Indications for transfusion

Assessment of the patient's status provides the clue for the indications for transfusing circulatory solutions and rheopolyglucan, which, apart from its antishock properties, improves defective microcirculation resulting from thrombophlebitis, thromboembolism, and vascular surgery.

Products with detoxicating properties are administered for sepsis and intoxication associated with trauma. Parenteral nutrition is used when enteral nutrition is a challenge or in hypoproteinaemia (e.g. purulent infections, burns).

During anaesthesia, electrolyte and acid-base imbalances, transfusion of electrolytes (e.g. sodium bicarbonate) and trisamine is indicated.

Contraindications for transfusion

Prior to transfusion, acute liver disease, cardiac failure, thrombosis and embolism have to be ruled out. The transfusion and allergic histories, i.e. data on previous transfusions and their outcome, and on the presence of any allergy, are of vital importance. Protein products are contraindicated in cases with liver failure, acute nephritis, allergies, or active tuberculosis.

Methods of nutritional support

Parenteral feeding mainly calls for intravenous route of administration of nutritional solutions, while in exceptional cases these can be given subcutaneously. Protein hydrolysates can also be given through tubes that are passed intranasally into the intestines following oesophageal or gastric surgeries. The following equipment is necessary for parenteral nutrition:

1) infusion set with a dropper;

2) needle for venipuncture;

3) sterile tray;

4) rubber tourniquet;

5) alcohol for cleansing the injection site as well as the cork of the bottle;

6) sterile gauze swabs;

7) drip stand and ampoules;

8) clamp for regulating the rate of infusion;

9) bilroth's forceps;

10) plaster.

The system for transfusing nutritional solutions should be mounted the same way as the one for blood transfusions or a disposable system can be used. The system is filled with the solution in such a way that all air bubbles are evacuated and the drops can be counted. The infusion technique is similar to that of blood transfusion.

Combination of blood products

This depends on the indications for transfusion therapy such as traumatic shock; sepsis; thermal shock; acute haemorrhage; prolonged starvation in postoperative patients; hypoproteinaemia; fluid, electrolyte, and acid-base disorders; preoperative workup of malnourished patients.

Viability of products

The shelf-life of the product, inappropriate storage (overheating or freezing) and intactness of the bottle all have to be considered. Any change in transparency of the product, turbid appearance and the presence of flakes or sediments all preclude its use for transfusion. Only the presence of small particles in amino-peptides or casein hydrolysates can be neglected.

Technique of transfusion

The system for transfusing nutritional solutions should be mounted the same way as the one for blood transfusions. After cleansing the injection site and venipuncture inject 20-25 ml of 0, 5% Novocain using a syringe, then connect the infusion set to the needle and start transfusion in drops. The stat dose for subcutaneous infusions should not exceed 500 ml. The subcutaneous infusion is used very rarely, since it is hardly ever efficacious: the absorption of protein is very low, and in shock it fails to duly replete the circulating blood volume.

The biologic testing

This is a prerequisite when using protein hydrolysates, fatty emulsions and Polyglucin. Biological testing involves infusion of 5, 10, 15 ml of the product at 3 minute intervals and if no reactions (e.g. agitation, tachycardia, difficulty in breathing, skin itching, facial hyperaemia, skin rash, hypotension) are visible, the transfusion can then be continued.

When transfusing fat emulsions a prolonged biological test is done: the product is given at the rate of 10-20 drops/minute in the first 10 minute, in the absence of reactions the transfusion is continued at a rate of 20-30 drops/minute.

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