What is a blood transfusion?
The process of transfusing blood is a medical practice that started 1600 years ago. It is a method where blood from a donor is transfused to a patient through a thin rubber tube linked to venous access in the arm. It is done if the patient’s body is not producing enough RBCs or loses blood after an injury or bleeding. Some would undergo blood transfusion for treatment of certain medical diseases such as anemia and cancer.
What are the different types of blood transfusions?
- Platelet Transfusion: Otherwise called “platelet concentrate,” are transfused to prevent hemorrhage in people with a low platelet count. Platelets are the disc-shaped components of the human blood that aids in the formation of a clot to stop bleeding. Following vascular endothelium damage, platelet activation will take place and produce a platelet plug known as “clot.”
- RBC Transfusion: This is given to patients with blood diseases such as Iron Deficiency Anemia or cancer. This kind of transfusion is used to treat these diseases since RBCs repair tissue oxygenation when the demand for oxygen increases.
- Plasma Transfusion: Plasma is a liquid yellow part of the blood that holds carbon dioxide, electrolytes, nutrients, clotting factors, and proteins. It is separated from the whole blood through a spinning centrifuge, and it suspends on the surface as the red blood cells settle at the bottom. The transfusion of plasma is done to replace lost protein levels in patients with medical diseases.
- Whole Blood Transfusion: this kind of transfusion is ordered for a patient with a massive hemorrhage and low hemoglobin levels after it is typed and cross-matched. It is usually used for the treatment of severe traumatic bleeding.
Why are Red Blood Cells Important?
The human blood has different components: white blood cells (leukocytes), red blood cells (erythrocytes), plasma, and platelets. The RBCs have the most vital job of transporting oxygen to the other parts of our body. It gives the blood its velvety red color and is repeatedly produced in the marrow of the bone. Inadequacy of this component will leave you pale, fatigued, tachycardic, and with a body malaise since the heart needs to work twice as hard to compensate the organs with oxygen. Red blood cells work hand in hand with protein hemoglobin to bring the oxygen from the lungs and remove carbon dioxide gathered in the body.
When are patients usually transfused with blood?
Blood transfusion usually happens when the individual experiences severe hemorrhage following an accident, surgery, or injury, suffering hemolytic anemia, or battling hematologic cancer that shows a low hemoglobin level after a blood test. The normal human hemoglobin levels are 14-18 g/dL for men and 12-16 g/dL for women.
Some of the clinical signs that indicate the need for transfusion are decreased blood pressure, decreasing O2 saturation, paleness, shortness of breath, and electrocardiographic changes are showing tissue hypoxia and low hemoglobin levels. Blood transfusion is a therapy that could save an individual from a life-threatening situation.
What are the nurse’s responsibilities when transfusing blood?
Transfusions must only be carried out by a registered nurse and must be verified or ordered by a licensed doctor. The nurse tasked to do the transfusion must know the procedure, risks, and reactions and is aware of the patient’s blood type.
Steps to consider to prevent blood transfusion complications:
- Verifying the patient’s blood type with the records/charts or schedule the patient for blood typing if possible
- Gathering an informed consent from the patient receiving the blood signed in the presence of a nurse
- Proper typing and cross-matching procedures are performed and checked by at least two nurses prior to the transfusion to confirm that the donor blood is compatible with the patient’s blood
- Documenting all reactions and vital signs taken observed before, during, and after the transfusion
- Monitoring the patient and checking vital signs every 15-30 minutes during the procedure
Preventing a transfusion reaction from packed RBCs is one of the steps in a successful transfusion and needs a lot of preparation. Although nurses commit a common clerical error, it can still be avoided by following the institution’s protocols for blood transfusion. Typing and cross-matching the donor’s blood thoroughly before the procedure is medically obligatory and is safe for the particular patient who will be receiving the blood.
After extracting the blood from the donor, it is then sent to the laboratory for proper typing process revealing the type of blood and the antigens present. Then it will be cross-matched with the patient’s blood to test its compatibility and prevent harmful reactions.
The nurse assigned should be knowledgeable about the Rh factors and different blood types. Patients with Type A blood can only receive Type A and O blood, Type B with Type B and O blood, Type AB with A, B, AB, and O blood, and Type O is limited to Type O blood only. Patients with blood Type AB are known as “universal recipients” while blood Type O patients are “universal donors”.
Signing an informed consent:
Having the patient’s consent is needed in almost all medical interventions. They should be educated on how the process will be done and the benefits and risks of this procedure. It is a way of putting the patient first and giving them a chance to participate and decide if they want to undergo the procedure or not.
Establishing a good nurse-patient relationship is a good way to start an open conversation with your patient. A good patient rapport can help the nurse gather more information about the patient’s thoughts, medical history, and possible allergies.
After the procedure, there are times that the patient’s body produces antibodies that cause fever and blood transfusion reactions that should be noted by the nurse and reported to the physician immediately. Informed consent could serve as ethical evidence that could protect both patients and medical practitioners from the rights and wrongs of human principles. It promotes patient’s autonomy for self-care.
Equipment to Prepare for Blood Transfusion
- A gauge 18 needle: It is one of the largest needles that is commonly used for blood transfusion since blood is thicker and requires a faster flow rate to prevent it from clotting.
- Y-Tubing with in-line filter: The infusion set and filter required for blood transfusion procedure. The purpose of this tubing is the quick closing of bloodlines and a full blast of saline during transfusion reaction.
- Normal Saline 0.9%: The only fluid that can be used for blood transfusion. It is used to prime the tube for easy blood flow at the start of the transfusion and for flushing at the end. Normal saline dilutes the blood and lowers osmotic pressure.
- 10cc Syringe with normal saline: placed at the patient’s bedside for easy flushing when the tube is blocked or if there’s blood clot formation.
- Biohazard Red Bag and sharps container: for proper disposal of tubing and needles after the procedure.