Considerations for selection of appropriate IV access include:. CVADs with multiple lumens allow blood components or PPP products to be given through one lumen while other medications or solutions infuse through other lumens. Do not administer medications that are known to cause adverse reactions at the same time as a blood component or PPP, where possible, because distinguishing between symptoms and signs of a medication-related adverse reaction and transfusion reaction is challenging.
In emergency situations it may be necessary to administer various blood components and products concurrently. This should be done using separate IV access. Administration set requirements vary for blood components and PPPs. These requirements are outlined in facility-specific policy, which should be developed in consultation with the transfusion service.
The administration of blood components requires the use of a standard blood filter, which may range in pore size from to microns. The filter, which must be completely covered with the blood component, is intended to remove clots, cellular debris and coagulated protein. A leukocyte reduction filter is no longer required during transfusion, as all blood components issued in Canada have undergone leukocyte reduction by filtration during preparation see the Canadian Blood Services Circular of Information 16 and Chapter 2 of this Guide for more information.
Blood components must be transfused within 4 hours of issue. If the transfusion is interrupted for any reason, administration must be discontinued after 4 hours even if the transfusion is not complete.
If there is a delay between units in a multiple unit transfusion, the administration set should be changed to minimize the likelihood of bacterial growth.
The administration of PPPs requires varied supplies, differing by product type and brand. PPPs for intravenous administration may require use of a standard, vented or filtered set or may be administered by direct intravenous push. Other PPPs are administered by intramuscular or subcutaneous route. Facilities should refer to the product monograph and local policy to determine what, if any, filtration is required during reconstitution or administration. Health-care facilities must have an approved process for ongoing inspection and validation for all infusion devices.
Infusion devices have been known to cause mechanical hemolysis; 18 therefore, prior to implementing the use of an infusion device, confirmation that it has been approved for use in transfusing blood components should be obtained from the manufacturer. See Chapter 10 of this Guide for more information about the causes of mechanical hemolysis.
Infusion devices may be used to transfuse blood components e. The use of infusion devices must always adhere to the health-care facility policy. A pressure infusion device may be used for rapid administration of blood components. The pressure applied to the blood component should not exceed mm Hg as this may result in hemolysis or bag breakage. A blood warmer device may be used to prevent hypothermia during rapid administration of cold blood components, such as in the operating room or trauma setting.
A blood warmer device may be used in routine transfusion for a patient with cold agglutinin disease; however there is limited evidence for the efficacy of this strategy and warming the patient is more likely to be feasible and just as likely to be beneficial.
When a blood warmer is used, the temperature upon initiation and the unique identifier of the device e. Pre-transfusion patient assessment and a measurement of baseline vital signs must be documented within 30 minutes prior to transfusion. Identify any potential risks of a transfusion reaction or any pre-existing symptoms that could later to be mistaken for a transfusion reaction e.
If the patient is able to participate, education should be provided so the patient understands the importance of immediately reporting any new onset symptoms during or after transfusion. Any pre-medications required should be prepared and administered as ordered e.
Blood components and PPP must be stored in monitored blood storage and transported in a validated system. Storage and transport systems are validated and monitored by the transfusion service. A blood component or PPP should only be obtained from storage when all preparation for administration is complete. Prior to obtaining a blood component or PPP, confirm that a transfusion order exists and informed consent is documented. Follow health-care facility procedures when obtaining a blood component or PPP from the transfusion service or satellite blood refrigerator.
It is imperative that positive patient identification is confirmed again at this time and the right product is obtained for the right patient. If the retrieved blood component or PPP is no longer required, it should be returned immediately to the transfusion service to maintain safe storage conditions and prevent waste.
The pre-transfusion safety check includes checking the blood component or PPP and verifying positive patient identification on the product to the patient. All identifying information linking the patient to the blood component or PPP must be matched. Always follow facility-specific policies for confirming patient identification and the blood component or PPP. Depending on the blood component or PPP to be administered, there will be additional considerations.
See Table 3 for a summary of administration requirements. As mentioned previously, misidentification can occur at several points during the transfusion process and it is imperative that positive patient identification is maintained through the entire process. The safety check immediately prior to administration of a blood component or PPP is the last opportunity to prevent an identification error from reaching the patient.
The following list summarizes the general steps included in preparing for and initiating a blood transfusion. Confirm consent for transfusion. Provide information to the patient regarding the planned transfusion e. Confirm pre-transfusion testing or collect pre-transfusion sample if applicable. Assemble required equipment. Complete a patient assessment and obtain baseline vital signs within 30 minutes pre-transfusion. Administer pre-medication s if required.
