Blood Transfusion – Complication – Precautions and Responsibility.

Blood Transfusion Complication Precautions and Responsibility

The Blood Transfusion is a process to give intravenously blood products, to a patient who is anemic or due to other reasons having heavy blood loss like major surgery, accidents other hemorrhagic diseases. In earlier medical practices Transfuse whole Blood But Modern Practics Use Only Blood Products (cells) Like RBCs, Platelets, and FFP (Fresh Frozen Plasma) according to the patient’s needs.

Most common type blood group – O positive
Universal Donner – O Negative
Universal Recipient – AB +ve

Blood Transfusion Complication Precautions and Responsibility
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Complication of Blood Transfusion

  • Transfusion Rxn (Reaction) – Most common complication. 
  • Haemolysis – O2 Decrease
  • Sign & Symptoms – Shivering, Chills, Temp. Increase, Cyanosis, Itching etc.
  • Intervention – Stop the transfusion immediately, Start 0.9% NS & Administer O2
  • Hypocalcemia – Occur due to rapidly blood transfusion (Calcium decrease) Or occur due to citrate toxicities Provide calcium gluconate after transfusion.
  • Start Slowly – Starting 15 minutes give slowly to identify Rxn
  • Hyperkalemia – (Increase Potassium) Occur due to stored / old blood transfusion less then 21 day’s.
  • Storage at 2-6°C temp (Cooler compartment)
  • Hyperkalemia (Potassium Increase) – 1 day old blood – Potassium level – 7 meq/lit 21 day’s old blood – Potassium level – 23 meq/lit Because Everyday RBC lysis- Release Potassium – Then Potassium level increase Normal Serum Potassium level – 3.5 to 5.1 meq/lit.
  • Provide Antidote – No polystyrene sulfonate (Kayexalate).
  • Iron Overload – Occur due to Repeated blood transfusion.
  • Provide antidote – Desferoxamine (Desferal) – I.V./ SC Remove accumulate iron via Kidney
  • Septicemia – Chills, fever, vomiting, diarrhea, hypo-tension Within 4 hrs.  Complete transfusion to prevent septicemia.
  • Special Points –
    1 Unit blood = 1 gm Hb increase or 2-3% PCV
    1 Unit PCV/ Hematocrit value = 250 ml of RBCs
    1 Unit platelets – 50-70 ml blood
    1 Unit fresh frozen plasma – 200-250ml

Precautions & Responsibility

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  1. No Solution or medication other than NS (0.9% Nacl) should be added to blood component.
  2. Sodium Chloride 0.9% (Normal Saline) is a standard Isotonic solution used to proceed and follow infusion of blood product.
  3. Dextrose is not used because it could result in clumping & Subsequent haemolysis of RBCs.
  4. Two licensed nurses need to check physician Prescription.
  5. At the bedside health worker asks the client to state his or her name, and compare the name with the name on the identification band or bracelet.
  6. The nurse also record the blood identification (unit) number, blood group & type & client’s name.
  7. The nurse also inspects the unit of blood for leaks, Abnormal color, clots & bubbles.
  8. If clot are noted, returns the unit of blood to blood band.
  9. The nurse notes or check the expiration date on the unit of blood to ensure that the blood is fresh before hanging.
  10. Just before beginning the transfusion the nurse assess priority vital signs of client.
  11. A change in vital signs during transfusion may indicate that a transfusion Rxm is occurring.
  12. The Nurse assess the vital sign before the procedure and again after the first is minute.
  13. If client temperature is elevated notify the physician before beginning the transfusion; A fever may be cause of delaying the transfusion.
  14. Before explaining the procedure to the client, the nurse asks the client about previous history of blood transfusion and previous Rxn to blood transfusion such as have you ever had a transfusion before.
  15. The blood transfusion set should be changed with each unit of blood to reduce the risk of septicemia.
  16. The nurse must remain with the client for first 15 minute of a transfusion and closely observe the patient for any transfusion Rxn.
  17. The most critical phase of transfusion is conforming product compatibility and verify client identify.
  18. Blood must be administered within 20 to 30 minutes (as soon as possible) from its being received from blood bank because it is may allowable time out of monitored storage.
  19. If the blood is not administered with in 20 to 30 minutes return it to blood bank.
  20. Infusion (1 UNIT ) should not exceeds 4 hours to patient to prevent septicemia.
  21. A large volume of refrigerated blood infusion through a central venous catheter into ventricles heart can cause cardiac dysrhythmias.
  22. Blood warmers – Blood warmers may be used to prevent hypothermia and adverse Rxn when unit of blood are being administered
  23. Do not warm blood product in microwave oven or in hot.
  24. If several units of blood are to be administer blood warmer devices should be used.
  25. Rapid infusion of cool blood places the client at risk for cardiac dysrhythmias. To prevent this the nurse warms the blood using a blood warming.
  26. Pulse oximetry and cardiac monitoring equipment use for the early assessment of complication but do not reduce the occurrence of cardiac dysrhythmias.
  27. Electronic Infusion devices are not useful in this cases.
  28. Infusion devices generally are used to control rate.
  29. Fresh frozen Plasma – may be used to provide clotting factor or to promote rapid volume expansion as a result of fluid and blood loss.
  30. It does not contain platelets so it is not used to treat any type of low platelet count disorder.
  31. It is rich in clotting factor and can be thawed quickly and transfused quickly (15 to 30 minutes ) & infused within 2 hrs of thawing.
  32. After stop the blood transfusion immediately start a NS, to prevent IV cannula blockage & maintain patency.
  33. Platelets are necessary for proper clotting. The client with insufficient platelets may exhibit frank bleeding or oozing of blood from puncture site, Would & Mucus membrane.
  34. A donation of the clients own blood before a scheduled procedure is autologous. The next most effective way is to ask a family member to donate blood before surgery.
  35. The client who has neutropenia may receive a transfusion of granulocytes, and WBC.
  36. These clients often have severe infections and are unresponsive to antibiotic therapy. The nurse notes the result of follow- up WBCs count to evaluate the effectiveness of the therapy.
  37. An 18 or 19 Gauge I.V, needle will be needed to achieve a maximum flow rate of blood products and prevent damage to RBCs.
  38. If a smaller Gauge needle must be used, RBCs may be diluted with NS.
  39. Premedicate the client with acetaminophen or Diphenhydramine (Benadryl), as prescribed if the client has a history of adverse Rxn.
  40. IV Medication administered immediately before transfusion is started.
  41. Oral medication administered before 3 minutes transfusion is started.

Precautions For Blood Donor –

Donors should be free from heart disease, kidney, and lungs disease.
The age of the donor should be between 18-55 Yrs.
Hb level of the donor should be above 12 gm.

Important Things about Blood transfusion –

EDTA – Ethenyl Diamine Tetra Ascetic
ACD – Acid Citrate Dextrose
CPD – Citrate Phosphate Dextrose
Anticoagulant – bind with free ca++ – IV( More Concentration )
Anticoagulant + free ca++ = ca citrate – Hypocalcemia – provide – Calcium gluconate – mgso4 (Antidote)
Max Flow rate of blood transfusion – 40 macro drops/minutes
1ml = 20 Macro drop
18 gz needle to be used for Blood transfusion.

Also Read –

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