(1) Normal human serum albumin. Normal serum albumin is a part of whole
blood. It is clear, moderately viscous, brownish fluid contains 25 grams of serum
albumin in 100 milliliters of product. Because each gram of albumin holds
approximately 18 milliliters of water, it is used as a blood volume expander in the
treatment of hemorrhage or shock. In this use, the albumin draws fluid into the
circulatory system from the surrounding tissues. This product has also been used as a
protein replacement in cases where the level of protein in the serum is very low (for
example, in nephrosis). Normal human serum albumin should not be given to
dehydrated patients since it draws fluid from the body tissues. If nine-tenths percent,
the product may be administered to dehydrated patients if it is necessary. Sodium
chloride solution or five percent dextrose solution is administered at the same time.
Fortunately, this product is very stable. Therefore, it is not necessary to keep it
refrigerated in its liquid state.
(2) Plasma protein fraction (plasmanate). Plasma protein fraction is a sterile
solution of stabilized human plasma proteins in nine tenths. Sodium chloride solution.
Each 100 milliliters of this product contains approximately five grams of protein. This
product is nearly colorless (slightly brown). Plasma protein fraction is used in the
treatment of nonhemorrhagic shock (that is, shock not associated with loss of whole
blood). Side effects associated with this product are uncommon, but they include
increased salivation, nausea, and vomiting.
(3) Hetastarch. Balanced electrolyte solution that resembles the composition
of the principal ionic constituents of normal plasma. Total dosage and rate of infusion
depend on the amount of blood or plasma lost and the resultant hemoconcentration as
well as age, weight, and clinical condition of the patient. Generally no more than 1L of
Hextend (hetastarch in lactated Ringer's solution) should be given. Side effects include
systemic overload, and it can inhibit the clotting processes.
3-17. SITE FOR VENIPUNCTURE WHEN A BLOOD PRODUCT IS USED
Blood products should be administered intravenously although other routes
(intraperitoneal, intra-arterial, intraosteous are possible. A vein should be selected
which will be large enough to accommodate the infusion needle but is comfortable for
the patient. Veins in the antecubital fossa are probably more accessible and most
widely used; however, infusion in these veins limits the patient's ability to flex the elbow
during transfusion. Veins in the forearm and hand are equally suitable for infusion,
although venipuncture in these areas is often more painful to the patient.
3-18. RATE OF TRANSFUSION
a. The rate of transfusion of blood products depends upon the clinical condition
of the patient and the product being transfused. In most administration sets, 15 drops
equal one milliliter.