blood transfusion by nurses in formations 1215736980991777 9
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IV Therapy
TrainingNursing Procedure
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C c to e t Master text sty esSecond level Third level Fourth level
Fifth level
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Forensic Science
Blood Basics
T. Trimpe 2006 http://sciencespot.net/
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What makes up our blood?
RED BLOOD CELLS (Erythrocytes) The most abundant cells
in our blood; they are produced in the bone marrow and contain aprotein called hemoglobin that carries oxygen to our cells.
WHITE BLOOD CELLS (Leukocytes) They are part of theimmune system and destroy infectious agents called pathogens.
PLASMA This is the yellowish liquid portion of blood thatcontains electrolytes, nutrients and vitamins, hormones, clottingfactors, and proteins such as antibodies to fight infection.
PLATELETS (Thrombocytes) The clotting factors that arecarried in the plasma; they clot together in a process called
coagulation to seal a wound and prevent a loss of blood.
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Blood Facts
The average adult has about FIVE liters of blood inside oftheir body, which makes up 7-8% of their body weight.
Blood is living tissue that carries oxygen and nutrients toall parts of the body, and carries carbon dioxide and other
waste products back to the lungs, kidneys and liver fordisposal. It also fights against infection and helps healwounds, so we can stay healthy.
There are about one billion red blood cells in two to three
drops of blood. For every 600 red blood cells, there areabout 40 platelets and one white cell.
http://www.bloodbankofalaska.org/about_blood/index.html
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Genetics of Blood Types
Your blood type is established before you are BORN, by
specific GENES inherited from your parents.
You inherit one gene from yourMOTHERand one fromyourFATHER.
These genes determine your blood type by causing proteins called AGGLUTINOGENS to exist on the
surface of all of your red blood cells.
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What are blood types?
http://learn.genetics.utah.edu/units/basics/blood/types.cfm
There are 3 alleles or genes for bloodtype: A, B, & O. Since we have 2 genes,there are 6 possible combinations.
Blood Types
AA or AO =Type A
BB or BO =Type B
OO = Type OAB = Type AB
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How common is your blood type?
46.1%
38.8%
11.1%
3.9%
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Blood Transfusions
A blood transfusion is a procedure in which blood is given to a
patient through an intravenous (IV) line in one of the blood vessels.Blood transfusions are done to replace blood lost during surgery or aserious injury. A transfusion also may be done if a persons bodycan't make blood properly because of an illness.
A B
O
AB
Who can give you blood?
People with TYPE O bloodare called Universal Donors,
because they can give blood toany blood type.
People with TYPE AB bloodare called UniversalRecipients, because they canreceive any blood type.
Universal
Donor
UniversalRecipient
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Rh Factors
Scientists sometimes study Rhesus monkeys to
learn more about the human anatomy because thereare certain similarities between the two species.While studying Rhesus monkeys, a certain bloodprotein was discovered. This protein is also presentin the blood of some people. Other people, however,do not have the protein.
The presence of the protein, or lack of it, is referredto as the Rh (forRhesus) factor.
If your blood does contain the protein, your blood issaid to be Rh positive (Rh+). If your blood does not
contain the protein, your blood is said to be Rhnegative (Rh-).
A+ A-
B+ B-AB+ AB-O+ O-
http://www.fi.edu/biosci/blood/rh.html
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Blood Evidence
Blood samples Can be analyzed to determine blood
type and DNA, which can be matched to possiblesuspects.
Blood droplets Can be analyzed to give clues to thelocation of a crime, movement of a victim, and type ofweapon.
Blood spatter Can be analyzed to determine patternsthat give investigators clues to how a crime mighthavehappened.
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Microscopic
ViewsBird Blood
Cat Blood
Dog Blood
Fish Blood
Frog Blood
Snake BloodHuman Blood
Horse Blood
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Blood
TransfusionNursing Procedure
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*Whole blood transfusion replenishes thecirculatories:
Volume
Oxygen-carrying capacity
*Packed Red Blood Cells (RBCs) restores:
Oxygen-carrying capacity
Both treat decreased hemoglobin and hematocrit.
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Two nurses must identify the:
1. Patient2. Blood products
before administering a transfusion (toprevent errors & potentially fatalreaction)
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If a patient is a Jehovas Witness, atransfusion requires special writtenpermission.
