| Problem | Possible causes | Nursing interventions |
|---|
| Citrate toxicity (rare, unpredictable) | - Chelating effect on calcium of citrate in phosphate dextrose (CPD)
- Predisposing factors, including hyperkalemia, hypocalcemia, acidosis, hypothermia, myocardial dysfunction, and liver or kidney problems
| - Watch for hypotension, arrhythmias, and myocardial contractility.
- Prophylactic calcium chloride may be administered if more than 2,000 mL of CPD-anticoagulated blood is given over 20 minutes.
- Stop infusing CPD and correct acidosis. Measure arterial blood gas values and serum calcium levels frequently to assess for toxicity.
|
| Coagulation | - Not enough anticoagulant
- Blood not defibrinated in mediastinum
| - Add CPD or another regional anticoagulant at a ratio of 7 parts blood to 1 part anticoagulant. Keep blood and CPD mixed by shaking the collection bottle regularly.
- Check for anticoagulant reversal. Strip chest tubes as needed.
|
| Coagulopathies | - Reduced platelet and fibrinogen levels
- Platelets caught in filters
- Enhanced levels of fibrin split products
| - Patients receiving autologous transfusions of more than 4,000 mL of blood may also need transfusion of fresh frozen plasma or platelet concentrate.
|
| Emboli | | - Don’t use equipment with roller pumps or pressure infusion systems.
- Before transfusion, remove air from blood bags.1
- Transfuse with a microaggregate filter.
|
| Hemolysis | - Trauma to blood caused by turbulence or roller pumps
| - Don’t skim the operative field and don’t use equipment with roller pumps.
- When collecting blood from chest tubes, keep the vacuum below 30 mm Hg; when aspirating from a surgical site, keep the vacuum below 60 mm Hg.
|
| Sepsis | - Lack of sterile technique
- Contaminated blood
| - Give broad-spectrum antibiotics, as prescribed.1
- Use strict sterile technique.
- Transfuse within 4 hours.
- Don’t infuse blood from infected areas or blood that contains feces, urine, or other contaminants.
|