ISSN:1079-0713    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Blood conservation has evolved into an important issue in hospital-based medicine. Increased awareness of and worry about transfusion-associated diseases have prompted a focus on this important area. New technologies, including continuous intraarterial monitoring devices, microchemical technologies, new drug development (recombinant human erythnopaietin and aprotinin) and intraoperative salvage techniques have made the concept of clinically important blood conservation possible. In this article, the authors review clinically important areas regarding blood conservation, which are subsequently detailed in this issue of AACN Clinical Issues. Emphasis is placed on the need for blood conservation in acute and critical care practice and the technologies available to achieve this goal.

ISSN:1079-0713    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Normovolemic anemia is commonly found in acute and critically III adults. Compensatory physiologic effects of anemia ere governed by the extent and rate of development of the anemia as well as by chronic or acute diseases that limit physiologic reserves. Increased metabolic demands that frequency accompany critical illness confound how patients will tolerate anemia. Clinicians should be aware of the physiologic responses to anemia, to monitor for intolerance and prevent negative outcomes. In this article, the author reviews specific physiologic responses occurring in adults with normovolemic anemia and describes appropriate clinical monitoring parameters

ISSN:1079-0713    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The appropriate use of blood transfusions remains variable among helth-care institutions and patient populations. Transfusion practices are discussed in this article in relation to medical practice guidelines and utilization review. Specific transfusion practices in the settings of intensive care, orthopedic surgery, and open heart surgery are reviewed. A new, promising approach to improving transfusion outcomes is the use of transfusion algorithms. Transfusion algorithms may prove especially useful if they incorporate point-of-care testing that is both physiologic and patient-specific for transfusion decisions. Transfusion algorithms are discussed and data presented for cardiac surgical adults

ISSN:1079-0713    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Preoperative autologous blood donation (PABD) is the donation of the patient's own blood before surgery for use in planned surgical procedures. Appropriate patients for this form of blood conservation are those having elective surgery for which blood is usually transfused, whose hemoglobin is no less than 11 g/dL, and who display no signs or symptoms of bacteremia. Patients should begin donation 4–6 weeks before surgery, donate every 3–7 days, take oral iron, and donate the last unit more than 72 hours before surgery. Vesovagal reactions occur in 2–5% of donors. In this article, the authors review indications and associated risks of PABD. Also discussed are segregated processing, testing, disposition of unused units, platelet-rich plasma, recombinant erythropoietin, indications for autologous versus allogeneic transfusion, and cost-effectiveness of preoperative autologous blood donation. Nurses play important roles in PABD. Provision of information to patients regarding when, where, and how autologous donations are made along with prevention of errors in blood availability and transfusion are discussed. Nursing and blood bank staff members must establish regular communication to ensure the provision of a quality PABD program.

ISSN:1079-0713    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Blood conservation in infants and children has benefits even beyond those seen with the adult populations. For instance, acquired blood borne diseases such as cytomegalovirus not only cause illness but also can have deleterious effects on the growth and development of infants and children. Decreasing blood transfusions is especially important in preventing sensitization over a lifetime, which may require further transfusion and even organ transplantation. A less striking benefit, but one equally as significant, is decreasing the occurrence of graft-versus-host disease when blood conservation negates the need for multiple transfusions. The limitation of alternative transfusion practices in children and infants increases the benefits of blood conservation. Autologous blood donation may be an alternative to allogeneic transfusion in older children, but is not possible with neonates who may be born anemic and who experience a normal physiologic anemia during the first 2 months of life. Critical care nurses are instrumental in helping blood salvaging techniques, including correct collection techniques, noninvasive monitoring, evaluation of diagnostic sample needs, and administration of erythrocyte-stimulating factors.

ISSN:1079-0713    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Surgical patients present unique opportunities for reducing allogeneic transfusions via perioperative blood salvage. Intraoperative cell saver techniques enable the collection of autologous blood from the surgical field and cardiopulmonary bypass circuit for return to the patient. Washing and hemoconcentration creates a product with an average hematocrit of 50% that carries normal erythrocyte survival, with minimal coagulation factors or platelets. Postoperative autotransfusion of shed blood from chest tubes or surgical drains enables additional blood conservation, reducing allogeneic transfusions by as much as 50%. Both intermittent and continuous autotransfusion systems using available that require minimal setup and maintenance at the bedside. The hematocrit of shed blood is 20–25%, with depletion of clotting factors and platelet function. Potential advantages of perioperative blood salvage include the ready availability of large volumes, of patient-compatible blood, with optimal oxygen-carrying capacity, that is virtually free from the risk of viral contamination. Specific indications, contamination. Specific indications, contraindications, and techniques for the salvage and administration of these vital products are presented.

ISSN:1079-0713    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Rapid analysis of selected laboratory tests is essential in the management of critically ill patients.These tests facilitate accurate diagnosis of clinical problems and the initiation and evaluation of appropriate therapeutic interventions. Instruments are new available to perform analysis at a site near the patient, or “point-of-care” testing. These instruments incorporate electrochemical and optical sensors capable of providing information on multiple analytes from a small sample of whole blood. In this article, the author explores the technologies behind point-of-care testing, as well as the advantages and disadvantages of in vitro, in vivo, and ex vivo modalities

ISSN:1079-0713    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Pharmacologic agents are welcome therapeutic weapons in the fight to conserve blood.The goats of drug therapy cross a broad spectrum of potential areas. Blood-conserving pharmacologic agents are aimed at 1) increasing blood production, 2) decreasing blood loss during active bleeding, and 3) preventing the breakdown of the formed fibrin clots. In this article, the author reviews the mechanisms of action, dosing, and adverse affects of these agents. The role of phramacologic agents in blood conservation is significant because these agents have been shown to decrease transfusion requirements and provide significant cost savings

ISSN:1079-0713    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Blood loss associated with phlebotomy is significant in critically ill adults. Iatrogenic aneima may result and impose unnecessary stress on the cardiovascular and respiratory systems and may require allogeneic blood transfusions. Many strategies exist under nursing's direct control to decrease blood loss associated with phlebotomy. In the past, nursing effectively implemented many of these strategies in patients at high risk of anemia, such as pediatric, neonatal, transplant, or chronic renal failure patients, as well as patients who are Jehovah's Witnesses. Implementation of these strategies are needed for all critically ill patients because allogeneic blood transfusions carry infectious risk and becuase complications and chronic critical illness cannot be predicted reliably. Incorporation of these strategies into daily practice as well as the development of blood conservation programs represent imminent challenges for nursing

ISSN:1079-0713    

出版商:OVID    

年代:1996

数据来源: OVID