Pharmacology - Nursing Flashcards
This article focuses on blood transfusions, including blood type compatibility, types of blood products, and possible reactions to a blood transfusion.
This series follows along with our Pharmacology Basics and Safe Medication Administration Flashcards for Nursing Students, which are intended to help RN and PN nursing students build a strong foundation going into Pharmacology and as preparation for the ATI, HESI, and NCLEX.
What is a blood transfusion?
A blood transfusion is a common and safe medical procedure in which healthy blood is given to a patient through an intravenous (IV) line that has been inserted in one of their blood vessels.
Blood type compatibility
Blood types are determined by the presence or absence of specific antigens — substances that trigger an immune response if they are foreign to the body. Because some antigens will trigger the body's immune system to attack transfused blood, safe blood transfusions depend on careful typing and cross-matching.
A handy table showing compatibility is included in our Pharm Basics flashcards!
Types of blood products
Blood products come in a variety of types, depending on the needs of the patient. And each blood product has a different infusion time.
Packed red blood cells (PRBCs)
Packed RBCs are made from a unit of whole blood by centrifugation and removal of most of the plasma. They are typically given in situations where the patient has either lost a large amount of blood or has anemia. PRBCs are infused over a two- to four-hour period, with a maximum of four hours.
Fresh-frozen plasma
Fresh-frozen plasma is usually administered to correct deficiencies in a patient’s ability to form clots. Plasma is infused much faster than PRBCs — between 15 and 30 minutes. Fresh-frozen plasma must be administered within two hours of thawing.
Platelets
Platelets are cells that circulate within the blood. When they recognize damaged blood vessels, they bind together as part of the healing process. Platelets are also infused quickly in a transfusion — between 15 and 30 minutes.
Nursing best practices for blood transfusions
When performing a blood transfusion on a patient, first confirm the patient’s ID, their blood compatibility, and the expiration date of the blood product with another RN.
Make sure to use a 20-gauge or larger IV catheter — preferably an 18-gauge catheter.
Also, before ordering the blood product, check the patency of the IV to ensure it is working properly. This avoids having the blood product sent up, only to discover after setting up the IV that it has infiltrated or is not working properly, causing a delay that would damage or ruin the blood product.
Prime the blood transfusion administration set with normal saline only, that is 0.9% NaCl. Do not prime the line with any other type of fluid.
Never administer medications through an IV line that is transfusing blood. Just as with TPN (where the line is only for TPN), when a patient is receiving a blood transfusion, that line is just for blood.
If the blood is not administered within 30 minutes of delivery to the patient’s room, it must be sent back to the blood bank.
Remember, when administering packed red blood cells, complete the administration within four hours.
Take the patient’s vital signs before administration of the blood, and then stay with the patient for the first 15 minutes of administration to monitor for transfusion reactions. If they are doing well after 15 minutes, take their vital signs again to make sure everything is still okay.
Blood transfusion reactions
It is possible that the patient experiences an adverse reaction to their blood transfusion. Reactions can include: mild allergic, anaphylactic, febrile, septic, and acute hemolytic reactions, as well as circulatory overload.
General nursing care
In the event of a patient experiencing a serious reaction to their blood transfusion, stop the infusion. Then, administer 0.9% NaCl through a separate line, notify the provider, and send the blood bag to the lab for analysis.
It is important to administer the saline through a new line because there will still be blood in the tubing of the old line, and we do not want any more of that blood going into the patient.
Mild allergic
A mild allergic reaction to a blood transfusion is marked by symptoms that can include itching, flushing (redness), and urticaria (hives).
In response to a mild allergic reaction, diphenhydramine (Benadryl) may be administered.
Anaphylactic
An anaphylactic reaction is very serious. Symptoms include wheezing, dyspnea (difficulty breathing), hypotension (low blood pressure), and decreased oxygenation (the patient’s SpO2 will be decreased).
In response to this type of reaction, we will likely administer epinephrine and corticosteroids as ordered by the provider.
Febrile
If the patient experiences a febrile reaction, they may have symptoms such as fever, chills, hypotension, tachycardia, and tachypnea (abnormally rapid breathing). Antipyretics may be ordered to alleviate this type of reaction.
Septic
The symptoms of a septic reaction may include fever, chills, and abdominal pain.
In response, it may be necessary to collect cultures, in order to discern the exact nature of the reaction. Also, administer antibiotics as ordered. Check out our Pharmacology Flashcards to learn more about antibiotics.
Acute hemolytic
An acute hemolytic reaction is usually due to the transfusion of incompatible red blood cells.
A patient with an acute hemolytic reaction will experience low back pain, as well as fever and chills, tachycardia, tachypnea (abnormally rapid breathing), and hypotension.
Collect labs and specimens, and give the patient IV fluids as ordered by the provider.
Circulatory overload
A circulatory overload reaction to a blood transfusion is usually due to excessive fluid intake or volume overload.
A patient suffering from circulatory overload may exhibit signs such as dyspnea, tachycardia, tachypnea, crackles (crackling sounds in the lungs), hypertension, and distended jugular veins, all of which are the signs of fluid volume excess.
Usually, despite this reaction, the patient may continue to receive blood, but at a decreased infusion rate. Note that when slowing the infusion rate, the transfusion must still be completed within four hours.
Other treatments for circulatory overload include raising the head of the bed and monitoring the patient’s oxygenation and vital signs. In addition, the provider may order diuretics to be provided to the patient.