Update on Blood Product Administration and Massive Transfusion Next Slide In the Operative Setting.

Update on Blood Product Administration and Massive Transfusion

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 In the Operative Setting

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Objectives

In this presentation you will:

• Define Mass Transfusion Protocol (MTP)

• Identify your role and responsibilities in the blood administration process

• Verbalize blood storage & return requirements to reduce blood wastage

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Rationale

The activation of a standardized massive transfusion protocol (MTP) for large surgical bleeds and trauma exsanguinations will provide standardized component therapy to avoid coagulopathy associated with massive blood loss• Charge nurse will no longer routinely order “Trauma Blood”

Outline team responsibilities associated with transfusions

Reduce blood product waste

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Initiation of MTP Additional MTP Coolers Ending MTP

Who: Attending Anesthesiologist/Surgeon  Direct Communication to Blood Bank:Initiation of MTP:Physician NamePatient NamePatient genderMR# Location: OR#

Who: Attending Anesthesiologist/Surgeon Direct Communication to Blood Bank:Continue MTP:Physician NamePatient NameMR#Location: OR#

Who: Attending Anesthesiologist/Surgeon  Direct Communication to Blood Bank: Stop MTP for:PhysicianPatient NameMR#Location: OR # 

Blood Bank: Confirms Patient Location on E-OR Board Prepares MTP Cooler 6 units pRBC 4 units Plasma 1 PlateletMTP Cooler Packed Contacts OR Command Center of Ready for Pick up

BB call OR Room for Decision of Continue or Cease: Continue MTP Cycle:BB Prepares: 6:4:1 Ratio MTP Cooler Packed  Contacts OR Command Center of Ready for Pick up 

BB to Receive Order by Attending Surgeon or designee No additional MTP cooler picked up

 Discontinue MTP cycle:BB Anticipates Arrival of MTP Cooler

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Initiation of MTP Additional MTP Coolers Ending MTP

OR Charge Nurse: Receives Call From BB for cross check of:PatientPatient GenderOR LocationCommunication of MTP Protocol initiatedCN Communicates MTP activation to OR Team: Circulator; Anesthesia CN deploys runner for MPT cooler pick up:

To OR to obtain Blue Card or Chart prior to going to Blood Bank

Straight to BB for Level 1 trauma if blue card or chart cannot be obtained

OR Charge Nurse:Prepares for Continuation of MTPDeploys runner for MPT cooler pick up:

To OR to obtain Blue Card or Chart prior to going to Blood Bank

Straight to BB for Level 1 trauma if blue card or chart cannot be obtained

Anesthesia Tech Prepares: Cooler for Return to BB Anesthesia Tech transports Cooler to Command Center:CN deploys runner to return cooler to Blood Bank

Nurse/Anesthesia:Anticipates Arrival of MTP Cooler 

Nurse/Anesthesia:Follows Blood Administration Check PointsReceives call for continuation by BB

Nurse /Anesthesia Verifies:No Blood Products Remain in OR

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Initiation of MTP Additional MTP Coolers Ending MTP

OR Runner Deployed for MPT cooler pick up:

To OR to obtain Blue Card or Chart prior to going to Blood Bank

Straight to BB for Level 1 trauma if blue card or chart cannot be obtained

Returns : To OR with cooler if Blue

Card or Chart was obtained from OR prior to going to Blood Bank

To Command Center if blue card or chart was not obtained for patient location from charge nurse Delivers cooler to

designated OR

Deployed for MPT cooler pick up: To OR to obtain Blue Card or

Chart prior to going to Blood Bank

Straight to BB for Level 1 trauma if blue card or chart cannot be obtained

Returns : To OR with cooler if Blue

Card or Chart was obtained from OR prior to going to Blood Bank

To Command Center if blue card or chart was not obtained for patient location from charge nurse Delivers cooler to

designated OR

Returns cooler to Blood Bank

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The Circulating Nurse

Prior to setting up for a case the circulator will ensure that No blue cards, patient labels or blood boxes from previous cases remain in the room.

On the In-room white board verify:Patient’s name

Procedure, the surgeon,

Operative site (specifically L or R)

Number of blood products available.

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Prior to the beginning of the case• The circulator and anesthesia provider individually

verify patient identify• Ask patient to state his/her name when appropriate.

• Before patient is moved to the OR table, together the caregivers compare:• Stated name to wrist band • Blue addressograph card, whiteboard and face sheet on the

chart.

Names should be identical. Medical record number and physician name should also be compared on the ID Band, blue card, whiteboard and medical record.

