Blood and Blood Product Use in Perioperative Patient Care

Abstract

A variety of health care personnel are involved in the collection, storage, and administration of the 20 million units of blood products that are transfused into millions of patients each year. This article reviews blood transfusion practices, nursing care guidelines, and new developments to help perioperative nurses prevent or ameliorate adverse transfusion outcomes in surgical patients.

When Your Patient Is From the Obstetric Department: Postpartum Hemorrhage and Massive Transfusion

“…Choices for volume replacement include intravenous crystalloid fluids such as 0.9% normal saline (NS) or lactated Ringer's (LR) solution, or colloids such as hetastarch (Hespan, DuPont Merck, Wilmington, DE). 5,6 Use of 2 large bore (16 or 14 gauge) intravenous catheters will facilitate rapid replacement. Three milliliters of fluid replacement are used for each 1 mL of blood lost (Table 1).…”

“…Patient identification error is cited as the most common cause of incompatible blood. 3, 6 If a hemolytic transfusion reaction is suspected, the nurse should immediately discontinue the blood administration, infuse normal saline solution, and notify a physician. Two nurses who verify the patient name, identification number, and blood type at the patient's bedside with each unit of blood promotes prevention of this complication.…”

“…Two nurses who verify the patient name, identification number, and blood type at the patient's bedside with each unit of blood promotes prevention of this complication. 3,5,6 For febrile nonhemolytic reaction, occurring in 1 per 5 platelet transfusions and 1 per 100 PRBC transfusions, the physician should be notified, the current transfusion discontinued, and an order obtained for antipyretics. Any future transfusion will require leukocyte-poor products.…”

“…Epinephrine and/or corticosteroids are usually ordered immediately. 3,6 Despite blood donor screening, infectious diseases can still be transmitted during transfusion. HIV (1 per approximately 2,100,000), hepatitis C (1 per 1,900,000), and hepatitis B (1 per 200,000) are well screened, but pooled donors increase the risk of transmission.…”

“…Furthermore, it increases hemoglobin's affinity for oxygen, releasing less to the tissues, and predisposes the patient to cardiac dysrhythmias. 3,4,6,9 PRBCs are stored at around 5°C and are rapidly infused during an emergency. The nurse can prevent hypothermia by placing blood on a warmer for infusion and warming all IV fluids.…”