 Hi, welcome to nursing school explain and today's video on blood transfusions Please keep in mind that there's also another video that specifically goes over any possible adverse reactions to blood transfusions And this video gives you a basic overview of the different types of blood products We can administer as well as to their indications and associated nursing care, which is always super important So let's first look at what different types of blood products that are available So over here if a patient donates a unit of blood it basically is considered whole blood So that whole blood the patient donates that goes into the back is considered whole blood Now in the lab, but it's prepared. We can basically distinguish between Reds red cells as well as plasma if you've ever worked at a lab or seen a lab Or any kind of blood spilling, you know that those through in the centrifuge When the blood separates we have the red cells and then on top the liquid portion The kind of yellow serum portion, which is also called the plasma and the plasma contains three different Components which are platelets of human and cryoprecipitate. So we can really transfuse any one of these and Also, plasma as a whole and then it would contain platelets of human as well as cryoprecipitate or just each one of those So let's look at those in more detail here RBCs or packed red cells as there are many times referred to are probably the most commonly Transfused blood product the indications would be anemia or acute blood loss, which is also a type of anemia but keep in mind that also pertains to leukemia any of the blood disorders and Any kind of acute blood loss that might occur and one unit of blood typically contains between 250 and 350 milliliters and It has the ability to increase the patient's hemoglobin by about one gram per deciliter So why about one point many times the rules at many hospitals are That the patient needs to have a transfusion once the hemoglobin Drops below seven or eight depending on the overall circumstances So as you can see the patient depending on if they are male or female Typically, you know more hemoglobin level as anywhere between 12 and 16 So they could need multiple units to bring the level back up to where they should be and one unit of Red blood cells replaces about 500 milliliters of blood loss and that is because it's not only The red cells that we're losing if we have an acute blood loss But we're also having the plasma which will then regenerate itself from the bone marrow And for packed red cells there is also a product called buccal side reduction or a process that the blood can go through which Decreases the adverse reaction for patients who do require frequent transfusions because of their specific medical condition now platelets Are a part of the plasma as we can see over here but the lab again can filter out only the platelets and The treatment indication is thrombocytopenia. So low platelets count and One unit of platelets can increase the platelets by about 5,000 and one donor can donate multiple units the platelet bags usually are a lot smaller than the packed cells making anywhere from 50 to 100 mls Then we can also give the patient FFP or fresh frozen plasma and that now is that serum the whole serum component from the whole blood So it includes flintlets of human as well as cryoprecipitate and other minor things And it is a liquid portion of the whole blood and it treats coagulation factor deficiencies because it Contains the cryo precipitate and it is many times used in the emergency reversal of an elevated PT or INR When when that reversal is needed and when the patient has an increased risk for bleeding So that for example might be a patient who is on an Anticoagulant for whatever reason and now they have a fall or a trauma and they require Some sort of surgery an example is a patient who is on coagulant for atrial fibrillation And now they have a hip fracture and they require surgery Well the fresh frozen plasma replaces coagulation factors and the platelets that the anticoagulant kind of tries to Modify and so by replacing if the patient will be ready for surgery sooner Then they would if there would just be watchful waiting until the body regenerates their Their their plasma portion and the coagulation factors that we want to make sure are within normal limits before we send them to the operating room The other portion here that we can administer is up human and Up human keep in mind is this plasma protein that helps pull the fluid or hold the fluid in the Intravascular space so up human about 25 grams per deciliter equals 500 mls of plasma or similarity because it has that ability to pull the fluid into the Intravascular space it causes the fluid shift from the extra vascular or interstitial space into the intravascular space and Reasons that we need it is typically because the blood pressure is low such as in hyperbolemic shock or any condition where the Oblution level would be low so patients with malnutrition for example Patients with a lot of pitting edema because of congestive heart failure if their albumin is low and those kinds of disorders and In the last component is cryoprecipitate and that is the last component here from the plasma from the serums Section of the blood and it replaces coagulation factors only most of the time it's used to replace factor 8 one with a branch disease or Fibrinogen and a condition here specifically where we need to replace Fibrinogen is DIC or disseminated intravascular coagulopathy Which is a sequence of events that can occur due to multiple conditions and puts the patient in a very critical Bleeding state so then in order to give them these coagulation factors as well as the Fibrinogen is going to be super important Now the other thing that I brought out over here are recipients and donors so what recipient can receive blood from what donor and it goes