Page 290 - Critical Care Nursing Demystified

Chapter 6 CARE OF THE TRAUMATIZED PATIENT 275

Pulling of fluid into the intravascular space is known as an osmotic gradient or
colloidal osmotic pressure. The benefit of colloid therapy is that it is longer act-
ing, requires less volume to administer, and therefore is quicker.
Problems with colloids are similar to those of FVR with crystalloids. Use of colloids
in burns can be controversial, as some believe that until the acute phase is over and
capillary membranes are reestablished, vessels are permeable to colloids, therefore
crystalloids should be used. Colloids are also more expensive and some are developed
from blood products, which can cause an ethical dilemma in some instances. Com-
mon colloids that may be used include albumen, dextran, and hetastarch.

Blood Replacement Therapy
In addition to crystalloid and colloid therapy, blood can be administered to help
improve fluid volume deficits especially from frank hemorrhage. Crystalloid

H ? How to Do It—Administering a

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Blood Transfusion
Blood Transfusion Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
1. Check that a consent form has been obtained from a physician whenever pos-
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1
onsent
.
orm has been obt

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Check that a c
sible and the patient has been typed and crossed for blood.
sible and the patient has been typed and
2. Place a large-bore IV (16–18 gauge is pre
2. Place a large-bore IV (16–18 gauge is preferred) with an NSS solution Y tubing
and filter
and filter.
3. Perform baseline vital signs.
4. Obtain blood from the blood bank.
5. Two nurses need to check and sign that the type, screen, and patient ID are
confirmed. Type O blood can be used if the patient needs packed red blood
cells and time is of the essence.
6. Administer the blood slowly during the first 15 to 30 minutes, checking VS after
the first 15 minutes and then every hour.
7. Observe for transfusion reactions, which can include acute hemolytic, febrile,
and allergic reactions and circulatory overload.
8. If a transfusion reaction is suspected, stop the blood immediately. Preserve the
IV line by infusing a bag of NSS. Call the laboratory and the ordering health care
prescriber immediately. Anticipate the administration of fluids and corticoster-
oids, pressors if the BP drops to shocklike levels.