The Royal Marsden Hospital Manual of Clinical Nursing Procedures - Lisa Dougherty [294]
Hyperkalaemia
Hyperkalaemia is a rare complication associated with trauma and the subsequent infusion of large quantities of blood. Potassium is known to leak out of red cells during storage, thereby increasing circulatory levels in recipients receiving blood products (Cook 1997b). The process is exacerbated if products are kept too long at room temperature or gamma irradiated (Davies and Williamson 1998). From starting the infusion to completion, the infusion should take a maximum of 4 hours (McClelland 2007). The patient may present with irritability, anxiety, abdominal cramps, diarrhoea and weakness in the extremities (Cook 1997b). The patient’s medical team should be contacted to assess the patient.
Iron overload
Patients who are dependent on frequent transfusion, such as those with thalassaemic, sickle cell and other transfusion-dependent disorders, can become overloaded with iron (McClelland 2007). A unit of red blood cells contains 250 mg iron, which the body is unable to excrete, and as a result patients receiving large volumes of blood are at risk of iron overload (Davies and Williamson 1998). This can result in poor growth, pigment changes, hepatic cirrhosis, hypoparathyroidism, diabetes, arrhythmia, cardiac failure and death. Chelation therapy through the use of desferrioxamine, which induces iron excretion, is used to minimize the accumulation of iron (BNF 2011).
Websites and useful addresses
www.bda.uk.com/resources/Delivering_Nutritional_Care_through_Food_Beverage_Services.pdf
www.bapen.org.uk/ofnsh/OrganizationOfNutritionalSupportWithinHospitals.pdf
www.npsa.nhs.uk/nrls/improvingpatientsafety/cleaning-and-nutrition/nutrition/good-nutritional-care-in-hospitals/nutrition-fact-sheets
www.npsa.nhs.uk/nrls/improvingpatientsafety/cleaning-and-nutrition/nutrition/good-nutritional-care-in-hospitals/nutrition-fact-sheets
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_079931
www.scie.org.uk/publications/guides/guide15/mealtimes
www.bapen.org.uk/pdfs/nsw/nsw07_report.pdf
www.bapen.org.uk/pdfs/nsw/nsw07_report.pdf
www.ageconcern.org.uk/AgeConcern/Hungry_to_be_Heard_August_2006.pdf
www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_079931
www.dh.gov.uk/en/SocialCare/Socialcarereform/Dignityincare/
www.dh.gov.uk/PolicyandGuidance/HealthandSocialCareTopics/SpecialisedServices
www.espen.org/espenguidelines.html
www.nice.org.uk/nicemedia/pdf/cg032fullguideline.pdf
www.bcshguidelines.com
www.hospital.blood.co.uk
www.mhra.gov.uk
www.shotuk.org
www.transfusionguidelines.org.uk
Age Concern
Telephone: 0800 00 99 66
Website: www.ageuk.org.uk
Patients on Intravenous and Nasogastric Nutrition Therapy (PINNT)
Telephone: 01202 481 625
Website: www.pinnt.com
PINNT is a support group for patients receiving parenteral or enteral nutrition therapy.
References
Adam, S.K. and Osborne, S. (2005) Critical Care Nursing: Science and Practice, 2nd edn. Oxford University Press, Oxford.
Age Concern (2006) Hungry to be Heard. Age Concern, London. www.ageconcern.org.uk/AgeConcern/Documents/Hungry_to_be_Heard_August_2006.pdf
Aguzzi, A. and Collinge, J. (1997) Post-exposure prophylaxis after accidental prion inoculation. Lancet, 350 (9090), 1519–1520.
Ainslie, P.N., Campbell, I.T., Frayn, K.N. et al. (2002) Energy balance, metabolism, hydration, and performance during strenuous hill walking: the effect of age. Journal of Applied Physiology, 93 (2), 714–723.
Alexander, M.F., Fawcett, J.N. and Runciman, P.J. (2000) Nursing Practice: Hospital and Home: the Adult, 2nd edn. Churchill Livingstone, Edinburgh.
BAPEN (1999) Current Perspectives on Enteral Nutrition in Adults. British Association for Parenteral and Enteral Nutrition, Maidenhead.