Update on Blood Product Administration and Massive Transfusion

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

2. 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

3. 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

4. Role of Physician and Blood Bank

5. Role of Charge nurse & Anesthesia provider

6. Role of OR Runner

7. The Circulating Nurse • Prior to setting up for a case the circulator will ensure that Noblue 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.

8. 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)

9. 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

10. 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 cardorpatient chart for the patient needing blood as soon as the call is received or patient arrives to the OR. • The runner presents the blue cardorpatient chart to the Blood Bank.

11. 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.

12. 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

13. 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 date • Blood product donor numbers and type • Verify all information with the Transfusion Record Expiration Donor number and type Previous Slide Next Slide

14. 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

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

16. Cooler 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.

17. 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 Blood Product Reminders Ice No Ice

18. 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.

19. 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!

20. 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

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

22. 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)