Guía de cuidados de enfermería para la administración de la sangre y sus componentes (Revisión integrativa) / Nursing Care Guide for the administration of blood and its components (integrative review) / Guia de cuidados de enfermagem para a administração de sangue e seus componentes (revisão integrativa)

Resumen 13. El objetivo de esta investigación fue identificar la mejor evidencia científica que respalda el cuidado de enfermería a las personas que reciben una transfusión de sangre y sus componentes. La metodología siguió las pautas de la revisión integrativa partiendo de una pesquisa general a partir de la que se redactó una pregunta utilizando el formato PCC (Población, concepto y contexto); se estableció una estrategia de búsqueda de información en bases de datos en idioma español, inglés y portugués. Se llevó a cabo la selección y análisis crítico e interpretación de la evidencia encontrada. Se identificó inicialmente un total de 3543 artículos, de los que se removió 3513 (por duplicación) y se excluyó 30 (por título); por tanto, se seleccionó 16. Como resultado, se destaca los cuidados de enfermería antes, durante y posterior a la administración de los hemocomponentes, relacionados con el receptor, calidad del producto, materiales, prevención y valoración e intervención oportuna ante eventuales reacciones adversas. Se concluye que los cuidados de enfermería establecidos son semejantes entre los diferentes documentos, esta revisión integrativa se considera una guía óptima, para que los profesionales apliquen las diferentes actividades descritas para mejorar la calidad del procedimiento de transfusión de hemocomponentes en las instituciones de salud.

Abstract 17. The objective of this research was to identify the best scientific evidence that supports nursing care for people who receive a transfusion of blood and its components. The methodology followed the guidelines of the integrative review based on a general survey from which a question was written using the PCC format (Population, concept and context); an information search strategy was established in Spanish, English and Portuguese databases. The selection and critical analysis and interpretation of the evidence found was carried out. A total of 3543 articles were initially identified, of which 3513 were removed (by duplication) and 30 were excluded (by title); therefore, 16 were selected. As a result, the nursing care before, during and after the administration of blood components, related to the recipient, product quality, materials, prevention and assessment and timely intervention in the event of adverse reactions is highlighted. It is concluded that the established nursing care is similar among the different documents, this integrative review is considered an optimal guide for professionals to apply the different activities described to improve the quality of blood transfusion procedure in health institutions.

Resumo 21. O objetivo desta pesquisa foi identificar as melhores evidências científicas que sustentam o cuidado de enfermagem às pessoas que recebem transfusão de sangue e seus componentes. A metodologia seguiu as diretrizes da revisão integrativa com base em uma pesquisa geral da qual uma questão foi escrita usando o formato PCC (População, conceito e contexto); uma estratégia de busca de informações foi estabelecida em bancos de dados espanhóis, ingleses e portugueses. A seleção e análise crítica e interpretação das evidências encontradas foram realizadas. Um total de 3543 artigos foram inicialmente identificados, dos quais 3513 foram removidos (por duplicação) e 30 foram excluídos (por título); portanto, foram selecionados 16. Como resultado, destaca-se o cuidado de enfermagem antes, durante e após a administração dos componentes sanguíneos, relacionado ao receptor, qualidade do produto, materiais, prevenção e avaliação e intervenção oportuna em caso de reações adversas. Conclui-se que a assistência de enfermagem estabelecida é semelhante entre os diferentes documentos, sendo essa revisão integrativa considerada um guia ótimo para que os profissionais apliquem as diferentes atividades descritas para melhorar a qualidade do procedimento de transfusão sanguínea nas instituições de saúde.

Accurate costs of blood transfusion: a microcosting of administering blood products in the United Kingdom National Health Service.

BACKGROUND: In an environment of limited health care resources, it is crucial for health care systems which provide blood transfusion to have accurate and comprehensive information on the costs of transfusion, incorporating not only the costs of blood products, but also their administration. Unfortunately, in many countries accurate costs for administering blood are not available. Our study aimed to generate comprehensive estimates of the costs of administering transfusions for the UK National Health Service. STUDY DESIGN AND METHODS: A detailed microcosting study was used to cost two key inputs into transfusion: transfusion laboratory and nursing inputs. For each input, data collection forms were developed to capture staff time, equipment, and consumables associated with each step in the transfusion process. Costing results were combined with costs of blood product wastage to calculate the cost per unit transfused, separately for different blood products. Data were collected in 2014/15 British pounds and converted to US dollars. RESULTS: A total of 438 data collection forms were completed by 74 staff. The cost of administering blood was $71 (£49) per unit for red blood cells, $84 (£58) for platelets, $55 (£38) for fresh-frozen plasma, and $72 (£49) for cryoprecipitate. CONCLUSIONS: Blood administration costs add substantially to the costs of the blood products themselves. These are frequently incurred costs; applying estimates to the blood components supplied to UK hospitals in 2015, the annual cost of blood administration, excluding blood products, exceeds $175 (£120) million. These results provide more accurate estimates of the total costs of transfusion than those previously available.

