Massive Transfusion ...and all things blood
Description: Massive Transfusion ...and all things blood related MICU Workshop Discuss patient scenarios that result in need for massive transfusion protocol (MTP) Review Blood Administration policy (6379) Discuss Massive Transfusion Protocol (217409)
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slide1. Massive Transfusion ...and all things blood related MICU Workshop<br>
slide2. Discuss patient scenarios that result in need for massive transfusion protocol (MTP)
Review Blood Administration policy (6379)
Discuss Massive Transfusion Protocol (217409)
Explain Emergency Release blood products
Review Level 1 Rapid Infuser (217184)<br>
slide3. By the end of this session, you should be able to: Recognize patient care situations that could require massive blood transfusions
Understand how to properly administer blood products at the bedside
Follow Duke’s Massive Transfusion protocol
Order and document Emergency Release blood product
Set up and run Level 1 Rapid Infuser
Help insert and maintain Minnesota tube<br>
slide4. Revalidation Requirement Demonstrates knowledge of blood administration in accordance with policy:
Identification of transfusion recipients and blood components
**Double RN verification
Observation of recipients during and after transfusion
Recognition and reporting of adverse transfusion events<br>
slide5. DUHS Blood Administration Policy (6379) Basic Info
Most common blood products for MICU – PRBCs, platelets, cryoprecipitate, fresh frozen plasma
REQUIRED – Type & Screen (expires after 3 days)
Need Prepare AND Transfuse blood orders
Supplies – filtered blood administration set, saline, 20-24g PIV or TLC
Once blood product has been tubed it CANNOT be returned
Using a cooler? Only for PRBCs and FFP, keep products under ice<br>
slide6. Patient scenarios that could lead to massive blood transfusion: Variceal bleed
"upper GI bleed"
Associated with portal hypertension caused by cirrhosis
Once you have 1 bleed you have a high likelihood of rebleed
Treatment: beta blockers, Minnesota tube, endoscopy, TIPS
Retroperitoneal bleed
Trauma, rupture of aneurysm, or caused by medical exam/treatment
Treatment: embolization or surgical exploration
Diverticular bleed
"lower GI bleed"
Unclear etiology of diverticulosis
Treatment: usually self-resolving, may need colonoscopy, IR with angiography<br>
slide7. Emergency Release Uncrossmatched, Type O red cells
Fill out “Transfusion Services Emergency Conditional Blood Release” form
*Can be filled out retrospectively **Going down to Blood Bank?
*Find them at HUC or in Blood Bank Bring patient name and MRN
Get a Type & Screen ASAP<br>
slide9. Need that Minnesota tube? DUH ED Esophageal Balloon Device (Minnesota Tube) Insertion for Esophageal-Gastric Varices (942)
How it works:
Tamponades esophageal and/or gastric bleeding that is unresponsive to endoscopic and/or medical treatments.<br>
slide12. Minnesota tube insertion video
Insertion Quick Reference Helpful Links for Minnesota tube<br>
slide13. So, you need to start the MTP... Notify Charge, PCC, RT, Transfusion services
Grab
a TON of nurses
line cart/MAC line
Level 1 and D-300 tubing
Fluids (LR/NS)
Pressors
Extra blood tubing
*Get ready to scope, travel to IR, or send to OR*<br>
slide15. DUH Trauma - Massive Transfusion Protocol Adult (217409)<br>
slide17. Level 1 Rapid Infuser<br>
slide18. D-300 Tubing<br>
slide19. Step by Step Guide Level 1® H-1200 Rapid Infuser with Integrated Air Detector/Clamp<br>
slide26. Helpful Links for Level 1 setup Level 1 H-1200 Rapid Infuser Step-by-Step guide
Training video #1
Training Video #2<br>
slide27. Please scan QR code and fill out the survey Text: TOVLEY to 919-213-8033<br>
slide2. Discuss patient scenarios that result in need for massive transfusion protocol (MTP)
Review Blood Administration policy (6379)
Discuss Massive Transfusion Protocol (217409)
Explain Emergency Release blood products
Review Level 1 Rapid Infuser (217184)<br>
slide3. By the end of this session, you should be able to: Recognize patient care situations that could require massive blood transfusions
Understand how to properly administer blood products at the bedside
Follow Duke’s Massive Transfusion protocol
Order and document Emergency Release blood product
Set up and run Level 1 Rapid Infuser
Help insert and maintain Minnesota tube<br>
slide4. Revalidation Requirement Demonstrates knowledge of blood administration in accordance with policy:
Identification of transfusion recipients and blood components
**Double RN verification
Observation of recipients during and after transfusion
Recognition and reporting of adverse transfusion events<br>
slide5. DUHS Blood Administration Policy (6379) Basic Info
Most common blood products for MICU – PRBCs, platelets, cryoprecipitate, fresh frozen plasma
REQUIRED – Type & Screen (expires after 3 days)
Need Prepare AND Transfuse blood orders
Supplies – filtered blood administration set, saline, 20-24g PIV or TLC
Once blood product has been tubed it CANNOT be returned
Using a cooler? Only for PRBCs and FFP, keep products under ice<br>
slide6. Patient scenarios that could lead to massive blood transfusion: Variceal bleed
"upper GI bleed"
Associated with portal hypertension caused by cirrhosis
Once you have 1 bleed you have a high likelihood of rebleed
Treatment: beta blockers, Minnesota tube, endoscopy, TIPS
Retroperitoneal bleed
Trauma, rupture of aneurysm, or caused by medical exam/treatment
Treatment: embolization or surgical exploration
Diverticular bleed
"lower GI bleed"
Unclear etiology of diverticulosis
Treatment: usually self-resolving, may need colonoscopy, IR with angiography<br>
slide7. Emergency Release Uncrossmatched, Type O red cells
Fill out “Transfusion Services Emergency Conditional Blood Release” form
*Can be filled out retrospectively **Going down to Blood Bank?
*Find them at HUC or in Blood Bank Bring patient name and MRN
Get a Type & Screen ASAP<br>
slide9. Need that Minnesota tube? DUH ED Esophageal Balloon Device (Minnesota Tube) Insertion for Esophageal-Gastric Varices (942)
How it works:
Tamponades esophageal and/or gastric bleeding that is unresponsive to endoscopic and/or medical treatments.<br>
slide12. Minnesota tube insertion video
Insertion Quick Reference Helpful Links for Minnesota tube<br>
slide13. So, you need to start the MTP... Notify Charge, PCC, RT, Transfusion services
Grab
a TON of nurses
line cart/MAC line
Level 1 and D-300 tubing
Fluids (LR/NS)
Pressors
Extra blood tubing
*Get ready to scope, travel to IR, or send to OR*<br>
slide15. DUH Trauma - Massive Transfusion Protocol Adult (217409)<br>
slide17. Level 1 Rapid Infuser<br>
slide18. D-300 Tubing<br>
slide19. Step by Step Guide Level 1® H-1200 Rapid Infuser with Integrated Air Detector/Clamp<br>
slide26. Helpful Links for Level 1 setup Level 1 H-1200 Rapid Infuser Step-by-Step guide
Training video #1
Training Video #2<br>
slide27. Please scan QR code and fill out the survey Text: TOVLEY to 919-213-8033<br>