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Packed Red Blood Cells (PRBCs) By: Jenna Machin, image - Coggle Diagram
Packed Red Blood Cells (PRBCs)
By: Jenna Machin
Etiology
PRBCs are measured in units. 1 unit should increase a client's hemoglobin approximately 1% and hematocrit 3%
Improves oxygen-carrying capacity (via increase in hematocrit due high number of RBCs) and augment plasma volume
fluid is pulled from the extravascular space into the intravascular space to increase colloid osmotic pressure (COP), causing the plasma volume to increase
PRBCs are created from whole blood donation through centrifugation and the separation of red blood cells (RBCs) from plasma and other cellular elements
PRBCs contain 100% erythrocytes, 100% leukocytes, and 20% plasma from the original whole blood product
Indications
client who has lost at least 25% of their total blood volume (hypovolemia)
increase oxygen-carrying capacity in anemia clients
clients with substantial hemoglobin deficits
Most commonly used blood product
Assessment
Obtain baseline vital signs
Heart Rate
Respiratory rate
Blood pressure
temperature
general appearance and energy levels
Pulse oximetry
Pre-transfusion testing
ABO typing
Identify whether the client has A, B, AB, or O type blood
Antibody screening
sample of plasma is collected and tested against selected commercial Type-O RBCs to detect antibodies that may react to antigens in the donor PRBCs unit
Rh typing
positive or negative
Crossmatching
final step in finding PRBCs unit for transfusion by confirming the compatibility between the client and the donor
Consent
Informed consent is required in Canada for administration of all blood components.
This must include information regarding risks, benefits, and alternatives in a language the client can understand
Clients with personal or religious beliefs, such as Jehovah's Witnesses, will refuse blood transfusions
In emergency situations, unless a medical alert bracelet is found, consent is assumed as it would be considered a life-saving intervention
This would typically result in the infusion of Type-O PRBCs unit being administered as there likely is not time for pre-transfusion testing and type matching
Client history
previous blood product transfusions and responses to treatments
previous/current health concerns
status and size of venous access areas
Intravenous access is necessary for administration of blood product
Lab values
hematocrit
RBCs
white blood cells (WBCs)
Platelets
hemoglobin
clotting factors
Drug interactions, specifically calcium and aspirin as these can alter clotting and increase risk for bleeding
Nursing Care
Client does not provide consent
consult agency policy regarding documentation of client refusal of PRBCs.
Investigate which products the client is willing/allowed to receive and which fluids would be best for the situation. For example, many Jehovah's Witness clients may receive albumin infusions
Provide client PRBC transfusion
Transfusion of PRBCs should be performed over 2-3 hours, with a maximum of 4 hours. If the client cannot tolerate this volume, the unit may need to be divided into smaller units, with these other portions being properly refrigerated until needed.
Must be administered with normal saline 0.9%
Strict asepsis technique
Ensure a
double
check is done prior to administration of the product (6 medication rights, correct product, blood type, Rh factor)
Warm product to room temperature to prevent chills
Remain at bedside for 15 to 30 minutes to assess for adverse reactions
Assess and monitor post infusion
Hemolytic reaction
flushed face
feeling bloated or very full
patient feels warmth in the involved vein
chills
pain in chest or abdomen
hypotension
tachycardia
infusion with incompatible blood products
lower back discomfort is often first sign due to the kidney's inflammatory response
headache
nausea
tachypnea
Allergic reaction
plasma protein of the donor antibody reacts with recipient antigen due to sensitivity
flushing
pruritus
laryngeal edema or difficulty breathing
rash, hives
Febrile non-hemolytic reaction
most symptomatic complication of blood transfusion
sudden chills and fever
flushing
headache
anxiety
hypersensitivity to donor WBCs, platelets, or plasma
Septic reaction
Bacteria has compromised a component of the blood transfusion or product
vomiting
marked hypotension
rapid onset of chills
high fever
Circulatory overload
Occurs when administration of PRBCs is done at a greater rate than the client's circulatory system can handle
cough
dyspnea
rise in venous pressure
distended jugular vein
crackles or rales on auscultation
elevated BP
If reaction does occur, immediate recognition and laboratory investigation should be done. The transfusion must be stopped immediately and the IV line kept open with 0.9% NS. Complete another check on the given blood product to ensure it is the "right" blood unit for the "right" client.
Client Education
Blood typing
Rh factor
positive or negative
Provide information on why blood type and cross-matching prior to infusion is important for the reduction of
4 Types of Blood:
A, B, AB, O
Risk of transfusion reaction
Educate the client on the various risks of allergic reactions, transfusion reactions, and possibility of transfusion contracted virus' (HIV or Hepatitis)
Educate the client on the array of adverse reactions that they may experience and the importance of immediately reporting any side effects to the nurse or provider
Educate the client on what to expect during and after receiving PRBCs
The client will need to have an IV inserted. Explain the procedure of inserting an intravenous line and its necessity as the point of entry for the PRBCs
Procedure typically takes 1-4 hours
The IV line will be removed after the procedure, but the client may develop a bruise around the needle site, but this should dissipate in a few days
Further monitoring and lab tests will be conducted to ensure that the client's hemoglobin and hematocrit levels have been adjusted as desired