Plasma Transfusions Prior to Central Line Placement in People with Abnormal Coagulation.

Editor's note: This is a summary of a nursing care-related systematic review from the Cochrane Library. For more information, see http://nursingcare.cochrane.org.

Implementation of nurse authorisation of blood components.

A collaborative project between the Better Blood Transfusion teams in the Scottish National Blood Transfusion Service (SNBTS) and NHS Blood and Transplant (NHSBT) explored the feasibility of nurses prescribing blood components, and clarified that blood components are not considered medicinal products, so the term prescription does not apply. No legal barriers to trained, competent nurses and midwives undertaking this role were identified and nurse authorisation of blood components was seen as having the potential to improve patients' experiences. A number of NHS Scotland boards showed interest in implementing this but there are challenges to ensuring that a robust governance structure is in place to support role development . Progress has been made with support from the Scottish Government Health Department and using a governance framework that was developed to support nurses who wish to undertake this role.

Optimal use of fresh frozen plasma.

Fresh frozen plasma contains a number of therapeutically useful substances, most notably coagulation factors. As with any transfusion, there are risks associated with plasma transfusion. Ironically, the risk of viral transmission (human immunodeficiency virus or hepatitis), although widely publicized, is extremely small. On the other hand, less well-known, noninfectious complications are common. Indeed, these noninfectious complications are the most significant cause of morbidity and mortality following transfusion. Although certain patients undeniably benefit from plasma transfusion, the benefit for many patients is less clear. This review will discuss indications for plasma transfusion, the associated risks, and special considerations for plasma administration.

Infusion of hematopoietic stem cells: types, characteristics, adverse and transfusion reactions and the implications for nursing.

Hematopoietic stem cell infusion is an important procedure in Hematopoietic Stem Cell Transplantation (HSCT). This study identifies transfusion and other adverse reactions that can occur during infusion and the nursing care related to the procedure. This epidemiologic study used transplantations performed between 2006 and 2008. A total of 166 transplantations were performed: 114 were autologous, 47 allogeneic and five haploidentical. Three transfusion reactions and 96 adverse reactions were observed. Adverse reactions were related to the presence of cryoprotectant, though the infusion rate and quantity of infused cryoprotectant were not related to the occurrence of reactions. The products were fresh and infused within the recommended time when transfusion reactions occurred. In regard to cell source, lower engraftment time was found in peripheral blood. Nursing documentation is relevant for patients' safety as well to planning an infusion in order to minimize the occurrence of reactions.

Infusion of Hematopoietic Stem Cells: Types, Characteristics, Adverse and Transfusion Reactions and the Implications for Nursing / Infusão de células-tronco hematopoéticas: tipos, características, reações adversas e transfusionais e implicações para a enfermagem / Infusión de células madre hematopoyéticas: tipos, características, reacciones adversas y de transfusión y sus implicaciones para la enfermería

Hematopoietic stem cell infusion is an important procedure in Hematopoietic Stem Cell Transplantation (HSCT). This study identifies transfusion and other adverse reactions that can occur during infusion and the nursing care related to the procedure. This epidemiologic study used transplantations performed between 2006 and 2008. A total of 166 transplantations were performed: 114 were autologous, 47 allogeneic and five haploidentical. Three transfusion reactions and 96 adverse reactions were observed. Adverse reactions were related to the presence of cryoprotectant, though the infusion rate and quantity of infused cryoprotectant were not related to the occurrence of reactions. The products were fresh and infused within the recommended time when transfusion reactions occurred. In regard to cell source, lower engraftment time was found in peripheral blood. Nursing documentation is relevant for patients' safety as well to planning an infusion in order to minimize the occurrence of reactions.

