chapter 13 intravenous infusion & transfusion. section two intravenous transfusion definition:...

Chapter 13Chapter 13

Intravenous Intravenous

Infusion & TransfusionInfusion & Transfusion

Section Two Section Two

Intravenous TransfusionIntravenous Transfusion

• Definition: Intravenous transfusion is the

intravenous administration of whole blood or

a blood component such as plasma, packed

red cells, white blood cells, or platelets.

TransfusionTransfusion Blood transfusion requires the nurse to

• follow a specific procedure to match the blood accurately

• identify the blood for the individual and recipient correctly

• monitor the patient throughout the procedure for transfusion reactions

The nurse is responsible for assessment before, d

uring, and after transfusion and for regulation of tran

sfusion.

Contents of Blood TransfusionContents of Blood Transfusion1. Physiology of Blood

2. Categories of Blood Products

3. The Purposes of Transfusion

4. Methods of Transfusion

5. Transfusion and Nursing process

6. Autologous Transfusion

7. Componential Transfusion

8. Transfusion Reactions and Nursing Interventions

9. Selection of Blood Donors

10. The Principles of Transfusion

1. Physiology of Blood1. Physiology of Blood

• Blood Groups and Types

• Blood Typing and Cross-matching Test

Blood Groups and TypesBlood Groups and Types

• Blood groups are named by types of the prot

eins as antigens on the surface of an individu

al’s red blood cells.

ABO Blood Groups System

Rhesus ( Rh ) Blood Group System

ABO Blood Groups SystemABO Blood Groups System

Blood type

Red Blood cells Antigens ( Agglutinogens )

Plasma

Antibodies

( Agglutinin )

A

B

AB

O

A

B

A and B

--

B

A

--

A and B

Rh Blood GroupRh Blood Group

• Blood that contains the D antigen is known as Rh-positi

ve.

• If Rh-positive blood is transfused into an Rh-negative pe

rson, the recipient will form antibodies to the Rh factor a

nd a second exposure to Rh-positive blood will result in

red blood cells destruction (hemolysis) in the recipient.

• The Rh factor is of special importance during pregnancy.

Blood Typing and Cross-Blood Typing and Cross-matching Testmatching Test

• Direct Cross-matching Test

Red blood cells from the donor blood are mixed with serum from the

recipient to examine whether the antibodies to the donated red blood

cells are present in the recipient’s serum.

• Indirect Cross-matching Test

Red blood cells from the recipient blood are mixed with serum from the

donor to examine whether the antibodies to the recipient’s red blood

cells are present in the donated serum.

2. Categories of Blood Products2. Categories of Blood Products • Whole Blood Fresh Blood

Stored Blood • Blood Components Plasma Red Blood cells White Blood cells Concentrate Platelet concentrate Coagulants

Albumin

PlasmaPlasmacontains plasma protein without blood cells

and antigens

Fresh plasma is suitable for the patients who lack

of clotting factors. Stored plasma is suitable for the patients with low

blood volume and protein.

Frozen plasma: be preserved in -30 and is valid ℃for 1 year; thaw in 37 ; be transfused within 6 hours. ℃Dry frozen plasma: validity is 5 years ; be dissolved in normal saline before transfusion

Fresh BloodFresh Blood

• be preserved in 4 within 1 week℃

• contains all kinds of components, and can replace b

lood volume and all blood components such as bloo

d cells, plasma, platelets, and other clotting factors

• be often suitable for the patients with hematopathy

Stored BloodStored Blood• be preserved in 4℃ for 2 to 3 weeks

• contains many kinds of components, but some components such as white blood cells, platelets and thrombogen are damaged

• Lysis of red blood cells release potassium into the bloodstream, and the levels of potassium and acid in serum are increased

• the large infusion of stored blood can result in hyperkalemia （高钾血症） and acidosis （酸中毒）

• It is applicable for the massive hemorrhage or surgery.

