incompatible;
red cell destruction
*Circulatory overload
Fluid given too fast & too much
Iron overload- delayed reaction
Hypocalcemia- citrate in blood binds

Transfusion Reactions
Blood transfusion reaction: adverse reaction to
blood therapy: range from mild symptoms to life
threatening; can be acute or delayed!
What vital signs would you expect to see?
Ask An Expert
Vital signs taken prior to start of infusion critical; may
actually give blood even if patient has slight temp
elevation; must inform MD and Tylenol might be
administered!

Consider a temperature increase of 2 degrees significant

Ask An Expert
Action taken will be determined by type of
reaction; careful assessment, monitoring of
patient!

Febrile
Caused by leukocyte
incompatibility; sudden
onset: usually within first 15
minutes of transfusion!
Fever/chills (^1 degree)
Sensations of Cold
Hypotension/Shock
Flushed skin, abdominal
pain, vomiting and diarrhea
**Bacterial (pyrogenic): similar

Prevent by use of leukocyte

poor blood!
Stop infusion/antipyretics

to febrile; due to bacterial

contamination of blood: see S
& S above

Allergic Reactions (Hypersensitivity reactions)

Antibodies in patients blood react

against proteins, such as
immunoglobulin A in donor blood
May occur during or after the
transfusion
Mild and transient: stop infusion,
possibly restart, give antihistamine
prophylactically, use washed RBCs
Severe: stop infusion, keep line
open with new saline tubing; CPR
& epinephrine (if indicated)

Mild (initially)
*Urticaria
Pruritis
Itching
Severe (text does not
include this description)
Wheezing
Dyspnea
Bronchospasm
Swelling of tongue,
face
Shock, pulmonary
edema

Hemolytic/Transfusion Reaction!
Most dangerous!
Develops within first 15 minutes of
transfusion: free hemoglobin in blood
and urine specimens provide evidence of
acute hemolytic reaction; delayed at 214 days
Occurs after 100-200 ml blood infused!
Blood incompatibility
*RBCs clump (lysis of RBCc), block
capillaries, decrease blood flow to
organs.
Hgb released (myogloburia), blocks
renal tubules > acute renal failure=ATN
(acute tubular necrosis)

Fever/chills
SOB/dyspnea/wheezing
Apprehension
Headache/low back pain
Chest pain/chest
tightness
Urticaria/tachycardia
*Hematuria

Hemolytic/Transfusion Reaction!
If hemolytic reaction occurs:
Stop transfusion, keep IV line open
with new tubing, saline, colloid
solution to maintain BP; monitor
Notify MD of patient signs and
symptoms
Treat shock (anaphylactic) if present
(epinephrine, oxygen, antihistamines,
vasopressors, fluids, corticosteroids)
Draw blood samples for serologic
testing; send urine to
lab and return blood tubing to
blood bank for testing
Prevent acute renal failure: give
diuretic, fluid challenge

Stop the blood, send tubing and

remaining blood to lab; urine to lab!
Follow facility policy and procedure
for administering blood, blood
products and transfusion reaction!

Reactions/complications
*Circulatory overload
Fluid given too fast & too much
Note cough, dyspnea, HTN, etc
Slow infusion, elevate HOB, treat overload,
phlebotomy
Iron overloaddelayed reaction
Vomiting diarrhea, hypotension, altered
hematological values
Administer deferoxamine (Desferal) Iv to remove
accumulated iron via the kidneys (urine red)
Hypocalcemiacitrate in blood binds with calcium & is excreted
Check lab values
Also hyperkalemia: stored blood liberates potassium
through hemolysis (older blood greater risk for
hemolysis)

Review
What is the purpose of administering
Good job
blood and blood components?
A.

treat hypervolemia.
NOBlood and its components increase intravascular volume, not
decrease. In fact, a potential complication with the administration of
blood when given too rapidly is hypervolemia.

B. alleviate sodium retention.

NOAlleviate sodium retention: an answer for consideration;
however, it is not the reason that blood is given; indirectly sodium
retention might be decreased by effect on restoration of intravascular
volume and normal hemodynamics (renin-angiotensin-aldosterone)
C.increase the level of electrolytes .
NOIncrease level of electrolytesperhaps indirectly as
normal hemodynamics are restored, but not primary reason
for giving blood and blood products.
D. promote tissue oxygenation.
(RBCs carry oxygen! Blood and it components also provide
clotting factors and maintain intravascular volume.)

PRBCs are utilized to treat impaired

clotting such as in liver dysfunction.
True
True. If you said true,
you were not correct.
PRBCs are used to
correct anemia and
blood loss.

or False

False! If you said false you

were right on! PRBCs are
used to correct anemia and
blood loss, not given for
clotting factors, need fresh
frozen plasma or
cryoprecipitates

Platelets are used to treat?

A.

Hemophilia

hemophilia No Platelets do not contain the specific clotting

factors needed by a client with hemophilia; platelet levels are
typically normal

B.

Thrombocytopenia

thrombocytopenia RIGHT Platelets (if normal) release

thromboxane to cause vessel; spasm when there is damage
to a vessel activates the clotting pathway to convert
fibrinogen to fibrin

C.

Polycythemia
polycythemia No Polycythemia is the presence of excess
RBCs; administration of platelets would not decrease the
abnormal amount of RBCs in fact would cause increased
problemsincreased viscosity and more likely to form clots.

Good job

D.

Low white cell count

low white cell count N WBCs are leukocytes and

originate from hemopoietic stem cells in the bone
marrow; must use hematopoietic growth factors
to stimulate granulocyte maturation and
differentiation

Congratulations on Your
Successful Completion!