A infusão de células-tronco hematopoéticas é importante procedimento no transplante de células-tronco hematopoéticas. Este estudo se propôs a identificar as reações adversas e transfusionais que podem ocorrer durante a infusão e os cuidados de enfermagem inerentes ao procedimento. Trata-se de estudo epidemiológico em transplantes, ocorridos entre os anos 2006 e 2008. Ocorreram 166 transplantes, sendo 114 autólogos, 47 alogênicos e 5 haploidênticos. Observaram-se três reações transfusionais e 96 reações adversas. As reações adversas estão ligadas à presença do crioprotetor. No entanto, velocidade de infusão e quantidade do crioprotetor infundido não tiveram relação com a ocorrência das reações. Nas reações transfusionais, os produtos eram frescos e infundidos na velocidade preconizada. Quanto às fontes de células, houve menor tempo de enxertia no sangue periférico. A documentação de enfermagem é relevante tanto para a segurança do paciente como para o planejamento da infusão, a fim de minimizar a ocorrência das reações.

La infusión de las células madre hematopoyéticas es un importante procedimiento en el trasplante de células madre hematopoyéticas. Este estudio se propuso identificar las reacciones adversas y de transfusión que pueden ocurrir durante la infusión y los cuidados de enfermería inherentes al procedimiento. Se trata de un estudio epidemiológico en trasplantes ocurridos en los años de 2006 a 2008. En ese período ocurrieron 166 trasplantes, siendo 114 autólogos, 47 alogénicos y 5 haploidénticos. Se observaron tres reacciones de transfusión y 96 reacciones adversas. Las reacciones adversas están ligadas a presencia del crioprotector. Sin embargo, la velocidad de infusión y la cantidad del crioprotector infundido, no tuvieron relación con la ocurrencia de las reacciones. En las reacciones de transfusión, los productos eran frescos e infundidos con la velocidad preconizada. En cuanto a las fuentes de células, hubo menor tiempo de injerto en la sangre periférica. La documentación de enfermería es relevante tanto para la seguridad del paciente como para la planificación de la infusión, a fin de minimizar la ocurrencia de las reacciones.

Toward reducing perioperative transfusions.

Even though the supply of blood products has never been safer, disease transmission remains the chief patient concern about transfusions. The primary concerns for anesthetists center on risks associated with blood transfusions, such as transfusion-related acute lung injury, anaphylactic transfusion reaction, clerical errors resulting in ABO incompatibility, and blood products contaminated with infectious organisms. These concerns, combined with patients' religious tenets and other factors, have contributed to renewed efforts to minimize blood transfusion without negative patient consequences. Achieving this goal requires a concerted effort by surgeons, perioperative nurses, and anesthesia providers.

A computer-assisted transfusion management system and changed transfusion practices contribute to appropriate management of blood components.

BACKGROUND: ABO-incompatible blood transfusions attributable to inadequate identification (ID) of the patient or the blood unit are among the most serious of transfusion hazards. It has been unclear whether a computer-assisted transfusion management system connected to a bar code ID system could contribute to the appropriate management of blood components, as well as to the prevention of mistransfusions. STUDY DESIGN AND METHODS: A transfusion management system has been developed that links the hospital information system, a bar code patient-blood unit ID system, and an automated device for pretransfusion testing. The guidelines for issuing blood components from the transfusion service were also changed. The appropriateness of blood management was evaluated by monitoring the time to initiate transfusion after issuing a blood unit from the transfusion service (time after issuing [TAI]) and by calculating the number of units issued and subsequently returned, as well as the rate of date-expired red cell (RBC) components. RESULTS: From July 2002 to December 2006, a total of 49,974 blood components were transfused without a single mistransfusion. The monitoring of TAI and the notice to use the issued blood immediately had the effect of shortening TAI in the inpatient ward. The number of issued and subsequently returned RBC components, as well as the rate of date-expired RBC components, decreased significantly after the introduction of the system. CONCLUSION: A computer-assisted transfusion management system and changing transfusion practices appear useful in preventing mistransfusions and in contributing to the appropriate management of blood components.

Exploring the assessors' and nurses' experience of formal assessment of clinical competency in the administration of blood components.

