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Practical Aspects of Administration of Blood10. Practical Aspects of Administration of BloodTo ensure safety of transfusion, it is of utmost importance to identify the donor and recipient correctly. Accurate identification of donor has been discussed in the section on ‘Donor selection’ and the importance of identifying the recipient in the section on “Adverse reactions to blood transfusion”.The transfusion centre must ensure that the correct unit of blood has been issued for the right recipient. The nursing and medical staff has the responsbility of checking the identity of the recipient before starting the transfusion. Transfusion of blood Blood should not be kept at room temperature or stored in household refrigerators after issued from the transfusion centre. Effort should be made to transfuse the blood as soon as possible after it is issued. If for some reasons, blood cannot be administered within a short time, it must be returned to the blood transfusion centre, preferrably within half an hour of being issued. It is important to remember that the temperature of blood reaches 8° C after 30 minutes at room temperature. If the blood units is kept for several hours at room temperature and then returned to the blood transfusion centre, it is unfit for reissue. Identification of recipient Before starting the transfusion the medical officer must check. a. The name and hospital number of the patient. The patient may be asked his name. b. The donor number on the bag must match with that on the compatibility report and the transfusion form. The expiry date of the blood and the blood group must abs be verified. c. The compatibility report must be checked to confirm that data on this report and the blood bag is matching. Warming of blood In routine transfusions blood need not be warmed, as a slow rate of transfusion raises the temperature of blood during administration. However, is massive or exchange transfusion or very rapid transfusion, blood may be warmed either using automated blood warmer or a 37°C waterbath with adequate and correct temperature control. Hot towels should never be used to warm the blood. Starting the transfusion The medical officer starting the transfusion must record the date and time of starting the transfusion on the transfusion form along with the blood component used and clinical parameters of the patient (pulse, blood pressure, respiratory rate, temperature and any other symptom). This helps to detect any adverse effect of blood transfusion and provides a bseline data for furthe evaluation. Selection of the vein Any peripheral vein may be selected for transfusion of blood. Veins in the antecubital fossa are preferred. The vein selected should be large and straight and in such a psoition that discomfort to the patient is minimal. Venepuncture The site of venpuncture must be cleaned using asepric precautions. Transfusion is uäually given through a needle (18 or 19 gauge) or eatheter. For neonates, scalp vein infusion sets are used (23 gauge). Fluids compatible/non compatible with blood Sodium chloride is the fluid of choice. The reduces viscosity and increases flow. It can be used to rinse cryoprecipitate from the bag. Dextrose solution in water aggregates the red cells and plugs the blood filter or the needle. It also causes osmotic lysis of the red cells. Ringer lactate contains calcium sufficient enough to overcome the anticoagulant effect of CPD and form clots. These clots may clog the needle or the tubing. Blood Filters Blood and blood components are given through a filter to remove microaggregates or big fibrin clots. There is a drip chamber in the filtering unit through which the rate of transfusion can be regulated. The pore size of the routine blood transfusion filter is 170 urn while microaggregatE inters hae a 40 urn pore size. Rate of transfusion The rate of transfusion depends on the patient’s clinical condition. If the patient is in shock, rapid transfusion should be given. Under usual circumstances, for the initial 30 minutes, the transfusion should be slow to look for any immediate transfusion reaction. The unit of whole blood should not take longer than 4-6 hours for transfusion. Medication Bio medication rnust be added to the unit of blood. This increases the risk of bacterial contamination and may cause haemolysis. Monitoring the recipient during transfusion The recipient should be constantly monitored during the transfusion for occurence of any adverse reactions. The vital signs should be recorded at periodic intervals. After completion of transfusion, the patient’s condition should be recorded. The patient should be kept under observation for at least one hour postransfusion. The transfusion records must be mentioned in the patient’s case notes.
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