Red Blood cellsRed Blood cells

• to increase the oxygen carrying capacity of blood in

the patients with anemia, less surgical bleeding or di

sorders with less bleeding and replenish red blood c

ells in cardiovascular failure for avoiding cardiovasc

ular overload

• one unit is 100ml of red blood cells, and can raise he

matocrit by approximately 4%

Red Blood cellsRed Blood cells

• Red Blood cells Concentrate: to increase the oxyge

n carrying capacity of blood in the patients with ane

mia and normal blood volume

• Washed Red Blood cells: for the patients after organ

transplantation or the patients with immunological h

aemolytic anemia

• Red Blood cells suspension: for battleground first ai

d; middle or small operations

White Blood cells ConcentrateWhite Blood cells Concentrate

• be made from centrifugal （离心的） fresh blood

• be preserved in 4℃ and are valid for 48 hours

• be suitable for the patients who have agranulocyt

osis （粒细胞缺乏症） and severe infection

• one unit is 25ml

Platelet concentratePlatelet concentrate

• be made from centrifugal whole blood

• be preserved in 22 and is valid for 24 hours℃

• be indicated for treatment or prevention of

bleeding related to deficiency in number or

function of a patient’s platelets

• one unit is 25ml

CoagulantsCoagulants

• Coagulants include clotting factors and cryoprecipit

ate （冷凝蛋白） , and is suitable for the patients with de

ficiency of variety of clotting factors.

• Cryoprecipitate contains clotting factor , which is Ⅷmissing from the blood of hemophiliacs （血友病患者） .

It is abstracted （提取、分离） from frozen plasma and

administered in small quantities.

• One unit is 50ml .

AlbuminAlbumin

• It is transfused to increase blood volume and

provide plasma proteins for the patients with

low blood proteins.

3. The Purposes of Blood 3. The Purposes of Blood TransfusionTransfusion

• To supply and restore the blood volume.

• To correct anemia, maintain hemoglobin level and the oxygen c

arrying capacity of red blood cells.

• To supply plasma protein to increase the plasma protein and m

aintain the colloid osmotic pressure.

• To supply clotting factors and platelets to prevent or treat hem

orrhagic disease.

• To supply antibodies and alexin （补体） to resist the infection.

• To remove deleterious substances from blood.

The Indications of Blood The Indications of Blood

TransfusionTransfusion

• Hemorrhage

• Anemia or hypoproteinemia （低蛋白血症）

• Serious infection

• Disturbances of blood coagulation

The Contraindications of Blood The Contraindications of Blood TransfusionTransfusion

• Acute pulmonary edema

• Congestive heart failure

• Pulmonary embolism

• Malignant hypertension

• Hypercythemia （红细胞过多症）

• Serious renal failure

• Serious allergy to blood transfusion

4. Methods of Blood Transfusion4. Methods of Blood Transfusion

• Direct Venous Blood Transfusion: The blood which

is collected from a donors is infused into the

recipient immediately.

• Indirect Venous Blood Transfusion: The collected

blood is infused into the patient as well as the

method of intravenous infusion.

• Arterial Blood Transfusion: be appropriate for the

patients with serious hemorrhagic shock or first aid

resuscitation.

5.Preparations for Transfusion5.Preparations for Transfusion• Prepare the Blood: specimen; fill in the blank of the t

ransfusion form ; send them to the blood bank. —for blood type examination and cross-matching test

• Obtaining the Blood Three checks include: The expiry date of the blood is not beyond. The pack is intact and without any leaking. The quality of the blood.

Eight rights include: the patient’s name, the bed number, inpatient number, the number of the blood bag label, the ABO groups and Rh type on the blood bag label, the result of cross-matching, the category and the amount of the blood.

Preparations for TransfusionPreparations for Transfusion

• After Obtaining the Blood

The blood should not be shaken to avoid red blood

cells being damaged

make sure that the stored blood is kept in room

temperature for 15 to 20 minutes before transfusion

The blood must not be warmed to avoid the

reactions caused by solidified and denatured plasma

albumin.

Preparations for TransfusionPreparations for Transfusion

• Recheck the Blood: check the blood and the

laboratory report with another nurse, validate the

collect blood, and inspect blood for clots before

starting blood transfusion.

• Check Consent Form: The patient should

understand and agree to receive the blood

transfusion, and be asked to sign consent form

before blood transfusion.

