ADULT MASSIVE BLOOD TRANSFUSION PROTOCOL

Transcription

1 Manual: Administrative Policies and Procedures Manual Policy Number: Pages: 1 of 5 Initial Date: 8/15 Review Dates: Revised Dates: Purpose: ADULT MASSIVE BLOOD TRANSFUSION PROTOCOL To provide information regarding massive transfusion and to facilitate the ordering and release of blood and/or blood products in the most timely and efficient manner along with the timely results of coagulation and other hematological tests. Policy: I. Definition/s A. Massive transfusion is defined as replacement approximating or exceeding the patient s blood volume (10-12 units) within a 24 hour period. II. General A. Massive transfusion protocol is indicated for a critically ill patient presumed to require the rapid transfusion of greater than 10 units of blood and blood products within 24 hours OR 4 units of PRBCs transfused in less than 4 hours with uncontrolled bleeding, and has the potential to progress to consumptive coagulopathy and uncontrolled hemorrhage. B. Due to the high acuity, MTP may only be initiated on patients in the following locations: 1. ED 2. ICU 3. OR 4. OB III. MTP Blood Component Goals A. PRBCs: HCT > 25% B. FFP: INR less than or equal to 1.5 or PTT less than or equal to 45 sec C. Platelets: > 50,000/mL D. Cryoprecipitate: Fibrinogen >100mg/dL (Cryoprecipitate requires separate physician order)

2 IV. MTP Procedure A. Laboratory B. Nursing 1. Call for additional lab staff assistance 2. Order MTP profile STAT a. PT/INR b. PTT c. BUN and Creatinine d. Fibrinogen e. CBC f. Type & Cross 3. Repeat labs after 1 hour a. CBC b. PT/INR c. PTT d. Fibrinogen 4. Notify Blood Bank of need for 2 Platelets and 2 FFP 5. Prepare initial MTP pack a. 4 units O Negative PRBCs uncrossmatched (type specific if known) b. 4 units O Positive FFP/plasma uncrossmatched for males/females > 50 yrs old (type specific if known) c. 1 unit of Platelets 6. Notify runner when a. PRBC available b. FFP thawed c. Platelets available 7. Obtain Emergency Release Form (if required) 8. Check on team if MTP has not been deactivated and no products have been sent for > 60 minutes 1. Call lab to activate MTP 2. Order shock profile STAT and repeat in 1 hour a. ABG Page 2 of 5

3 b. Electrolytes (Na, K, Cl) c. Glucose d. Lactate e. Calcium 3. Designate a runner to pick up blood/blood products from lab a. Notify lab of runner phone number 4. Obtain a second 16-18G or large bore IV site a. Draw blood with IV start - collect purple, blue, and pink top tubes b. Complete the Blood Bank armband and attach to patient 5. Obtain blood/fluid warmer, tubing, blood tubing; prime and ready for administration 6. Goal for Administration as available 2 PRBCs 2 FFP (30-45 min thaw time) 1 Platelets (transport time 90 minutes) 7. If bleeding continues after FFP, consider use of TXA - See MTP orders 8. Stop MTP and notify lab a. Normalized lab values and/or no evidence of ongoing bleeding Approved: Chief of Medical Staff Date Chief Nursing Officer Date Reviewed by: Dr. Gordon Bell, Laboratory Medical Director; Dorothy Rice, Trauma Director; Trauma Services Committee; OB Services Committee; Medical Executive Committee References: The American College of Surgeons (2014). Advanced Trauma Life Support for Doctors (ATLS) Student Course Manual (8th Edition). United States of America. Page 3 of 5

4 Gonzalez, EA, et.al. Fresh Frozen Plasma Should be Given Earlier to Patients Requiring Massive Transfusion. Journal of Trauma, January 2007, 62 (1) Malone, DL, et.al. Massive Transfusion Practices Around the Glove and a Suggestion for a Common Massive Transfusion Protocol. Journal of Trauma, Supplement 2006, 60 (6), S Page 4 of 5

5 MASSIVE BLOOD TRANSFUSION PROCEDURE Patient with excessive blood loss with >10 units PRBC transfused within 24 hrs OR 4 units of PRBC s transfused in < 4 hrs with uncontrolled bleeding Laboratory: 1. Call for additional lab staff assistance 2. Order MTP profile STAT PT/INR PTT BUN and Creatinine Fibrinogen CBC Type & Cross 3. Repeat labs after 1 hour CBC PT/INR PTT Fibrinogen 4. Notify Blood Bank of need for 2 Platelets and 2 FFP 5. Prepare initial MTP pack 4 units O Negative PRBCs uncrossmatched (type specific if known) 4 units O Positive FFP/plasma uncrossmatched for males/females > 50 yrs old (type specific if known) 1 unit of Platelets 6. Notify runner when PRBC available FFP thawed Platelets available Nursing: 1. Call lab to activate MTP 2. Order shock profile STAT and repeat in 1 hour ABG Electrolytes(Na, K, Cl) Glucose Lactate Calcium 3. Designate a runner to pick up blood/blood products from lab Notify lab of runner phone number 4. Obtain a second 16-18G or large bore IV site Draw blood with IV start - collect purple, blue, and pink top tubes Complete the Blood Bank armband and attach to patient 5. Obtain blood/fluid warmer, tubing, blood tubing; prime and ready for administration 6. Goal for Administration as available 2 PRBCs 2 FFP (30-45 min thaw time) 1 Platelets (transport time 90 minutes) Anticipate ongoing excessive bleeding If bleeding continues after FFP, consider use of TXA-see MTP orders Stop MTP, notify lab Criteria: Normalized lab values and/or no evidence of ongoing bleeding Lab to check on team if MTP has not been deactivated and no products have been sent for > 60 minutes Page 5 of 5