What is special about the tubing used for administration of blood products?
Chapter 8. Intravenous Therapy Show
All healthcare practitioners who administer blood or blood products must complete specific training for safe transfusion practices and be competent in the transfusion administration process. Always refer to your agency policy for guidelines for preparing, initiating, and monitoring blood and blood product transfusions. These guidelines apply to adult patients only. The transfusion of blood or blood products (see Figure 8.31) is the administration of whole blood, its components, or plasma-derived products. The primary indication for a red blood cell (RBC) transfusion is to improve the oxygen-carrying capacity of the blood (Canadian Blood Services, 2017a). An order from a healthcare provider is required for the transfusion of blood or blood products. RBC transfusions are indicated in patients with anemia who have evidence of impaired oxygen delivery. For example, individuals with acute blood loss, chronic anemia and cardiopulmonary compromise, or disease or medication effects associated with bone marrow suppression may be candidates for RBC transfusion. In patients with acute blood loss, volume replacement is often more critical than the composition of the replacing fluids (Canadian Blood Services, 2017a). Transfusions can restore blood volume, restore oxygen-carrying capacity of blood with red blood cells, and provide platelets and clotting factors. The most common type of blood transfusion is blood that is donated by another person (allogeneic). Autologous transfusion is the transfusion of one’s own blood (Perry et al., 2018). Figure 8.31 Red blood cells and blood IV tubing. Note the filter is the bottom half of the drip chamberTransfusion therapy is considered safe, and stringent precautions are followed in the collection, processing, and administration of blood and blood components. However, transfusions still carry risks such as incompatibility, human error, and disease transmission, and blood transfusion must be taken seriously at all times. Incompatibility can be decreased by using irradiated red blood cells or leukocyte-reduced blood. The majority of blood transfusion complications are a result of human error (Perry et al., 2018). Compatibility testing is vital for all recipients of blood or blood products. Recipients must be transfused with an ABO group specific to their own blood type or ABO group-compatible. There are three types of blood typing systems: ABO, Rh, and human leukocyte antigen (HLA). For more information on these, refer to the online resources at the end of this chapter. It is vital to understand what types of blood groups are compatible for transfusions (Canadian Blood Services, 2017b). When administering blood and blood products, it is important to know the patient’s values and beliefs regarding blood products. Some groups of individuals, mainly Jehovah’s Witnesses, may refuse blood transfusions or blood products based on religious beliefs. These individuals sometimes refuse transfusion of whole blood and primary blood components but may accept transfusion of derivatives of primary blood components such as albumin solutions, clotting factors, and immunoglobulins. Always assess each individual’s preference to establish if a blood component is an acceptable treatment to manage their illness or condition (Canadian Blood Services, 2017a). When managing blood transfusions, it is important to identify issues promptly to manage reactions effectively. Transfusion reactions (mild to life-threatening) may occur despite all safety measures taken. All transfusion reactions and transfusion errors must be reported to the agency’s transfusion medical services (TMS, a.k.a. the “blood bank”). It is imperative to know what signs and symptoms to look for, and to educate your patient on what to report and when to report potential transfusion reactions. Mild to severe reactions may include the following (Canadian Blood Services, 2017b):
It is important to note that some reactions can occur one or more days after a transfusion (Canadian Blood Services, 2017b). As such, patients going home after a transfusion require education about what to watch for and what do do in the event of a reaction. For more information on types of reactions, signs and symptoms, and treatments, review the article adverse events related to blood transfusions, or see the online resources at the end of this chapter. If patient has a blood transfusion reaction, always follow agency policy to manage mild to severe blood reactions. This text will cover pre transfusion preparation (Checklist 75), transfusion of blood and blood products (Checklist 76) and then managing a blood transfusion / blood product reaction (Checklist 77). The steps in Checklist 75 must be completed before obtaining the blood or blood product from the blood bank (Alberta Health Services, 2015a, 2015b; Perry et al., 2018; Vancouver Coastal Health, 2008).
Data Sources: Alberta Health Services, 2015a, 2015b; Canadian Blood Services, 2017; Interior Health, 2018; Critical Thinking Exercises
AttributionsFigure 8.31. Red Blood Cells from BCIT is used under a CC BY-SA 4.0 international license. Figure 8.32 Blood Product Example by author is licensed under a CC BY-SA 4.0 international license. Why is filtered tubing used during infusion of blood products?Blood Infusion. Blood components must be filtered during transfusion to remove clots and small clumps of platelets and white blood cells that form during collection and storage.
Can you use the same tubing for blood?We use the same primary tubing for all units of blood hung in a 24 hour period. We do change the secondary filter with each unit that is hung.
How often must you change the tubing for blood products?Specific blood administration tubing is required for all blood transfusions. Blood tubing is changed every 4 hours or 4 units, whichever comes first.
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