How To Preparation For Blood Transfusion And Its Effects..???
To ensure that the patient is safely transfused meticulous attention to detail is necessary from the moment the transfusion is ordered. The request form must be tilled in (by the doctor) carefully and clearly. The specimen of the patent's blood which accompanies the form to the laboratory must he clearly labelled. Ample time should be allowed to the laboratory to find blood of the correct group and to carry out a cross match. When ready the blood will be retained in the laboratory until required for use.
When the blood is collected check all details carefully. Compare the information given on the label tied to the bottle (i.e., the bottle number and group, the patent's full name and hospital number, and the ward) with that shown in the blood register, and also in the patent's case notes. On return to the ward re-check all details with a second person--nurse or doctor before the transfusion is set up. Sometimes special measures are adopted to identify the patient when unconscious, as during an operation, by writing his name or hospital number on the skin, or attaching a label to wrist or ankle. Whatever the local requirements the nurse should know them, and carry them out carefully.
Note that the colours of the bottle labels are different for each group:
Group A is yellow. Group B is pink.
Group 0 is blue. Group AB is white.
Rhesus negative blood is distinguished by having the writing on the labels in red.
Do not warm the blood before use unless specifically instructed to do so by the doctor. Raising the temperature will encourage the growth of bacteria. If you are instructed to warm the blood, stand the bottle in water at blood heat, no more.
Finally set out the appropriate instruments, sterile towels, etc., needed for a minor operation, and include a straight splint and some bandages.In difficult cases it may be necessary to 'cut down'; the instruments required are seen in Fig. 48/1. The skin is first cleansed, then incised; the vein is exposed and a cannula is introduced and tied into the vein. The skin is then sutured. Once the blood is running in freely the needle or cannula is secured in position with sticking plaster; the limb may be lightly bandaged to a splint—do not obstruct the blood flow—and secured to the side of the bed.
The patient is now kept under very close supervision for 15 to 20 minutes, and intermittently thereafter until the transfusion is complete. The same pattern of supervision should be followed with each new bottle. The speed of the transfusion is usually about 20 to 40 drops per minute, but may be required to be much slower, as in cases of long-standing anaemia in which the heart muscle is weak, or very fast, as when there has been severe hemorrhage.
When the transfusion is completed the bottles should be sent back to the laboratory. Do not wash the bottles, nor detach their labels. Finally, a precise record of the transfusion is made in the patent's notes. For care of the administration of an infusion postoperatively, see p. 461.
THE EFECTS OF BLOOD TRANSFUSION
When a patient receives blood which is in any way unsuitable he may suffer a reaction. This usually occurs within 20 minutes of commencing the transfusion. There may be backache, hot flushes, sweating, rigors, headache, or a rise in temperature. Urticarial weals may appear, and rarely, there is rapidly developing severe shock. When a reaction is noted, stop the transfusion and inform the doctor immediately. He may require the blood to be returned to the laboratory for checking, together with a fresh specimen of the
patient's blood and a sample of his urine. The ill-effects of transfusion may be the result of the following.
Incompatibility—i.e., blood of the wrong group. The red cells become agglutinated in the patient's circulation and are rapidly destroyed (haemolysed). Symptoms may appear early, or they may be delayed. Haemoglobin may appear in the urine, and later the patient becomes jaundiced. Rarely, the kidneys may fail and the flow of urine cease.
Allergy the patient being sensitive to substances in the plasma. Symptoms are usually mild and skin manifestations common.
Bacterial contamination. If bacteria havi been able to grow in the blood the reaction is likely to be very severe and even fatal, sometimes after only a few ml of blood have been given.
Transmission of disease. Virus hepatitis, syphilis, and (in the tropics) malaria are commonly transmitted if the donors are not carefully screened. Circulatory overload, due to too rapid transfusion.
Air embolism. If pressure is being used to hasten the transfusion air may get into the vein with serious consequences. Never apply air pressure in an effort to relieve a blockage in the needle.