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Equipments needed
1. Bloodrecipient set(filter & tubing
with dripchamber forblood, orcombined set)
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Equipments needed
2. I.V. pole
3. Gloves
4. Gown5. Face Shield
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Equipments needed
6. Multi-lead tubing
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Equipments needed
7. Whole blood or packed RBCs
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Equipments needed
8. 250 ml of Normal Saline Solution
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Equipments needed
9. Venipuncture equipment, ifnecessary (should include 20G orlarger catheter)
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Equipments needed
10. optional: ice bag, warmcompresses
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Getting Ready
Avoid obtaining either whole blood orpacked RBCs until youre ready tobegin the transfusion
Prepare the equipment when youreready to start the infusion.
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The Procedure
Explain the procedure to the patient
Make sure an informed consent hasbeen signed
Record baseline vital signs
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The Procedure
Obtain whole blood orpacked RBCs from theblood bank within 30
minutes of the transfusionstart time.
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The Procedure
Check theexpiration date onthe blood bag, &observe forabnormal color, RBCclumping, gasbubbles, &extraneousmaterial. Returnoutdated orabnormal blood tothe blood bank.
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The Procedure
Compare the name & number on thepatients wristband with those on the bloodbag label.
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The Procedure
Check the blood bagidentificationnumber, ABO bloodgroup, and Rh
compatibility.
Also, compare the
patients blood bankidentificationnumber, if present,with the number on
the blood bag.
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The Procedure
Identification of blood & bloodproducts is performed at the patientsbedside by two licensed profesionals,according to the facilitys policy.
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The Procedure
Wash your hands.Put on gloves, a gown, & a face shield.
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Remove IV administration set and fluid frompackaging
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Remove the cover from the selectedspike and the cover from thebottle/bag of fluid.
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The Procedure
Then insert the spike of the line youreusing for the normal saline solutioninto the bag of saline solution
aseptically.
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When fluid drips out of the end of the
distal tubing turn off the infusion rateclamp.
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The Procedure
Using a Y-type set, close all the clampson the set.
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The Procedure
Next, open the port on the blood bag &insert the other spike.
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The Procedure
Hang the bags onthe I.V. pole,
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The Procedure
open the clamp on the line of salinesolution,
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The Procedure
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The ProcedureIf the patient doesnt have an I.V. line
in place, perform venipuncture, using a20G or larger-diameter catheter.
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The Procedure
Avoid using an existing line if theneedle or catheter lumen is smallerthan 20G.
Ventral venous access devices alsomay be used for transfusion therapy.
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The Procedure
If youre administering whole blood,gently invert the bag several times tomix the cells.
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The Procedure
Attach the prepared bloodadministration set to the venipuncturedevice, & flush it with normal saline
solution.
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The Procedure
Then close the clamp to the salinesolution, & open the clamp betweenthe blood bag & the patient.
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The Procedure
Adjust the flowclamp closest tothe patient to
deliver the bloodat the calculateddrip rate.
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The Procedure
Remain with the patient, & watch forthe signs of a tranfusion reaction, suchas fever, chills, & wheezing.
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The Procedure
Infuse saline solution at a moderatelyslow infusion rate, & notify the doctorat once.
h d
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The Procedure
If no signs of a reaction appear within15 minutes, youll need to adjust theflow clamp to the ordered infusion
rate.
h d
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The Procedure
A unit of RBCs may be given over 1-4hours as ordered.
Th P d
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The Procedure
After completing thetransfusion, youllneed to put on
gloves & remove &discard the usedtransfusion
equipment.
Th P d
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The Procedure
Then remember to reconnect theoriginal I.V. fluid, if necessary, ordisconnect the I.V. infusion.
Th P d
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The Procedure
Return the empty blood bag to theblood bank, & discard the tubing &filter.
Th P d
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The Procedure
Record the patients vital signs.
P ti P i t
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Practice Pointers
Although some microaggregatefilters can be used for up to 10 units ofblood, always replace the filter &
tubing if more than 1 hour elapsesbetween transfusions.
P ti P i t
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Practice Pointers
When administering multiple units ofblood, use blood warmer to avoidhypothermia.
P ti P i t
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Practice Pointers
For rapid blood replacement, knowthat you may need to use a pressurebag.
P ti P i t
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Practice Pointers
If youre administering packed RBCswith Y-type set, you can add salinesolution to the bag to dilute the cells
by closing the clamp between thepatient & the drip chamber & openingthe clamp from the blood
P ti P i t
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Practice Pointers
Then lower the blood bag below thesaline solution container & let 30-50mlof saline solution flow into the packed
cells.
P ti P i t
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Practice Pointers
Finally, close the clamp to the bloodbag, rehang the bag, rotate it gently tomix the cells & saline container
D ti Bl d
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Documenting BloodTransfusion
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 actionstaken.
N rses Informations
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Nurses Informations