Blood transfusion, clinical competency, assessment, evaluation The change in nurse education from apprenticeship training to the higher education setting, has raised concerns about the lack of practical skills newly qualified nurses have on registration. Every practitioner must be able to administer blood components safely however, the Serious Hazards of Transfusion (SHOT) scheme have consistently demonstrated that 'wrong blood' incidents are the major cause of morbidity and mortality related to transfusion in the United Kingdom. As a result the SHOT working group have recommended that all practitioners should have their clinical competency formally assessed. This paper describes the development and evaluation of a tool for assessing clinical competency for staff involved in transfusing blood. The evaluation used a triangulated approach of phenomenology and survey. The tool was piloted in two different clinical settings by four registered nurses who each assessed two nurses. Individual semi-structured interviews were conducted to collate the nurses' and the assessors' experience of the process. The study participants were of the opinion that assessing clinical competency using a criterion-referenced tool gave practitioners the opportunity to relate theory to practice, promote best practice and encourage adherence to hospital transfusion policies. Formal assessment of clinical competency is therefore, a vehicle that could be used to promote safe transfusion practice, ensuring the safety of patients is paramount.

When your patient is from the obstetric department: postpartum hemorrhage and massive transfusion.

When caring for patients receiving massive transfusion, the nurse will be required to perform ongoing assessments and apply critical thinking to provide optimum care and avoid further complications. The perianesthesia nurse must be aware of the hemodynamic and coagulation changes of pregnancy when caring for an obstetric patient in the PACU to optimize patient outcomes. Understanding the causes of obstetric hemorrhage, which may result in the need for massive transfusion, will enable the nurse to anticipate and prevent potentially deadly complications.

Thromboelastography: a means to transfusion reduction.

Consider using thromboelastography to improve care outcomes for cardiac surgery patients.

Contamination control in nursing with filtration: part 2: emerging rationale for bedside (final) filtration of prestorage leukocyte-reduced blood products.

The first part of this 2-part series focused on the manufacture of filters and the application of filtration technology to intravenous fluids and point-of-care hospital water. This second part describes an apparent emerging potential for final filtration defined as bedside filtration of blood and component blood products leukocyte-reduced at the blood center prior to storage. Final filtration serves to further reduce the leukocyte burden in a previously leukocyte-reduced blood product. Another target for final filtration includes putative soluble mediators of morbidity.Selected patients may be at greater risk for alloimmunization and refractory to the benefits afforded by transfusion of blood leukocyte reduced to the current established standards. Multiparous patients who subsequently find themselves in need of a transplanted organ are alloimmunized by exposure to fetal proteins and may be further alloimmunized by transfusion. Such effects can put them at risk for increased latency for donor organ availability and organ rejection. Kidney transplant patients find themselves the recipients of transfused blood products particularly during end-stage renal disease and recent data suggest such patients are not benefited by the levels of leukoreduction prescribed by current standards and may need more dramatic leukocyte removal. The process of blood production is described and affords a greater appreciation for the levels of white cells found in component blood products. The development of alloimmunization is reviewed and fosters greater appreciation for a discussion of the potential for therapeutic value of more dramatic leukocyte reduction and blood conditioning accomplished through the removal of soluble mediators of morbidity.

Current and future trends in transfusion therapy.

The increase in intensive treatment for cancer has impacted blood product transfusion practices. Transfusion guidelines are primarily institution specific, but the general concepts and theories are universal. Blood product screening has decreased the risk of transfusion-acquired infections; however, the risk is not obsolete. This article reviews current approaches to platelet, white blood cell, and red blood cell transfusions, as well as risks associated with these therapies (e.g., infection and transfusion-associated graft-versus-host disease). Pertinent laboratory studies, patient assessment, blood product administration, and patient education is discussed. The current approaches to platelet, white blood cell, and red blood cell transfusions are constantly changed and evaluated. Pediatric oncology nurses must stay up to date with these changes to provide optimal patient care.

Efectos adversos inmunológicos de la terapia transfusional / Immunological adverse reactions to transfusion therapy

En este artículo se explican diversos cuadros clínicos que se observan al desencadenarse reacciones adversas a la terapia transfusional en pacientes que reciben transfusiones de sangre o hemoderivados, y se detallan las formas de tratarlas y prevenirlas (AU)

Efectos adversos inmunológicos de la terapia transfusional / Immunological adverse reactions to transfusion therapy

En este artículo se explican diversos cuadros clínicos que se observan al desencadenarse reacciones adversas a la terapia transfusional en pacientes que reciben transfusiones de sangre o hemoderivados, y se detallan las formas de tratarlas y prevenirlas