from O a B and a B blood types and then we always have positive and negative our age factors and so Any letter can receive blood from their own letter But remember that we cannot give a patient who is our age negative and are each positive blood product So hence all positive can receive all positive and all negative But a patient who has all negative blood type can only receive all negative Same with a a positive can receive a positive and a negative as well as all positive and all negative a Negative can only receive a negative and all positive Sorry or negative so no positive here B positive can get both B types as well as both all types Be negative again only B and all negative a B positive. They are the lucky ones They are the universal recipient They can receive all types of blood from any kind of donor and blood type and that a B negative Can basically have all of the above except the a B positive because it is a negative factor here And then also in black see what I've kind of circled here Oh negative is the universal donor so that blood is usually a hot commodity if you have one negative blood type Please consider donating blood because anybody can receive your blood in case there is an emergency or the need for that So then over here very important with blood transfusion is the nursing care and The precautions that we have to take now policies and procedures make very Depending on what hospital you work at and so always be our familiar be familiar with the policies and procedures of your specific Hospital these Some of those are universal, but some of them will depend on where you work So first of all when we when we give a blood transfusion we want to make sure that we have good IV access We want to have a minimum of a 22 gauge IV Many times if there is a cute blood loss Let's say the patient with a traumatic injury is actively bleeding a 22 gauge is not going to cut it You're going to have to go larger maybe an 18 maybe even a 16 or a 40 friend Gauge IV access so that the bigger the gauge the more blood can go through there faster So if there's a need for a rapid infusion, you want to have a very large bore IV Of course, we want to check the order and make sure that the physician or the provider has consent in the patient for the blood transfusion There's specific blood tubing available and the reason is that it has a filter because Certain particles might get caught there and we certainly don't want to infuse those into the patient's blood Patients vein and it also has a wide tubing Which will allow you to hang the blood back as well as the normal saline at the same height so that you can then prime them We typically want to use a pump again if this is a huge blood loss and the patient needs many units of blood Frequently we're not going to use the pump We're either going to let it free flow or even use a rapid infuser to be able to administer that blood fairly quickly We always want to double check the The blood with a second RN and you want to check the policies and procedure of your specific facility because Some facilities now have the ability with their electronic medical record through barcode scanning and very meticulous checking of the system that you do not need to check with a second nurse which is kind of a Little scary at first a little different when you're used to always checking in with a second second nurse But it is possible. So be aware of your policies and procedures The other thing that I didn't write down here That's probably one of the most important things we want to administer with normal saline only and the reason is that The any kind of other fluids such as D5 or LR can cause some precipitation with the blood and then we have a huge problem We can't use the blood unit the patient care is delayed or if it reaches the patient now they're getting an infusion of some Precipitated or quietly Once you pick up the blood from the blood bank at your hospital The requirement is to start within 30 minutes and that is pretty universal And the reason is that it comes out of the refrigerator And so it's only go just like food you wouldn't leave food on your table for ever before you even you would Administer the blood within 30 minutes and then also the other thing is the maximum infusion time is four hours And that again is for viability and make sure that it's still safe to do that Use the rate that's appropriate for the patient. So again, if this is a traumatic event acute blood loss It's going to have to be going in quickly But if this is a patient who just needs a transfusion for let's say a treatment of cancer or they have a condition like congestive heart failure or any kind of renal issues We want to make sure we go a little bit slower because anything we put in the patient's vascular system might cause some heart failure and my fluid They might end up in fluid volume overload and it might settle in their lungs So we want to be extra cautious here and then for vital signs We want to obtain a baseline set of vital signs including a temperature That's very important and then check the bios again after 15 minutes of start of the infusion And then typically every 30 minutes to one hour depending on your policy and procedure and the patient's status and If an adverse reaction occurs it typically occurs in the first 15 minutes So you want to stay with your patient for the first 15 minutes Educate them about what you're doing and what kinds of signs and symptoms to watch out for and that way you can intervene right away if something happens and then Swatch my other video on the different kind of blood reactions that are possible the adverse reactions as well as what to do about them So you can see my different video about that Thanks for watching this video on blood transfusions Please subscribe give me a thumbs up if you have enjoyed this video and I'll see you soon right here on nursing school explain