(See Patient Identification Policy # 100-32)

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Anesthesia Provider

In the OR, transfusion is the responsibility of:• Attending Physician

• Resident Physician

• Certified Registered Nurse Anesthetist (CRNA)

• Student Registered Nurse Anesthetist (SRNA)

• Perfusionist

When blood/blood products are needed:• Circulator is notified

• Circulator orders blood/blood products via Wiz Ordering application

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Notification by Blood Bank The Blood Bank calls appropriate location when blood cooler is

ready to be picked up or blood products have been tubed.

• The Command Center for the VOR - 22090

• MCE board- 66777

• 4 South/GYN surgery board- 32736

• Hybrid - 22090

• L & D - 22255 If cooler is needed, charge nurse will dispatch a runner to the

designated OR and obtain the blue card or patient chart for the patient needing blood as soon as the call is received or patient arrives to the OR.

The runner presents the blue card or patient chart to the Blood Bank.

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Blood Bank Technologist

Blood Bank Technologist

• Requests patient ID from runner

• Confirms transfusion order

• ID presented (current type and screen available)• All MTP cycles will be type-specific, cross-matched blood

products.

•  ID is presented (current type & screen unavailable)• Trauma blood will be issued.

• ID cannot be obtained• Trauma blood will be issued.

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Responsibilities of Runner

Runner has patient chart or blue card • Returns to the designated OR :

• Requested blood

• Patient’s blue card or patient chart

• OR runner gives blood product to licensed practitioner

Runner does not have patient chart or blue card

• Returns to Command Center for patient location from charge nurse

• Delivers cooler to designated OR

Blood Verification

Two (2) licensed personnel together verify the following information, (only one may be an LPN).

Patients name and medical record number from the wristband/blue card/whiteboard

Blood product expiration dateBlood product donor numbers and type Verify all information with the Transfusion Record

Donor number and type

Expiration

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Blood Product Transfusion Form Two licensed personnel sign and date Acts as the receipt for the blood product Circulator places on the chart Becomes part of the permanent record

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Multiple units- Cooler. Cooler stays with Anesthesia team May take units out to check off (with transfusion record, patients

name and medical record number from the wristband/blue card/whiteboard

Must return all units back in the cooler under ice after verification process

All units must remain under ice until used and lid closed at all times except when removing units

Blood bags kept on top of the ice do not remain at proper temperatures

Do not removed ice from bag Keep ice bag closed

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NOTE

• Coolers are returned to Blood Bank as soon as the need is over.

• Blood Bank checks the temperature at that time to determine if the blood is still the proper temperature.

Do Not place platelets or cryoprecipitate

in the cooler.

Cooler

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Ice RBC’s must be

transfused within 30 minutes unless in a blood box.

Plasma must be infused within 4 hours of leaving the Blood Bank

Platelets –use immediately

Cryoprecipitate – must be used within 4 hour of pooling

No Ice

Blood Product Reminders

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One or Two Units of Blood Tubed to OR

The Blood Bank calls appropriate location when blood products have been tubed. • The Command Center for the VOR - 22090

• MCE board- 66777

• 4 South/GYN surgery board- 32736

• Hybrid - 22090

• L & D - 22255 Charge Nurse/Runner Responsibilities

• Sends runner to tube station

• Runner returns to Charge Nurse for patient location

• Charge Nurse validates patient name on blood product

• Charge Nurse sends runner & patient blood product to OR where patient is located.

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Preventing Blood Wastage

RBCs & Plasma:• If tubed, & not needed,

return immediately to Blood Bank by runner

• In cooler, leave under ice, keep lid closed

• Return cooler as soon as possible

Platelets:• Never in a cooler!

• Pooled platelets expire in 4 hrs.

Cryoprecipitate:• Never in a cooler!

• Expires in 4 hours!

Never tube any blood products back to blood bank!

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Unused Products

Unused products are returned to Blood Bank:• As soon as the MTP is discontinued

• If blood products are tubed & not needed

• Patient is transferred to another location (Out of OR) Return process:

• Anesthesia Tech transports cooler to command center

• Charge nurse deploys runner to return:• Cooler to blood bank

• Any unused tubed blood products to blood bank

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MTP Review

Each MTP activation will be reviewed within 24 hours and feedback provided to the attending as well as Transfusion Committee leadership team

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Summary

MTP provides standardized component therapy to avoid coagulopathy associated with massive blood loss

MTP continues until:

• Attending anesthesiologist or attending surgeon discontinues

• No more coolers are picked up from the Blood Bank All unused products are returned to the Blood Bank

• As soon as the MTP is discontinued

• If tubed blood products are no longer needed

• If patient transfers to another location (out of OR)