Avaliação do conhecimento do enfermeiro sobre hemotransfusão em um hospital de referência em trauma / Evaluation of nurses knowledge about hemotransfusion in a trauma reference hospital

Os profissionais de enfermagem exercem um papel fundamental na segurança transfusional. A atuação da equipe de enfermagem não é limitada à apenas administrar os hemocomponentes, uma vez que tem a responsabilidade de prestar uma assistência livre de danos decorrentes de imperícia, negligência e imprudência. Portanto, esses profissionais devem ter conhecimento das boas práticas relacionadas ao ciclo produtivo do sangue e componentes, garantindo a qualidade dos processos e produtos, reduzindo os riscos sanitários e garantindo a segurança transfusional. Objetivo: Avaliar o conhecimento do enfermeiro sobre hemotransfusão, explorando os principais pontos da legislação que aborda o ciclo do sangue, enfatizando principalmente os conhecimentos necessários durante o ato transfusional. Materias e Métodos: Trata-se de um estudo exploratório, transversal, quantitativo, descritivo, realizado em um hospital de referência em urgência e trauma no estado de Goiás, sendo a coleta de dados estruturada por meio de questionário semi-estruturado, abordando os seguintes temas: legislação sobre o assunto, sistema ABO e Rh, bolsa de coleta, tempo de administração, reação adversa imediata e tardia. Resultados: A amostra foi constituída de 35 enfermeiros (n), que atuam na assistência direta ao paciente crítico nas quatro UTIs de um hospital de urgências de no estado de Goiás: 62,9% afirmam que nunca participaram de educação continuada sobre transfusão sanguínea, 68,6 % desconhecem a classificação das reações transfusionais quanto ao tempo de manifestação do quadro clínico. 37,1% apresentaram resposta satisfatória quanto a iniciar a transfusão de concentrado de hemácias de acordo com o percentual de perda volêmica no choque hemorrágico. Considerações finais: Os enfermeiros não têm os conhecimentos necessários para realizar de forma competente o ato transfusional, podendo comprometer a segurança do paciente e a qualidade do serviço de saúde. Parte das fragilidades podem estar relacionadas à formação acadêmica, já que, uma parcela considerável de profissionais relataram não ter cursado disciplina que abordasse a hemoterapia durante a graduação. Espera-se que esse trabalho possa contribuir com o conhecimento e desenvolvimento de estudos sobre a terapia transfusional e que possa servir de base para formulação de avaliação e treinamentos dos profissionais envolvidos na terapia transfusional

Nursing professionals play a key role in transfusion safety. The performance of the nursing team is not limited to just administering the blood components, since it has the responsibility to provide assistance free of damage resulting from malpractice, negligence and recklessness. Therefore, these professionals must be aware of good practices related to the production cycle of blood and components, ensuring the quality of processes and products, reducing health risks and ensuring transfusion safety. Objective: Evaluate nurses´knowledge about blood transfusion, exploring the main points of the legislation that addresses the blood cycle, emphasizing mainly the necessary knowledge during the transfusion act. Methodology: This is an exploratory, cross-sectional, quantitative, descriptive study, carried out in a reference hospital in emergency and trauma in the state of Goiás, with data collection structured through a semi-structured questionnaire, covering the following topics: legislation on the subject, ABO and RH system, collection bag, administration time, immediate and late adverse reaction. Results: The sample consisted of 35 nurses (n), who work in direct assistance to critical patients in the four ICUs of hospital de emergency in the state of Goiás: 62.9% claim that they have never participated in continuing education on blood transfusion, 68.6% are unaware of classification of transfusion reactions according to the time of manifestation of the clinical condition. 37.1% had a satisfactory response regarding initiating the transfusion of packed red blood cells according to the percentage of volume loss in hemorrhagic shock. Final considerations: Nurses do not have the necessary knowledge to competently perform the transfusion act, which may compromise patient safety and the quality of the health service. Part of the weaknesses may be related to academic training, since a considerable portion of professionals reported not having taken a course that addressed hemotherapy during graduation. It is hoped that this work can contribute to the knowledge and development of studies on transfussion therapy and that it can serve as a basis for the formulation of evaluation and training of professionals involved in transfusion therapy