.
To ensure that the patient is safely transfused meticulous attention to detail is necessary from the moment the transfusion is ordered. The request form must be tilled in (by the doctor) carefully and clearly. The specimen of the patent's blood which accompanies the form to the laboratory must he clearly labelled. Ample time should be allowed to the laboratory to find blood of the correct group and to carry out a cross match. When ready the blood will be retained in the laboratory until required for use.
When the blood is collected check all details carefully. Compare the information given on the label tied to the bottle (i.e., the bottle number and group, the patent's full name and hospital number, and the ward) with that shown in the blood register, and also in the patent's case notes. On return to the ward re-check all details with a second person--nurse or doctor before the transfusion is set up. Sometimes special measures are adopted to identify the patient when unconscious, as during an operation, by writing his name or hospital number on the skin, or attaching a label to wrist or ankle. Whatever the local requirements the nurse should know them, and carry them out carefully.
Note that the colours of the bottle labels are different for each group:
Group A is yellow. Group B is pink.
Group 0 is blue. Group AB is white.
Rhesus negative blood is distinguished by having the writing on the labels in red.
Do not warm the blood before use unless specifically instructed to do so by the doctor. Raising the temperature will encourage the growth of bacteria. If you are instructed to warm the blood, stand the bottle in water at blood heat, no more.
Finally set out the appropriate instruments, sterile towels, etc., needed for a minor operation, and include a straight splint and some bandages.In difficult cases it may be necessary to 'cut down'; the instruments required are seen in Fig. 48/1. The skin is first cleansed, then incised; the vein is exposed and a cannula is introduced and tied into the vein. The skin is then sutured. Once the blood is running in freely the needle or cannula is secured in position with sticking plaster; the limb may be lightly bandaged to a splint—do not obstruct the blood flow—and secured to the side of the bed.
The patient is now kept under very close supervision for 15 to 20 minutes, and intermittently thereafter until the transfusion is complete. The same pattern of supervision should be followed with each new bottle. The speed of the transfusion is usually about 20 to 40 drops per minute, but may be required to be much slower, as in cases of long-standing anaemia in which the heart muscle is weak, or very fast, as when there has been severe hemorrhage.
When the transfusion is completed the bottles should be sent back to the laboratory. Do not wash the bottles, nor detach their labels. Finally, a precise record of the transfusion is made in the patent's notes. For care of the administration of an infusion postoperatively, see p. 461.
THE EFECTS OF BLOOD TRANSFUSION
When a patient receives blood which is in any way unsuitable he may suffer a reaction. This usually occurs within 20 minutes of commencing the transfusion. There may be backache, hot flushes, sweating, rigors, headache, or a rise in temperature. Urticarial weals may appear, and rarely, there is rapidly developing severe shock. When a reaction is noted, stop the transfusion and inform the doctor immediately. He may require the blood to be returned to the laboratory for checking, together with a fresh specimen of the
patient's blood and a sample of his urine. The ill-effects of transfusion may be the result of the following.
Incompatibility—i.e., blood of the wrong group. The red cells become agglutinated in the patient's circulation and are rapidly destroyed (haemolysed). Symptoms may appear early, or they may be delayed. Haemoglobin may appear in the urine, and later the patient becomes jaundiced. Rarely, the kidneys may fail and the flow of urine cease.
Allergy the patient being sensitive to substances in the plasma. Symptoms are usually mild and skin manifestations common.
Bacterial contamination. If bacteria havi been able to grow in the blood the reaction is likely to be very severe and even fatal, sometimes after only a few ml of blood have been given.
Transmission of disease. Virus hepatitis, syphilis, and (in the tropics) malaria are commonly transmitted if the donors are not carefully screened. Circulatory overload, due to too rapid transfusion.
Air embolism. If pressure is being used to hasten the transfusion air may get into the vein with serious consequences. Never apply air pressure in an effort to relieve a blockage in the needle.
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