BLOOD TRANSFUSION AND NURSING INTERVENTIONS

1.Definition
Is the introduction of whole blood or component of the blood, e.g. plasma or erythrocytes into venous circulation.

2.Blood Group
Human blood is classified in to four main groups (A, B, AB and O) on the basic of polysaccharide antigen on the erythrocyte surface. These antigens type A and Type B, commonly cause antibody reaction and are called agglutinogens. In other words group A blood contain type A agglutinogen, group B blood contain type B agglutinogen, group AB contain both A & B agglutinogens, and group O blood containe neither agglutinogen.
In addition to agglutinogens on the erythrocytes agglutinin (antibody) are present in the blood plasma. No individual can have agglutinin and agglutinogen of the same type, that person's system would attack its own cells. Then group A blood does not contain agglutinin A but does contain agglutinin B. Group B blood does not contain agglutinin B but does contain agglutinin A. Group AB blood contain neither agglutinin and group O contain both anti A and anti B agglutinin. Blood transfusion must be match to the patient blood type in term of compatible agglutinogen mismatch blood will cause hemolytic reaction.
Rhesus (Rh) and other factors
Rh antigen also on the surface of erythrocytes are present in about 85% of the population are can be a mayor cause of hemolytic reaction. Persons who possess the Rh factor are referred to as Rh positive those who do not are referred to as Rh negative. 
Unlike the A and B agglitinogen, the Rh factor cannot cause a hemolytic reaction on the first exposure to mismatched blood, because the Rh antibody is not normally present in the plasma of Rh negative person.

3.Transfusion reaction
Transfusion reaction can be categorized as hemolytic, febrile, circulatory over load and allergic. The nurse must asses a client closely for reactions. Sign of an acute reaction include sudden chills or fever, low back pain, drop in blood pressure, nausea, flushing agitation or respiratory disorders. Sign of less severe allergic reaction include hives and itching but no fever.
Nursing management for transfusion reaction:
•Stop the transfusion. Maintain the intravenous line with normal saline solution
through new intravenous tubing, administered at a slow rate.
•Asses the patient carefully, compare the vital sign with those from the base line
assessment.
•Notify the physician of the assessment findings and implement any order obtained.
•Notify the blood bank that a suspected transfusion reaction has occurred.
•Send the blood container and tubing to the blood bank for repeat typing and
culture, the identifying tag and number are verified.

Before commencing a blood transfusion determine:
1.Base line data regarding blood pressure, temperature, pulse and respiration.
2.Any previous reaction to a blood transfusion.
3.The request for blood transfusion form has been completed and send specimen for
typing and cross matching, 3 ml in plain tube/red without wax or gel and 2 ml in
CBC tube.

4.Purpose
1.Restore blood volume after hemorrhage
2.Maintain hemoglobin levels in severe anemia
3.Replace specific blood component.

5. Assessment focus
Clinical signs of reaction (e.g. sudden chills, nausea, itching rash, dyspnea) status of infusion, site, any unusual symptoms.

Equipment
1.Unit of whole blood
2.Blood administration set either a straight line or a Y set ( Y set is preferred)
3.Normal saline solution
4.IV dressing
5.Vena puncture set containing a 18 needle or catheter, or if blood is to be
administered quickly no 16 needle or a larger.
6.Alcohol swab
7.Tape
8.Disposable gloves (Sterile)

6.Initiating, Maintaining and Terminating a Blood Transfusion

* Nursing Intervention
a.Pre Procedure

1.Obtain patient’s 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 doctor’s 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 patient’s 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 patient’s 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)

Rational :
Rationale it must be possible to trace each transfusion product to the original blood donor.