Educação permanente de equipe de enfermagem em reação transfusional / Permanent education of the nursing team in transfusional reaction

Objetivo: identificar o conhecimento dos profissionais de Enfermagem sobre a reação transfusional, antes e após atividade de educação permanente. Método: trata-se de um estudo qualiquantitativo e explicativo, desenvolvido em um hospital de pequeno porte. Usou-se a estatística do Teste T pareado para testar a diferença entre as médias dos grupos e o software R para gerar as medidas-resumo. Resultados: compôs-se a amostra por 37 profissionais, sendo 22 técnicos de Enfermagem, oito enfermeiros e sete estagiários de Enfermagem, sendo a maioria do sexo feminino, jovem, solteira e trabalhando há menos de cinco anos na instituição e na Enfermagem. Quanto às avaliações, o percentual de acerto foi de 56% no pré-teste, enquanto, no pós-teste, esse percentual subiu para 87%, uma melhora de 31% no percentual de acerto. Conclusão: mostrou-se, pelo desempenho dos profissionais entre as avaliações do pré e do pós-teste, que o treinamento em reação transfusional se deu de maneira satisfatória, pois, de acordo com o teste estatístico utilizado, a HA das médias dos grupos serem significativamente diferentes foi aceita, sendo que o teste atingiu 82% da equipe de Enfermagem do hospital.(AU)

Objective: to identify the knowledge of nursing professionals about the transfusion reaction, before and after the activity of permanent education. Method: it is a qualitative and explanatory study, developed in a small hospital. The paired T-test statistic was used to test the difference between the means of the groups and the software R to generate the summary measures. Results: the sample consisted of 37 professionals, of whom 22 were nursing technicians, eight were nurses and seven were Nursing trainees, the majority being female, young, single and working less than five years in the institution and in Nursing. Regarding the evaluations, the percentage of correctness was 56% in the pre-test, while in the post-test, this percentage rose to 87%, a 31% improvement in the percentage of correctness. Conclusion: it was shown by the professionals' performance, between the pre-and post-test evaluations, that training in transfusion reaction occurred satisfactorily, since, according to the statistical test used, the averages of the groups were significantly different was accepted, and the test reached 82% of the hospital's nursing team.(AU)

Objetivo: identificar el conocimiento de los profesionales de enfermería sobre la reacción transfusional, antes y después de la actividad de educación permanente. Método: se trata de un estudio cuali-cuantitativo y explicativo, desarrollado en un hospital de pequeño porte. Se utilizó la estadística del Test T pareado para probar la diferencia entre los promedios de los grupos y el software R para generar las medidas-resumen. Resultados: se compuso la muestra por 37 profesionales, siendo 22 técnicos de enfermería, ocho enfermeros y siete pasantes de enfermería, siendo la mayoría del sexo femenino, joven, soltera y trabajando desde hace menos de cinco años en la institución y en la enfermería. En cuanto a las evaluaciones, el porcentaje de acierto fue del 56% en el pre-test, mientras que en el post-test, ese porcentaje subió al 87%, una mejora del 31% en el porcentaje de acierto. Conclusión: se mostró, por el desempeño de los profesionales entre las evaluaciones del pre y del post-test, que el entrenamiento en reacción transfusional se dio de manera satisfactoria, pues, de acuerdo con el test estadístico utilizado, la HA de las media de los grupos haber sido significativamente diferentes fue aceptada, siendo que la prueba alcanzó el 82% del equipo de Enfermería del hospital.(AU)

CE: A Review of Current Practice in Transfusion Therapy.

