Unit 14  Intravenous Therapy and Blood Transfusion

Chapter 1  Intravenous Therapy

Types of Solutions

IV solutions serve different functions. In most therapy situations, solutions of normal saline, glucose, or glucose in normal saline are used. Some special purpose solutions are follows.

Electrolyte solutions

Electrolyte solutions are either saline solutions or multiple electrolyte solutions. Saline solutions are available in isotonic, hypotonic, and hypertonic concentrations.

Blood volume expanders

Blood volume expanders increase the volume of the vascular compartment after loss of blood or plasma. When whole blood is not available, the administration of plasma to severely hemorrhaging patients maintains the blood volume.

Nutrient solutions

The patient resting in bed has a daily caloric requirement of about 450 calories. Intravenous nutrient solutions supply these calories in the form of carbohydrate, nitrogen (as amino acids), and vitamins, all of which are essential to metabolism. The caloric content of nutrient solutions varies from approximately 200 to 1500 calories per liter. Nutrient solutions may contain the following:

Infiltration is escape of fluid into subcutaneous tissue due to dislodgment of the needle. It is easily detected because the subcutaneous tissues swell, the skin becomes cold since the intravenous fluid is at room temperature rather than body temperature, and the patient may complain of pain at the site.

Phlebitis is another potential complication of intravenous caused by the mechanical trauma to the vein or the chemical irritation of infused substances, such as potassium chloride.

 Circulatory overload occurs when the intravascular fluid compartment contains more fluid than normal. Overload may be the result of overly rapid infusion rates and may lead to cardiac failure and pulmonary edema.

Chapter 2  Blood Transfusions

A blood transfusion is the introduction of whole blood or components of the blood, such as plasma, serum, erythrocytes, or platelets, into the venous circulation.

Blood Matching

Blood matching includes identifying blood groups and cross match blood. Before blood transfusion, the two tests should be carried out. ABO groups and Rhesus (Rh) groups are common classifications of blood groups. 

ABO groups 

Human blood is classified into four main groups (A, B, AB, and O) on the basis of polysaccharide antigens on the erythrocyte surface. These antigens, type A and type B, commonly cause antibody reactions and are called agglutinogens. In other words, Group A blood contains type A agglutinogen. Group B blood contains type B agglutinogen, Group AB blood contains both A and B agglutinogens, but Group O contains neither agglutinogen.

Rhesus (Rh) groups

    Rh antigens, also on the surface of erythrocytes, are present in about 85% of the population and can be a major cause of hemolytic reactions.

Assisting with Blood Transfusions

●  Fill out blood requisitions carefully and accurately.

●  Collect the blood specimen according to the medical order. Send the blood specimen with blood requisitions to do blood matching and transfusion reactions.

●  Check out the blood carefully and accurately with another nurse, before taking the blood to the ward. The nurses must check the period of validity, quality of blood and intact device of blood transfusion. Besides, the following must be checked including the full name of patient, the bed number, the hospital number, the number of the blood bag (or bottle), the blood group, the result of cross match blood, the type and dosage of blowww.med126.comod.

●  Forbid to waggle the blood violently or heat it. Lay the blood for 15 to 20 min at room temperature, before transfusing it.

●  Identify the patient and ensure that the patient receives the correct blood. Some agencies require that two nurses carry out this procedure. The nurses make sure the identification number, blood group, and the complete patient name written on the blood matches the patient's exactly.

●  Always use the correct administration set and follow the manufacturer's directions. Special administration sets, with a filter inside the drip chamber, are used for blood transfusions.

Reactions of Blood Transfusions

Although technologic advances have made blood transfusions a relatively safe procedure, some risks are involved; therefore transfusions are given only when absolutely necessary. It has been estimated that 1 in 2000 persons receiving a blood transfusion dies. Transfusion reactions can be categorized as hemolytic, febrile, and allergic.

Haemolytic reaction  

Intervention

●  Observe the patient closely for the first 10 minutes of transfusion, since these reactions occur rapidly.

●  Discontinue blood immediately when reaction is happening.

●  Notify the physician of the patient’s symptoms and vital signs.

●  Notify the laboratory to type and cross match blood and confirm diagnosis; the residual blood is sent back to the lab and a specimen of the recipient’s blood is retested.

●  Maintain intravenous infusion with D-5-W or saline.

●  Monitor vital signs q.15 minutes to assess respiratwww.med126.comion and temperature.

●  Record fluid intake and output to assess degree of kidney functioning.

●  Save first voided specimen for laboratory analysis.

●  Implement treatment as prescribed by the physician.

Febrile reaction

Intervention

●  Observe the patient closely for the first 30 minutes of transfusion.

●  Stop the transfusion.

●  Maintain intravenous infusion with saline or D-5-W.

●  Monitor the patient’s vital signs q.30 minutes.

●  Notify the physician.

●  Notify the lab to take a culture of the patient’s blood and transfusion blood.

●  Implement therapy as prescribed by the physician.

●  Alcohol sponges may be given for fever.

Allergic reaction

Intervention

●  Slow the transfusion.

●  Notify the physician immediately.

●  Maintain intravenous infusion with saline or D-5-W.

●  Monitor vital signs frequently.