5-1. 5-1. Indirect Venous Blood Indirect Venous Blood TransfTransfusionusion

• Preparation before Implementation

• Procedure

• Cautions

PreparationPreparation

• Assessment

• Preparation of the patient

• Preparation of the nurse

• Equipment preparation

• Environment preparation

AssessmentAssessment• History: clinical condition, treatment and transfusio

n history ; gender of the patient, medical diagnosis, place and reason for the blood transfusion, the amount and type of the blood or blood components required, the history of the transfusion reactions

• Physical Examination: temperature, pulse, respiration and blood pressure; skin and blood vessels for the paracentesis

• Psychological status and the knowledge about transfusion

Preparation of the patientPreparation of the patient

• Education: The patient can tell the knowledge

related to transfusion, and identify the reactions

related to transfusion.

• Sign Consent Form.

• Ask the patient to void. Position the patient for

comfort and optimal visibility for skill

performance.

Preparation of the nursePreparation of the nurse

Wear working clothes

prune nails

wash hands

wear mask.

Equipment preparationEquipment preparation

Medical tray:

transfusion sheet transfusion set

antiseptic solution Sterile swabs

tourniquet infusion pad

adhesive tape 250 ml normal saline

blood unit ( packed blood )

Kidney-shaped tray

Environment preparationEnvironment preparation

• cleanness;

• commodiousness ;

• brightness

Procedures and key pointsProcedures and key points

1. Wash hands, wear a mask, and carry the equipment

to bedside

2. Recheck the physician’s order for number and type

of transfusion unit and the patient’s name and bed

number.

3. Explain procedures to the patient, instruct the

patient to identify transfusion reactions.

4. Perform venipuncture on a suitable vein use transfus

ion set connecting with 0.9% normal saline.

5. Gently agitate and suspend blood bag.

6. Complete the transfusion, infuse NS to clear the tubi

ng, then remove the needle.

7.Wash hands.

8. Record administration of transfusion.

CautionsCautions

1. Comply with the principles of surgical asepsis and tr

ansfusion procedure ； check the blood with another

registered nurse and make sure it correct before tran

sfusion

2. perform the intravenous infusion before transfusion,

and choose the sterile blood administration set with

in-line filter, and prime it with 0.9% normal saline

3. Drugs such as ( hyperosmolar or hypoosmolar soluti

ons, medications or other additives ) must not be ad

ded to blood under any circumstances.

4. During transfusion the patient is at risk for a reaction,

particularly during the first 15 minutes. --observe the v

ital signs and skin color--detect the early warning sym

ptom and signs of reactions, and provide the intervent

ion. 5. Most adults can tolerate receiving one unit of blood in

1.5 to 2 hours. Transfusion rate should be slow proper

ly for elders, serious anemia patients, and heart functi

on failure patients.

6. The empty blood bag should be preserved for 24 hour

s after transfusion in order to analyse the transfusion

reaction reasons when it occurs.

5-2. Direct Venous Blood 5-2. Direct Venous Blood TransfusionTransfusion

Equipment Medical Tray: 50ml syringes 3.8% sodium citrate solution sphygmomanometer antiseptic solution sterile swabs adhesive tape sterile dressing

Procedures and key pointsProcedures and key points1. Explain the procedures to the donor and recipient ----making the patient and the donor understand the procedure and cooperate with it2. Wash hands and wear mask, put anticoagulant in the

syringes ----adding 5ml of 3.8% sodium citrate solution into 50ml of blood3. The donor and patient lie on bed and show one arm

respectively

4. Check the name, the result of blood typing and cross-

matching between the donor and the recipient

----preventing the mistake

5. The sphygmomanometer is tangled on the arm and

pressured by air. The nurse should choose the large

vena, clear the skin over insertion site with antisepti

c swabs, perform venipuncture to collect the blood,

and infuse blood to the recipient by intravenous inje

ction

----the pressure is maintained 100mmHg

6. Cooperate with three nurses, the first nurse is respo

nsible for collecting the blood, the second nurse is f

or transferring and the third nurse is for infusion

7. When transfusion is completed, remove the

needle and press the venipuncture site

8. Disinfect and clean the equipment, and recor

d administration of blood transfusion

----record the time and amount of blood

transfusion and reaction

6. Autologous Transfusion6. Autologous Transfusion

Definition: Autologous transfusion also be called aut

otransfusion, is the collection and reinfusion of a pa

tient’s own blood.