: In the United States, roughly 4.5 million patients per year receive transfusions of various blood products. Despite the lifesaving benefits of transfusion therapy, it is an independent risk factor for infection, morbidity, and death in critically ill patients. It's important for nurses to understand the potential complications patients face when blood products are administered and to recognize that patients who have received blood products in the past remain at risk for delayed reactions, including immune compromise and infection. Here, the authors review the blood products that are commonly transfused; discuss potential complications of transfusion, as well as their associated signs and symptoms; and outline current recommendations for transfusion therapy that are widely supported in the medical and nursing literature.

Simplified Blood Transfusion.

Editor's note: From its first issue in 1900 through to the present day, AJN has unparalleled archives detailing nurses' work and lives over more than a century. These articles not only chronicle nursing's growth as a profession within the context of the events of the day, but they also reveal prevailing societal attitudes about women, health care, and human rights. Today's nursing school curricula rarely include nursing's history, but it's a history worth knowing. To this end, From the AJN Archives highlights articles selected to fit today's topics and times.At one time, blood transfusions were routinely performed only in an operating room (OR). This 1937 article describes how one hospital found a way to change this practice by bringing the OR to the bedside. Author Frances A. Burgess details the contents of the sterile tray and recommends including a second sterile instrument pack in case a "cut down" might be needed for vein access. An OR nurse brings the equipment cart to the ward and assists with the transfusion.Burgess ends her article by emphasizing the benefits of the new protocol, highlighting priorities that will sound familiar to today's hospital nurses. "With this method the operating rooms are not held up by transfusions when as many as seven to nine are given in a day, and ill patients need not be moved to the operating room."For a review of blood products, current recommendations for their use, and the potential complications of transfusions, see "A Review of Current Practice in Transfusion Therapy" in this issue.

Is This a Blood Transfusion Reaction? Don't Hesitate; Check It Out.

Blood transfusions can be lifesaving. The majority are completed without incident. However, every transfusion recipient runs the risk of developing a transfusion reaction or adverse event. These reactions can be acute, occurring during or soon after transfusion, or delayed, occurring days to weeks later. Nurses need to be able to recognize and respond to these reactions appropriately.

Transfusion-Associated Circulatory Overload: Evidence-Based Strategies to Prevent, Identify, and Manage a Serious Adverse Event.

Transfusion-associated circulatory overload (TACO) is a potentially life-threatening complication of blood transfusion and is associated with increased morbidity, length of stay (hospital and intensive care unit), and hospital costs. Bedside nurses play a key role in the prevention, identification, and reporting of this complication. A common misperception is that the most frequently encountered serious adverse event during transfusion is a hemolytic reaction in a patient who receives ABO-incompatible blood. In fact, the incidence of TACO-related fatalities is higher than fatalities caused by ABO-related hemolytic reactions. Surveillance and evidence-based strategies such as clinical decision support systems have the potential to reduce the incidence of TACO and mitigate its effects. Practical suggestions for conducting bedside transfusion surveillance and future directions for improving transfusion care are presented.

Adverse reactions to whole blood donation, basic human needs and nursing diagnoses: a reflection / Reacciones adversas a la donación de sangre total, necesidades humanas básicas y diagnósticos de enfermería: una reflexión / Reações adversas à doação de sangue total, necessidades humanas básicas e diagnósticos de enfermagem: uma reflexão

ABSTRACT A theoretical-Reflective study with the objective to reflect on human needs regarding the imbalance of whole blood donors considering adverse reactions to the donation, and the existing nursing diagnoses that best meet the imbalance needs. The following needs were pointed out according to the signs and symptoms of adverse reactions and based on the Theory of Basic Human Needs: skin and tissue integrity, emotional security, pain perception, body mechanics, oxygenation, physical integrity, physical comfort, elimination, neurological, electrolytic and vascular regulation. By observing NANDA International's Definitions and Classifications, adaptations to the existing nursing diagnoses and suggestions for new headings have been proposed. We conclude that some of the needs are interrelated, such as vascular regulation, oxygenation and physical integrity. Thus, more contextualized nursing diagnoses related to the needs of whole blood donors are needed, given the specific nature of the situation generating imbalances such as: ineffective systemic vascular regulation characterized by self-reported dizziness, cutaneous pallor and arterial hypotension related to vasovagal reaction.