Obtain the blood component or PPP from storage or the transfusion medicine laboratory. Complete pre-transfusion checks. Refer to facility-specific policies and procedures.
Document the pre-transfusion checks, including date and time and the identity of the persons completing the checks. Prepare to initiate the blood component or PPP:. Meanwhile, nearly 21 million transfusions of blood elements, such as red blood cells, platelets, or plasma, take place each year in the U.
Here, we look at how long a transfusion takes, when it starts working, and what the process involves. It depends on how much blood and which blood products the person needs. According to the National Heart, Blood, and Lung Institute, a blood transfusion typically takes 1—4 hours.
People with anemia may need transfusions of red blood cells. These take longer than transfusions of plasma or platelets. The typical duration of a red blood cell transfusion is 4 hours. The table below shows how long different transfusions may take, based on information from the Joint United Kingdom Blood Transfusion and Tissue Transplantation Services Professional Advisory Committee. But these times can vary, based on several factors specific to each person. Learn more about blood transfusions and anemia.
Barring emergency situations, a healthcare professional aims to administer a transfusion at a pace that suits the person. This can depend on the reason for the transfusion. One study from showed that people with cancer and anemia reported a significant increase in their sense of well-being and had improved hemoglobin counts immediately after receiving a transfusion of red blood cells.
However, if the person has lost blood due to a traumatic injury, the benefits are likely to take longer to show. It will depend on the amount of blood lost and any other health issues. In this case, the person may need more than one transfusion, as well. The duration of the benefits depends on the reason for the transfusion. We explore some specifics below. When a person needs blood due to a traumatic injury or during surgery, the benefits tend to last. This is because the transfusion replaces lost blood.
If a person has a long-term illness, they will likely need further transfusions. The length of time before the next transfusion depends on the health issue and factors specific to the person. Some people with myelodysplastic syndrome, a bone marrow disorder that can lead to a form of anemia, for example, may need a transfusion every 2 weeks , while others need them every few months. Overall, once a person starts having transfusions, the intervals between tend to become shorter over time.
One study found that people with cancer and anemia experienced significant improvements from transfusions and that the improvements lasted for about 15 days.
How many transfusions can a person have? A person might need a transfusion if they:. The circulatory system of the average, healthy adult contains about 1. This is 10 units. They may lose consciousness as the oxygen supply to their brain falls. Learn more about blood volume here.
The end goal of transfusion is to restore volume and oxygen-carrying capacity. The type of component to be transfused depends on assessment of the clinical status of the patient. With the advent of blood component therapy, the use of whole blood as a resuscitation fluid has become obsolete. Whole blood is deficient in clotting factors and has high levels of potassium, ammonia, and hydrogen ions. Although it provides volume expansion along with increased oxygen-carrying capacity, there can be volume overload before the needed components are replenished.
Since the central pathophysiology of hemorrhagic shock is failure of oxygen delivery, timely administration of red blood cells is the most important component of resuscitation. Fresh frozen plasma FFP is utilized for its clotting factor content in trauma resuscitation. In the presence of massive hemorrhage or coagulopathy, 1 unit of FFP is given for every 4 or 5 units of red cells administered.
FFP is not indicated just for volume expansion in trauma cases. However, a more proactive approach is beneficial in rapid bleeding to prevent the development of a coagulopathy.
Hemotherapy decisions should be inclined towards reducing the magnitude of a problem before it worsens to the point of no return. If correction is required before a hemostatic challenge such as a major surgery, it should be given shortly before the procedure for maximum benefit.
The decision to transfuse platelets should be based on the etiology of the thrombocytopenia, the presence or absence of active bleeding, and the need for surgical intervention. The trigger for starting platelet transfusion is also undecided.
Platelet therapy should be guided by monitoring of the post-transfusion platelet count. Patients with fever, infections, disseminated intravascular coagulation, excessive bleeding, and splenomegaly may not show the expected increase in platelet count following transfusion. Hemoglobin-based oxygen carriers HBOCs represent an attempt to create a resuscitative fluid with the oxygen-carrying capacity of red blood cells but without the need for cross-matching or the potential for viral transmission.
These solutions are either human or bovine in origin and consist of hemoglobin dimers or tetramers. They have shorter half-lives than red blood cells hours to days. Ongoing research into the use of HBOCs in lieu of blood transfusion in trauma patients may prove their effectiveness in the near future.
Hemorrhagic shock leads to suppression of erythrocyte production due to the effect of cytokines released as a part of the systemic inflammatory response. In a prospective randomized double-blind placebo-controlled multicenter trial, it was found that weekly administration of recombinant human erythropoietin reduces allogeneic red cell transfusions in critically ill patients.
