massive transfusion protocol · -1000ml fresh frozen plasma (ready in 40) the initial pack will be...
TRANSCRIPT
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Reason for Action
• Rapid Release protocol for urgent clinical
scenarios is unique to SBH.
• Since the creation of the MTP at HSC, some
physicians that provide coverage at both sites
have become confused between the two
protocols.
• Increased potential to compromise patient safety
during a life-threatening crisis.
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What is a Massive Transfusion
Protocol (MTP)?
• Massive Transfusion Protocols provide large
amounts of blood products in predefined ratios
to patients with life-threatening hemorrhage.
• A massive transfusion is an emergency situation
where there is an expected transfusion of 4 or
more units of Red Blood Cells within 1 hour and
on-going substantial need is expected.
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Background
• Hospital based protocols have been developed
across Canada & the USA based upon
recommendations of studies published by the
US military on massive bleeding occurring in
war.
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Why Use It?
• MTPs improve survival in patients with
exsanguinating hemorrhage
(Rajasehkar et. al, 2011).
• Uncontrollable hemorrhage is the most common
cause of preventable death under 44 (Cotton et.
al, 2009).
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Where will MTP be implemented @ SBH?
• Operating Room
• Post-Anaesthesia Recovery Room
• Labour & Delivery
• ICMS
• ICCS
• Emergency
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Who is eligible for MTP activation?
• Intended for use in patients 16 years of age or
greater.
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Components of the MTP
• INITIAL PACK
-5 units PRBC (ready in 15 minutes)
-1000ml Fresh Frozen Plasma (ready in 40)
The initial pack will be a split delivery. The PRBC
will be delivered prior to the Fresh Frozen Plasma.
• SUBSEQUENT PACKS (will arrive hourly)
-1000ml frozen plasma
-1 adult dose of platelets
-5 units of red blood cells
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Red Blood Cells Fresh Frozen Plasma
•Platelets will come in a bag attached to the blue cooler.
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Sealed Cooler
This is an example of a sealed cooler.
This is how the cooler will come to the unit.
The coolers are sealed with a plastic wrapping or velcro strap.
Each cooler also has a packing slip on the top.
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Do you require additional Blood
Products?
• Use the Blood Products STAT order set in the
EPR to order any products that are in addition to
the MTP packs.
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Baseline Blood Work
• Type & Screen
• CBC
• Lytes/Biochemistry
• Fibrinogen
• INR/aPTT
STAT collection
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Haemostatic Monitoring during MTP
• Complete blood count – every 1 hour
• INR – every 1 hour
• Fibrinogren – every 1 hour
• Na, Cl, K, Ca, HCO, glucose, creatinine-q 2 hrs
• ABG PRN (at least hourly)
• Temperature every hour or continuously
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The RBC cooler can be returned to the Blood Bank as long as it has not been
opened. Once the seal is broken or the cooler is opened, the blood/plasma expires
in 4 hours. Write the time on the tag when you open the cooler.
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Activation of MTP
• Physician to complete MTP order set in EPR.
• Unit staff will dial “55” and state
“Transfusion 25 AND location.”
• Unit staff will use the MT package for documents
required during this event.
• Unit staff to fax for release of blood products to
Blood Bank with the addressograph & MTP
sticker.
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Massive Transfusion Package
• Is a pre-packaged envelope that includes all the
written materials necessary for a MT.
• A MT package is located on each unit where a
MT can be activated.
• The MT package is reordered through Print
Shop.
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Responsible Physician:
• Is the physician who has the primary
responsibility for the direct care of the patient
during the MT.
• The responsible physician completes the MTP
order set in the EPR when a MT emergency
arises.
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Transfusion Medicine Physician (on call):
• Will receive the “Transfusion 25” page
• Will call the nursing unit & request:
*full name of the responsible physician
*contact person for future call back
*patient demographics
• Following this, the transfusion medicine physician (on call) will:
1. Call Blood Bank & confirm patient demographics & preparation of
blood products.
2. Call Canadian Blood Services & confirm supply & notify if more
blood / blood products are needed.
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Blood Bank
• Upon receipt of paging notification and faxed
Request for Release of Blood/Blood
Component/Derivatives, the Blood Bank will
begin preparation of the Blood Cooler Packs.
• Preparation will continue as detailed in the MTP
order set until notified by the Responsible
Physician or designate that the protocol is
discontinued.
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Transportation of Blood Samples
• Where available, blood samples (for Crossmatch
and / or Chemistry / Hematopathology) will be
sent via pneumatic tube with the red Massive
Transfusion paper from the Massive Transfusion
package facing the exterior of the pneumatic
tube.
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Transportation of Blood Products
• Upon receipt of paging notification (overhead /
numeric), a messenger will respond to the
nursing unit to pick up a copy of the Release for
Blood/Blood Products form that was faxed to
Blood Bank. It must indicate “MTP” along with
the patient demographics.
• The form is required to validate correct patient
identification during pick up the blood coolers in
Blood Bank.
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Transferring an active MT patient
• During a massive transfusion event, a patient
may be transferred to another patient care unit
identified as part of MT and continue to receive
MT coolers.
• Communication is crucial with Blood Bank &
Patient Transport to assure a constant flow of
blood/blood products to the correct clinical unit.
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Transferring an Active MT patient
The Sending Unit:
-notifies the receiving unit
-phones Blood Bank with details (patient
demographics & location change info)
-notifies Transport of patient location change and
requirements
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Transferring an Active MT patient
• The Receiving unit:
-notifies the Transfusion Physician on-call of
change in patient location & physician contact
information.
• Blood Bank:
-receives phone call from Sending unit of patient
location & change.
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Discontinuation of the MTP
• Discontinue the MTP when the patient has
stopped bleeding, the bleeding is controlled, the
patient has died or resuscitation efforts have
been withdrawn.
• The unit staff will inform the Blood Bank &
Transport when the MTP has ended.
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After the MTP is Discontinued
• Return the Record of Transfusions to the Blood
Bank.
• Collaborate with the team to complete the
evaluation.
• Externally clean the blood cooler with Oxyvir®
TB wipes and return to the Blood Bank.
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MTP: Team Debrief
• Complete the form with the team and return to
the Patient Safety office through
interdepartmental mail.