Advantages:

be safer for the patient ---- decrease the risk of complications

such as mismatched blood

exposure to blood-borne infectious agents

save time---needn’t to type and cross-match the blood

6. Autologous Transfusion6. Autologous Transfusion

There are three approaches of autologous bloo

d:

Preoperative autologous Blood Storage

Perioperative Hemodilution

Intraoperative Lost Blood

Preoperative autologous Blood StoragePreoperative autologous Blood Storage

• 1 to 5 units of patient’s own blood be prestored before operation depending on the type of surgery and the ability of the patient to maintain an acceptable hematocrit

• blood be drew from a patient usually starting 3 to 5 weeks before an elective surgical procedure

• The blood should be collected once a week or two weeks until 3 days before surgery.

• It is helpful for the patient to withstand the blood loss that occurs with the collection, and return to normal level of plasma albumin.

Perioperative HemodilutionPerioperative Hemodilution• Blood is collected at the date of surgery ( most often

prior to surgery ). The fluid volume lost is replaced w

ith intravenous crystal solution or colloid solution.

• Blood loss in surgery thus occurs at a lower hemato

crit -- the amount of red blood cells and other blood

components lost during the entire procedure may be

reduced.

• Finally, collected blood is returned to the patient afte

r the surgical procedure.

Intraoperative Lost BloodIntraoperative Lost Blood

• The lost blood is salvaged from the surgical field for

reinfusion during or after the surgical procedure.

• For the patients with rupture of spleen or

fallopian-tube, if the bleeding in abdominal cavity is

not contaminated and coagulated within 6 hours, the

blood can usually be collected.

• Then, the filtered blood is returned to the patient

after anticoagulation is added in.

7. Componential Transfusion7. Componential Transfusion

Advantages:

Economic: allows several patients to benefit from

one unit of donated whole blood, appropriate

component is usually transfused for the patients

who are lack of the component in blood

be helpful to reduce the blood transfusion reaction

7. Componential Transfusion7. Componential Transfusion

• principles

1. During the transfusion of blood components, the pati

ents may receive the blood components from severa

l donors, so it is necessary to administer medication

( antihistamines 抗组胺药 ) as ordered to prevent the a

naphylactic reactions.

2. It is necessary for the patient to be tested blood typi

ng and cross-matching before red blood cells is tran

sfused.

7. Componential Transfusion7. Componential Transfusion3. Some of blood component, such as white blood

cells, platelet concentrate, are living for a short

time, so it is necessary to transfuse blood

components completely within term of validity by

special blood administration set.

4. Blood components should be first transfused to

provide the fresh components if the patients need

both whole blood and blood components.

8. Transfusion Reactions and 8. Transfusion Reactions and

Nursing InterventionsNursing Interventions• Fever Reaction

• Anaphylactic Transfusion Reactions

• Hemolytic Reaction

• The reaction Related to Large Volume of

Blood Transfusion

• Other Reactions

Fever ReactionFever Reaction

• Causes

The blood, blood bag or blood administration set is

contaminated by bacteria.

The principles of surgical asepsis are violated

during blood transfusion.

Antibodies in recipient’s blood react to antigens on

donor’s white blood cells, platelets, or plasma

proteins, especially with multiple transfusions.

Fever ReactionFever Reaction• Clinical Manifestations

After first 30 minutes to 6 hours after the transfusion,

the patient may have chills and fever suddenly ( the

temperature can range from 38 to 40 ), flushing, ℃ ℃

headache, anxiety, nausea, vomiting, muscle pain.

The mild reaction may be relieved within 1 to 2 hours,

and the temperature drops to the normal level

gradually.

Fever ReactionFever Reaction

• Preventing Intervention

remove the factors causing fever

follow the principles of surgical asepsis during

blood transfusion

choose disposable blood administration set

Fever ReactionFever Reaction• Nursing Intervention

Transfusion should be administered slowly if mild

reaction occurs.

Stop transfusion immediately and send the blood

bag and blood administration set to the laboratory if

severe reaction occurs.

Monitor the vital signs.

Provide cold therapy if the patient has hyperthermia.

Administer antipyretics as ordered.