RESUMEN Estudio teórico-Reflexivo, cuyo objetivo fue reflejar acerca de las necesidades humanas en desequilibrio de donantes de sangre total frente a las reacciones adversas a la donación y acerca de los diagnósticos de enfermería existentes que más se adecuan a las necesidades en desequilibrio. De acuerdo con las señales y los síntomas de las reacciones adversas, se tomó como base la Teoría de las Necesidades Humanas Básicas y fueran enlistadas las siguientes necesidades: entereza de piel y tejidos, seguridad emocional, percepción dolorosa, mecánica corporal, oxigenación, integridad física, confort físico, eliminación, regulaciones neurológica, electrolítica y vascular. Al observar las Definiciones y Clasificaciones de la NANDA International, se realizaron propuestas de adaptaciones a los diagnósticos de enfermería ya existentes y sugerencias de nuevos enunciados. Se concluye que algunas necesidades están interrelacionadas, como regulación vascular, oxigenación e integridad física. Son necesarios diagnósticos de enfermería más contextualizados a las necesidades de donantes de sangre total, en virtud del carácter específico de la situación generadora de desequilibrios, como ejemplo: regulación vascular sistémica ineficaz caracterizada por autorrelato de tontura, palidez cutánea e hipotensión arterial relacionada con reacción vasovagal.

RESUMO Estudo teórico-reflexivo, cujo objetivo foi refletir sobre as necessidades humanas em desequilíbrio de doadores de sangue total diante de reações adversas à doação e sobre os diagnósticos de enfermagem existentes que mais se adéquam às necessidades em desequilíbrio. De acordo com os sinais e sintomas das reações adversas, tomou-se por base a Teoria das Necessidades Humanas Básicas e foram elencadas as seguintes necessidades: integridade de pele e tecidos, segurança emocional, percepção dolorosa, mecânica corporal, oxigenação, integridade física, conforto físico, eliminação, regulações neurológica, eletrolítica e vascular. Ao observar as Definições e Classificações da NANDA International, realizaram-se propostas de adaptações aos diagnósticos de enfermagem já existentes e sugestões de novos enunciados. Conclui-se que algumas necessidades estão inter-relacionadas, como regulação vascular, oxigenação e integridade física. São necessários diagnósticos de enfermagem mais contextualizados às necessidades de doadores de sangue total, haja vista o caráter específico da situação geradora de desequilíbrios, como exemplo: regulação vascular sistêmica ineficaz caracterizada por autorrelato de tontura, palidez cutânea e hipotensão arterial relacionada à reação vasovagal.

Early Identification of Acute Hemolytic Transfusion Reactions: Realistic Implications for Best Practice in Patient Monitoring.

Acute hemolytic transfusion reactions can result in severe complications and death. Through early identification and prompt intervention, nurses can reduce the risks associated with these serious reactions. Realistic evidence-based patient monitoring protocols can help guide identification of acute hemolytic transfusion reactions and facilitate lifesaving interventions to avert critical patient situations.

Análisis de las reacciones transfusionales en el Hospital Universitari de Bellvitge / Determinants and impact of economic crisis analysis of transfusion reactions in a tertiary level ospital (Hospital Universitari de Bellvitge, L´Hospitalet de Llobregat, Sapin)

