Question

1- Describe the differences between an Ileostomy and a colostomy.

2- For which conditions do we use these procedures?

3- What IV size and type of fluid do we use for blood transfusions ?

4- What is considered a hemolytic reaction?

5- How is the fluid overload treated after a blood transfusion?

Answer 1

1. Differences between an Ileostomy and a colostomy.

Ileostomy: Ileostomy is a stoma constructed by bringing the end or loop of small intestine out onto the surface of the skin, or the surgical procedure which creates this opening. Intestinal waste passes out of the ileostomy and is collected in an external ostomy system which is placed next to the opening. An ileostomy is used to move waste out of the body. This surgery is done when the colon or rectum is not working properly. The word "ileostomy" comes from the words "ileum" and "stoma." Ileum is the lowest part of your small intestine

Colostomy: A colostomy is an opening in the large intestine, or the surgical procedure that creates one. The opening is formed by drawing the healthy end of the colon through an incision in the anterior abdominal wall and suturing it into place.This provides a new path for waste material and gas to leave the body. A colostomy can be permanent or temporary.

2. Conditions we use Ileostomy and a colostomy

Conditions we use Ileostomy: If you have a large intestine problem that can't be treated with medications, you might need an ileostomy. One of the most common reasons for an ileostomy is inflammatory bowel disease (IBD). The two types of inflammatory bowel disease are Crohn's disease and ulcerative colitis.

Conditions in which you may need a colostomy include: A blockage, an injury, Crohn's disease, which is an autoimmune form of inflammatory bowel disease, colorectal cancer,colonic polyps, which is extra tissue growing inside the colon that may be cancer or may turn into cancer.

3. IV size and type of fluid we use for blood transfusions

IV size: An 18-gauge needle is standard, but a needle or catheter as small as 23-gauge can be used for transfusion if necessary. The smaller the gauge, the slower is the flow rate and the higher is the risk of clotting. Care must be taken to avoid excessive pressure and resulting hemolysis when very narrow devices are used.

Type of fluid use for blood transfusions: Normal saline is the only compatible solution to use with the blood or blood component. This serves the dual purpose of administering to the patient any residual blood left in the administration set (up to 40 mL), and it flushes the line for later use. Crystalloid solutions and medications may cause agglutination and/or hemolysis of the blood or blood components.

4. Hemolytic reaction

A hemolytic transfusion reaction is a serious complication that can occur after a blood transfusion. The reaction occurs when the red blood cells that were given during the transfusion are destroyed by the person's immune system. When red blood cells are destroyed, the process is called hemolysis.

The most common cause of acute hemolytic transfusion reaction is ABO incompatibility, which is typically due to human error that results in a recipient receiving the incorrect blood product.

Symptoms are back pain, bloody urine, chills, fainting, fever, flank pain, flushing of the skin.

Hemolytic transfusion reactions are treated as follows:

· Stop transfusion as soon as a reaction is suspected.

· Replace the donor blood with normal saline.

· Examine the blood to determine if the patient was the intended recipient and then send the unit back to the blood bank.

5. Treated of fluid overload after a blood transfusion

Transfusion associated circulatory overload (TACO) is a transfusion reaction (an adverse effect of blood transfusion) that can occur due to a rapid transfusion of a large volume of blood, but can also occur during a single red cell transfusion.

Transfusion associated circulatory overload can be prevented by avoiding unnecessary transfusions, closely monitoring patients receiving transfusions, transfusing smaller volumes of blood at a slower rate, and considering the use of diuretics. A pre-transfusion TACO checklist can be used to assess patients' risk of developing TACO.

Treatment:

i. Stop transfusion immediately.

ii. Check and monitor vital signs.

iii. Maintain intravenous (IV) access (Do not flush existing line and use a new IV line if required)

iv. Place the patient in an upright position and treat symptoms with oxygen, diuretics and other cardiac failure therapy.

v. Check the right pack has been given to the right patient

vi. Notify your Medical Officer and Transfusion Service Provider

vii. In serious cases mechanical ventilation and treatment in the intensive care unit (ICU) may be required.