Anaphylactic Transfusion Anaphylactic Transfusion ReactionsReactions

• Causes

The patient has anaphylactic predisposition( 过敏体质 ).

There are substances causing anaphylaxis in donor’s blood.

After the patient received several blood transfusion, the allergi

c antibody is produced in patient’s plasma. When blood transfu

sion is performed again, the antibody-antigen reaction cause a

naphylaxis.

The allergic antibodies( 变应性抗体 ) in donor’s blood is infused in

to the patient. The anaphylaxis may occur if the antibody reacts

to corresponding antigen.


• Clinical Manifestations In mild anaphylaxis After blood transfusion, the patient

may feel skin itching, and covered with urticaria.( 荨麻疹 )

In middle anaphylaxis The patient may have vascular and neuropathic edema, normally appear in face. The patient may have palpebra （眼睑） , or lip edema. The laryngeal edema also may occur. The patient may have dyspnea, bronchial spasm （支气管痉挛） , or chest pain. The wheezing sounds （哮鸣音） are found when lungs auscultated.

In serious anaphylaxis The patient may suffer from anaphylaxis shock.



Administer blood or blood products correctly.

Choose blood donor without allergy history.

Blood donor should be fasting for 4 hours before bl

ood donation.

The patient having history of allergy should be give

n antihistamines( 抗组胺药 ) as ordered before transfusi

on.


• Nursing Interventions

In mild anaphylaxis

Slow down the transfusion.

Administer antihistamines as ordered.

Monitor vital signs.

In middle or serious anaphylaxis

1.Stop transfusion immediately. Notify physician

and blood bank.

2. Administer 0.5 to 1ml of 0.1% adrenaline( 肾上腺素 ) by h

ypodermic injection as ordered. The antihistamines

should be given as ordered.

3. Maintain intravenous access with normal saline.

4. Give oxygen therapy to patient with dyspnea. Give tr

acheotomy （气管切开术） for patient with severe laryng

eal edema.

5. Manage shock. Initiate cardiopulmonary resuscitatio

n if necessary.

6. Monitor the patient’s vital signs.

Haemolytic ReactionHaemolytic Reaction

• Intravascular Haemolytic reaction

• Extravascular Haemolytic Reaction

Intravascular Haemolytic reactionIntravascular Haemolytic reaction• Causes Incompatibility blood infusion: 10ml or more of ABO

incompatible whole blood or red blood cells are infused.

Degenerated blood transfusion: The red blood cells are destructive and haemolytic in infused blood.

Hyperosmolar, hypoosmolar solution or medicines that influence the blood pH may have been added into the infused blood, then resulting in damage of red blood cells.

Intravascular Haemolytic reactionIntravascular Haemolytic reaction

• Clinical Manifestations (3 stages)

In the first stage: headache, nausea, vomiting, chest

pain, limbs numbness, and increased pain in kidney

region

In the second stage: hemoglobinuria( 血红蛋白尿 ), jaun

dice （黄疸） , chills, fever, dyspnea, cyanosis, and hy

potension

In the third stage: oliguria （少尿） , anuria （无尿） , e

ven acute renal failure or death



The nurse should meticulously verify and document

patient identification from sample collection to comp

onent infusion to prevent the haemolytic reaction, an

d make sure the compatibility of blood typing and cr

oss-matching.



1. Stop transfusion immediately, remove blood and any

blood-filled tubing, and replace with saline bag and n

ew tubing to keep line open, notify the physician and

blood bank immediately.

2. Provide oxygen therapy, maintain intavenous access,

administer medications as ordered.



3. Return blood bag and tubing to blood bank. Obtain

blood and urine samples of the patient and send to

the laboratory.

4. Local blocking in both renal regions; heat therapy on

the back should be provided to reduce the spasm of

renal blood vessels.

Intravascular Haemolytic reactionIntravascular Haemolytic reaction• Nursing Interventions

5. Infuse sodium bicarbonate by intravenous injection to make urine alkaline to promote hemoglobin dissolved to reduce the obstruction of renal tubule.

6. Monitor vital signs every 15 minutes; monitor and record urine output hourly by inserting indwelling catheter. Peritoneal dialysis( 腹透 ) or haemodialysis( 血透 ) may be required if renal failure occurs.

