Question

We have a 40-year-old patient who is anemic. related to a gastric bleed. They are stable but still needs a transfusion of Red packed blood cells because of hemoglobin of 6.9. The blood bank has called and notified you that the blood is ready to be picked up.

Answer the following questions?

1) Before we administer a blood product what are the steps the nurse needs to do?

2) With another RN when the nurse is about to administer the blood, what needs to be verified before the infusion begins?

3) What is the rationale for flushing the line with NS before administration of the blood?

4) What is the rationale for infusing the blood slowly for the first 15 minutes?

5) The patient begins complaining of chills and headache after 10 minutes of the infusion and their temp is 101.2. What kind of reaction is this?

6) What does the nurse need to do because of the reaction?

Pharmacology:

7) What are the differences in Levoquin, Penicillin, Erythromycin, Doxycycline and their effects on different organisms and give examples?

Answer 1

Anemia is a condition in which hemoglobin in the blood reduced less than normal level. The normal value of hemoglobin in men is 13.5 - 17.5 gm / dl and in women is 12 - 16 gm / dl. Hemoglobin level below 8 g / dl is known as severe anemia which needs immediate interventions to prevent complications. Blood transfusion is one of the best method in replacing the lost hemoglobin level in the body.

There are some nursing responsibilities before, during and after blood transfusion procedure.

1) The steps to follow before blood transfusion.

• Confirm the need of blood transfusion; The need of blood transfusion to be identified to avoid unnecessary transfusion of blood. This can be achieved by collecting and re checking the recent laboratory data for blood components.
• Informed written consent; The nurse must secure the consent of transfusion from the patient or relative (in certain circumstances like unconscious patients, child etc). The patient must be informed about all the information regarding transfusion like the indication, amount and type of blood component to be transfused, the complications of transfusion and the management before transfusion by the prescriber in an understandable language and signature must be obtained.
• Proper history collection to be done about the past blood transfusions and events during and post transfusion to know about any type of past blood transfusion reactions.
• Check the order or prescription of the blood transfusion and compare and confirm with the patient details. Check for the type amount and duration of blood transfusion, medications to be administered prior, during and post transfusion,etc.
• Assess the vital signs
• Insert a large bore intravenous catheter and keep the vein open to maintain patency.

2 . Data to be verified by two registered nurses

The identification of patient ,the blood component and amount of blood component to be administered, blood group on the blood bag unit and patients blood group, general appearance of the blood bag for any unusual change or clot formation and the expiry date of the blood unit to be verified by two nurses prior to blood transfusion.

3. The rationale for flushing the line with NS before administration of the blood

i) If the IV line is used for administration of any intravenous medications of fluids, it should be flushed with normal saline to clear the line to prevent cross contact with blood.

ii) To reduce the chance of extravasation, block during the transfusion, it is necessary to check if the Iv line is patent or not.

4.  Rationale for infusing the blood slowly for the first 15 minutes

The signs of serious blood reactions will start to appear in the first 15 minutes of transfusion soon after the blood components start to enter into patients circulating blood. If the blood is given fast from the beginning, More blood components will go to the patients blood stream in a short period of time which leads to increase in the intensity of the reaction.

5. The sudden emergence of fever and chills in the initial phase of transfusion are the most common symptoms of febrile transfusion reaction which is most commonly seen in patients transfused with packed red blood cells. Here, patient started complaining of chills and headache after 10 minutes of the infusion and their temp was 101.2 . Thus it will be a febrile transfusion reaction.

6. Nursing action during a transfusion reaction

i) Discontinue the blood transfusion immediately

ii) Disconnect the Iv tubing from the Iv catheter.

iii)Start with normal saline infusion to flush the line and keep the vein opened.

iv) Monitor the vital signs of the patient.

v) Inform the prescriber and administer the medications as directed.

vi) Inform the blood bank regarding the reaction and return the remaining blood component ( as per the policy)

vii) Document the event in patient records.

viii) Complete the blood transfusion reaction report and incident report and submit to the quality department. ( as per the policy)