Objetivos. Los objetivos de este estudio son conocer la incidencia y el tipo de reacciones transfusionales en un hospital de tercer nivel, comprobar si existe algún protocolo que determine la actuación ante una transfusión y detectar cual es la reacción más frecuente en este ámbito. Metodología. Es un estudio con un diseño cuantitativo, descriptivo, longitudinal y no experimental. La recogida de datos se hizo durante los meses de enero a diciembre del año 2013. El ámbito de estudio es el Hospital Universitari de Bellvitge. La población de estudio fueron los pacientes que recibieron una transfusión de cualquier componente sanguíneo. La muestra son los pacientes que han presentado una reacción transfusional. Resultados. Los resultados obtenidos son: el sexo masculino fue el predominante, representando un 60 % del total de las reacciones transfusionales; la edad media de los pacientes que presentaron alguna reacción fue de 67.85 años, con una desviación estándar de 11.06 años. Se estudiaron 8090 pacientes que presentaron 20 reacciones transfusionales. Se observa un mayor porcentaje de reacciones transfusionales en pacientes transfundidos ocasionalmente (45 %). Las reacciones transfusionales más frecuentes fueron as febriles no hemolíticas, seguidas de las alérgicas, las cuales representan un 75 % del total de las reacciones recogidas. Según el tipo de reacción, los síntomas que se presentaron con mayor frecuencia fueron: fiebre (55 %), escalofríos (25 %), prurito (15 %), disnea (15 %). Conclusión. Como conclusión, las reacciones más frecuentes en nuestro hospital son las reacciones febriles no hemolíticas. En el Hospital Universitari de Bellvitge existe un protocolo para el abordaje correcto del seguimiento completo de una transfusión y de la actuación que se ha de seguir ante una reacción transfusional (AU)

Objectives. The objectives of this study are to find out the incidence and the type of transfusional reactions in a tertiary level hospital, check for any protocol which determines the proceedings facing a blood transfusion and to detect which is the most common and frequent reaction in this area. Methodology. This is a study with quantitative, descriptive, longitudinal, non-experimental design. Data collection was done from January to December 2013. The scope of the study is the University Hospital of Bellvitge, the study population are the patients who received a transfusion of any blood component, and the sample is constituted by the patients who filed a transfusion reaction. Results. The results obtained indicate that male sex was the predominant, accounting for 60% of all transfusion reactions; and the average age of patients who presented a reaction was 68 years. There was 8090 patients who presented 20 transfusion reactions were studied. It’s observed a larger percentage of transfusion reactions in patients transfused occasionally (45 %). The most frequent transfusion reactions were febrile nonhaemolytic reactions, followed by allergic reactions, representing 75 % of the registered reactions. Depending on the type of reaction, symptoms that occurred most frequently were fever (55 %), chills (25 %), pruritus (15 %), dyspnea (15 %). Conclusión. In conclusion, the most common reactions in a tertiary level hospital are non-haemolytic febrile reactions. At the University Hospital of Bellvitge there is a protocol for the correct approach of the full monitoring of a transfusion and the procedures to follow facing a transfusion reaction (AU)

Effects of Leukoreduction and Premedication With Acetaminophen and Diphenhydramine in Minimizing Febrile Nonhemolytic Transfusion Reactions and Allergic Transfusion Reactions During and After Blood Product Administration: A Literature Review With Recommendations for Practice.

Transfusion-related reactions cause unwanted interruptions in blood-product administration and potential complications for patients. The most common reactions are febrile nonhemolytic transfusion reactions (FNHTRs) and allergic transfusion reactions (ATRs). The presence of leukocytes in blood products has been associated with these reactions, and efficacy of leukoreduction in minimizing FNHTRs and ATRs has recently been investigated. In addition, premedication with acetaminophen and diphenhydramine is the most widely used practice in minimizing FNHTRs and ATRs, yet the benefit of this is not supported by research. The aim of this systematic literature review was to evaluate the potential benefits of both of these interventions in minimizing FNHTRs and ATRs and provide recommendations for practice. We found moderate quality evidence with strong recommendations for the practice of leukoreduction in minimizing FNHTRs but not ATRs. We did not find evidence to support the use of premedications in minimizing transfusion-related reactions, and we question the need for this practice in settings where leukoreduction is used.