7. Treating shock as prescribed, if present.

8. Give mental support.

Extravascular Haemolytic ReactiExtravascular Haemolytic Reactionon

• caused by D, C, and E antibodies in Rh system.

• is present after one week or more of blood transfusi

on.

• the signs of reaction are mild: mild fever, anemia , fe

el tired. The bilirubin( 胆红素 ) in blood is increasing.

• These kinds of patients should avoid transfusion ag

ain as far as possible.

The reaction Related to Large The reaction Related to Large

Volume of Blood TransfusionVolume of Blood Transfusion

• Circulatory Overload

• Hemorrhage

• Sodium Citrate Poisoning Reaction

Circulatory OverloadCirculatory Overload

• Causes: pulmonary edema

• Clinical Manifestations: occur at anytime during or i

mmediately after completion of the transfusion; chest

pressed ， shortness of breath ， dyspnea, cough, froth

y or pinkish sputum ， facial paleness ， diaphoresis ， a

nxiety, headache, tachycardia, tachypnea( 气促 ), ortho

pnea( 端坐呼吸 ), increased venous pressure, neck vein

s tension, rales in lungs

Circulatory OverloadCirculatory Overload

• Nursing Interventions slow or stop the transfusion immediately ， notify the phys

ician assume a Folower’s position with the feet dangling at the b

edside if the patient’s condition is allowed apply oxygen inhale with higher flow rate, put 20 ％ to 30

％ ethanol solution into humidifying bottle administer the sedative ， vasodilators ， antiasthma( 平

喘 ) ， digitalis ， and diuretics to the patient according to the physician’s order

apply tourniquet to limbs of the patient in alternation in order to reduce the venous return if necessary

HemorrhageHemorrhage • Causes

Platelets and thrombogen （凝血酶原） are damaged i

n stored blood.

Too much sodium citrate is infused, and may cause t

he disturbances of blood coagulation.

• Clinical Manifestations wound bleeding, skin ble

eding, gingival （牙龈） bleeding, bleeding in venipun

cture site, or hematuria （血尿）

HemorrhageHemorrhage


Monitor the symptoms and signs of hemorrhage .

One unit of fresh blood is infused after 3 units of

stored blood.

The patient should be provided the blood

components according to the lack of clotting factors.

Sodium Citrate Poisoning ReactionSodium Citrate Poisoning Reaction

• Causes sodium citrate and serum calcium

are combined -- hypocalcemia ( 低血钙症 )

• Clinical Manifestations tetany （抽搐） , hypotens

ion, Q—T interval is prolonged in EKG, cardiac arres

t may occur if the condition is serious

• Nursing Intervention 1000ml of blood--10ml of 10

% calcium gluconate IV

Other ReactionsOther Reactions

• air embolism

• Sepsis （败血症）

• hypothermia

• blood transmitted disease

(hepatitis, malaria, AIDS )

• hyperkalemia (stored blood )

• Acidosis (stored blood )

9. Selection of Blood Donors9. Selection of Blood Donors

• The Contraindications for Blood donors The person who have the history of allergies, hepatit

is and malaria, HIV infection

The person with risk factors for HIV infection, heart disease, cancers, severe asthma （哮喘） , bleeding disorders, convulsions （惊厥） , hypertension or hypotension

The patient who undergo the operation, pregnancy women, or the persons who take certain medicines

The person who have high-risk behaviors such as having unsafe sex relationships, IV drug abuse

10. The Principles of Blood 10. The Principles of Blood

TransfusionTransfusion• Need physician’s order; blood typing and cross-

matching should be tested before transfusion

• Cross-matching test should be did again if the

patient need another transfusion to examine

antibodies produced in the serum

10. The Principles of Blood 10. The Principles of Blood TransfusionTransfusion

• In general, whole blood is administered ABO

identical. In emergency situations, when time does

not allow ABO determination, group O blood may be

given, group AB blood can accept group A and B

blood with direct cross-matching test negative,

transfusion rate must be slowly, and the amount of

blood should not overrun 400ml.

chapter 13 intravenous infusion & transfusion. section two intravenous transfusion definition:...

Documents

recipient blood

rhpositive blood

donor blood

transfusion blood transfusion

recipients red blood

donated red blood cells

individuals red blood

types blood typing