Talking someone through a blood transfusion

More specifically, telling someone how to give themselves a blood transfusion. Why they have to isn't really important, the fact is that person is in a situation where they have access to all the proper medical supplies but no qualified personnel (or anybody for that matter) can reach them in time.

So imagine this situation: A civilian woman was separated in a convoy delivering her and a bunch of others to safety. While making a heroic mad dash for an abandoned hospital (racking up an impressive kill count along the way) she is seriously injured from an enemy mine. She makes it safely inside but has suffered from some nasty shrapnel wounds and has lost a lot of blood. Using her cellphone, she gets in contact with her husband, who is an army medic. A rescue team can get to her in a few days but she needs the transfusion NOW. What steps would he have to take to walk her through the process?

Ok first a few considerations:

> Could it be 2 stranded civilians? Because a) it is a bad idea to leave someone alone during a transfusion and b) "needs a transfusion NOW" and "is alert, clear headed, and physically strong enough set up a transfusion" don't normally go together.

> Is this the past, present, or future? The procedure for transfusing whole blood in a glass bottle in the 1950's would be different then transfusing packed red cells in a modern hospital.

> Does the hospital have power? Blood that has been sitting @ room temp for more than a few hours may do much more harm than good.

>Does it have to be blood? A plasma transfusion or even a regular IV carry some of the benefits, with fewer risks.

edited 29th Jan '14 4:01:29 PM by HistoryMaker

The circumstances set up by the story means she's alone by herself and bringing in a second character just to oversee her seems like something of a waste. Though I guess there could be some sort of remotely controlled robot that could be around to help assist when things got a little too hairy.

This is set 20 Minutes into the Future so familiar tools and procedures can be used.

I like to think the hospital is running on some emergency power generator.

I did not even consider those. What sort of benefits would those give if a person had to use one on themselves?

edited 29th Jan '14 9:36:00 PM by SandJosieph

The benefit of using a regular IV (containing isotonic saline, albumin, or some kind of electrolyte blend) is that it is simpler and restores blood volume with none of the risks asociated with transfusing actual blood. Basically you'd be diluting the patients renaming blood so that the heart has something to pump and they don't go into shock. You can live for a while with pretty diluted blood if you don't exert yourself too much (better if you can get an oxygen tank) and your body will work towards restoring your hemoglobin.

A plasma transfusion is similar to above except it has slightly higher risks (she could have an allergic reaction or -very rarely - an acute lung injury), but the added benefit would be that plasma contains clotting factors which help stop the bleeding.

When people think about the risks of blood transfusions they usually worry about catching something, but blood is tested so that's not a big concern. What could kill you are transfusion reactions. These can range from allergic to hemolytic. A hemolytic reaction is when your immune system destroys the foreign blood cells causing very bad things including death. Using incompatible blood, especially the wrong blood type, is the best way to cause a hemolytic reaction.

I wouldn't trust a lay person to type there own blood or to know there blood type with absolute certainty, therefor if she must have blood I'd use type O negative packed red cells. It would be safer if she could do a cross-match, but this would entail drawing a sample of her own blood spinning it down in a centrifuge pipetting the plasma from her blood into another tube and mixing it with a drop of blood from the bag spinning that down and gently shaking it to see if it clumps (clumps are bad). This is probably too much work/time considering her condition. So she'd probably just risk it withought a crossmatch. The chance of a reaction is still low if she's using O- and has never had a transfusion or a pregnancy.

>Ok first deside what you're transfusing and locate it. Saline would be on the shelf. Plasma is keept frozen and must be thawed in either a water bath or microwave. Red cells would be in the fridge.

> Gather all supplies you will need at minimum : whatever you are transfusing, a cannula, IV tubing, alcohol swabs, and a tourniquet. If you are using red cells you will also need a Y connector set and a bag of isotonic saline.

> Atach the tubing to the bag by removing the cap from the spike end and stabbing it into the port on the bottom of the bag. Hang up the bag, let some fluid flow into the chamber then clamp it shut. If you are using red cells Always attach the bag of saline to one side of the Y connector first, make sure the filter is fully covered in saline then attach the blood to the other side. (Packed red cells must be mixed with saline and filtered before entering the body)

> Start the IV : You will need to place the tourniquet a few inches above the vein you want to use (not too tight). Squeeze and unsqueez your hand a few times. Find the vein with your fingers then sterilize the area with alcohol swabs. Insert the cannula gently into the vein wait to see a little blood then push it in about a centimeter more. Then advance the catheter part of the cannula all the way in and remove the needle. Remove the Tourniquet and tape the catheter in place. Now that I think about it all of this sounds super hard to do to yourself. It would really help if she had an assistant.

> Lock the tubing from the IV bag into the catheter and remove the clamp.

edited 30th Jan '14 1:22:56 AM by HistoryMaker