There was an increase in the hemoglobin and hematocrit values in the study group, which included both medical and surgical patients. However, the treatment is associated with significant increase in the number of thrombotic events. Cryoprecipitate is obtained by slowly thawing FFP. Recombinant factor VIIa is being used in the treatment of bleeding in trauma and non-trauma patients when all other measures fail.
It can stop blood loss, reduce blood requirement, and improve clotting parameters. They suggested that dosing be adjusted according to the clinically estimated blood loss and the rate of bleeding. Urgent need for transfusion in a patient requiring immediate surgical intervention may preclude the performance of usual testing protocol.
Adequate pretransfusion samples should be collected before infusion of any donor blood so that compatibility testing, antibody screening and, if necessary, identification studies can be performed subsequently. If blood must be issued in an emergency and there is no time for cross-matching, group-specific blood can be issued. In such a situation the clinician must sign a release authorizing and accepting responsibility for the use of incompletely tested products as a life-saving measure.
The total volume and type of fluid infused during initial resuscitation has a strong influence on the outcome. Priority should be given to maintenance of intravascular volume and adequate oxygen-carrying capacity.
Other parameters such as clotting factors and serum electrolyte levels should also be monitored. Whereas all transfusions have potential adverse reactions, the transfusion of massive amounts of stored blood is associated with unique consequences, such as shift to the left in the oxygen dissociation curve, acid-base imbalance, hypothermia, hypocalcaemia, dilutional coagulopathy, and respiratory distress.
The American College of Surgeons and the American Association of Blood Banks both recommend that the transfusion of blood and blood components be guided by laboratory tests such as PT, PTT, platelet count, and fibrinogen levels. Only a minimum level of coagulation factors are required for normal formation of fibrin and hemostasis and normal plasma can therefore be said to contain coagulation factors in excess, a reserve that usually allows patients to tolerate replacement of one or more blood volumes of red cells and crystalloid without needing FFP.
There was a significant difference in mortality during the first 6 h after admission. Thus early administration of FFP and platelets is critical in trauma with massive bleeding.
These being a key element of damage control, early and aggressive transfusion intervention and resuscitation with blood components is the novel approach to major trauma that addresses the lethal triad of acidosis, coagulopathy, and hypothermia. Although the ideal amounts of plasma, platelet, cryoprecipitate, and other coagulation factors in relationship to the red blood cell transfusion volume are not known, current data support a target ratio of plasma : red blood cell : platelet transfusions of Initial resuscitation of a patient with hemorrhagic shock should be based on identification and correction of the source of bleeding and fluid administration to stop, and then reverse, the pathophysiology of shock.
The rate of administration of resuscitation fluids should be adequate to support tissue perfusion. Early use of blood component therapy can help to preserve oxygen delivery and coagulation parameters. However, blood transfusion carries the added risk of transfusion reactions, infections, and several metabolic complications in massive transfusion.
Hence, the indiscriminate or prophylactic use of blood products is not warranted. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. J Emerg Trauma Shock. Author information Article notes Copyright and License information Disclaimer. Address for correspondence: Dr. Paramjit Kaur, E-mail: moc. Received Jan 29; Accepted Jan 2.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
This article has been cited by other articles in PMC. Abstract Blood and blood components are considered drugs because they are used in the treatment of diseases. Keywords: Blood transfusion, massive transfusion, resuscitation, trauma.
Whole blood With the advent of blood component therapy, the use of whole blood as a resuscitation fluid has become obsolete. Packed red blood cells Since the central pathophysiology of hemorrhagic shock is failure of oxygen delivery, timely administration of red blood cells is the most important component of resuscitation. Fresh frozen plasma Fresh frozen plasma FFP is utilized for its clotting factor content in trauma resuscitation. Platelets The decision to transfuse platelets should be based on the etiology of the thrombocytopenia, the presence or absence of active bleeding, and the need for surgical intervention.
Hemoglobin-based oxygen carriers Hemoglobin-based oxygen carriers HBOCs represent an attempt to create a resuscitative fluid with the oxygen-carrying capacity of red blood cells but without the need for cross-matching or the potential for viral transmission.
Recombinant erythropoietin Hemorrhagic shock leads to suppression of erythrocyte production due to the effect of cytokines released as a part of the systemic inflammatory response. Cryoprecipitate Cryoprecipitate is obtained by slowly thawing FFP. Factor VIIa Recombinant factor VIIa is being used in the treatment of bleeding in trauma and non-trauma patients when all other measures fail.
Current shock models and clinical correlations. Ann Emerg Med. Pathophysiology of hemorrhagic shock. Anaesth Intensive Care.
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