UT HEALTH PEDIATRIC TRAUMA GUIDELINES

Transcription

1 TITLE: Pediatric Massive Transfusin Prtcl (P-MTP)/ Emergency Release f Bld frm Bld Bank SUPERCEDES: 08/2011, 05/2012, 08/2013 LAST REVIEW DATE: 06/2017 Purpse Statement: T describe the prcess f rapidly prviding apprpriate number and cmpsitin f bld and bld cmpnents t the acutely injured pediatric patient. Prcedure: Initial Transfusin: a. Ntify Bld Bank (4-3640) immediately f an urgent need fr bld. At a minimum, infrm the Bld Bank hw many RBCs are needed and hw they shuld be issued: O Negative Uncrssmatched (available immediately) Type-Specific Uncrssmatched (available 5-10 min; requires a specimen) Cmpletely Crssmatched (available 40 min; requires a specimen) This will ensure that a cler is ready fr pickup when a runner arrives. If pssible, let the Bld Bank knw the type f trauma as well. A bld sample (labeled with a red arm band label and patient first name, last name and MR number) must be sent t Bld Bank fr a Type & Crss. The cllectr s initials must be n the sample label, the Bld Order Frm, r the Pickup Slip that accmpanies the sample. The Emergency Release f Bld frm must be cmpleted with the patient s name and number, the estimated age and weight, the estimated ttal bld vlume, the number f RBCs and FFP needed, and signature f the requesting physician/designee. This frm must be taken by a designated runner t the Bld Bank. Units will nt be issued withut a medical recrd number. If the bld type is unknwn and the team cannt wait fr type-specific RBCs, O Negative RBCs will be issued. If O Neg RBCs have been issued and a sample is still unavailable fr typing, the patient will be switched t O Ps RBCs, but nly if there is a shrtage f O Neg RBCs. All RBCs will be transfused in the standard manner. All patients must be identified (name and number) prir t transfusin. 1

2 b. The Pediatric Massive Transfusin Prtcl (P-MTP) shuld be initiated as sn as the Pediatric Surgery, Trauma r Anesthesilgy attending recgnizes that a patient will require massive transfusin (see Indicatins, under #8). The MTP must be initiated with a telephne call t the Bld Bank (4-3640) by the attending Pediatric Surgen, Trauma Surgen r Anesthesilgist. The Bld Bank will require the name f the requesting physician. Pediatric Massive Transfusin Prtcl: 1. Within 5-10 minutes f ntificatin f a P-MTP, the Bld Bank will have ne set f RBCs, FFP (number f units depend n child s estimated weight; see Table 1) packed in a cler, and Platelets (see table 2) available fr runner pickup. If FFP is nt immediately available (based n type f patient), the Bld Bank will issue units that are ready and ntify apprpriate persnnel when the remainder is thawed. 2. The secnd set f RBCs, FFP, and platelets will be issued and will be repeated as lng as needed. The result f the TEG shuld be taken int cnsideratin. If nn ABO cmpatible platelets will be prvided, the bld bank will ntify the attending by phne. 3. After the first cler leaves the Bld Bank (#1 abve), the Bld Bank will then prepare the next set f RBCs, FFP (r 1-2 Jumb FFP), and Platelets. This cmpnent rder will be available within 5-10 minutes f the first cler leaving the Bld Bank. This prcess will autmatically be repeated each time the set f cmpnents is issued until the attending Pediatric Surgen, Trauma Surgen, Anesthesilgist, r Pediatric Intensivist ntifies the Bld Bank that the P-MTP is n lnger needed. 4. Requests f cmpnents exceeding this prtcl may be made at any time by direct ntificatin f the Bld Bank, phne number (4-3640). 5. Bld clers shuld fllw the patient at all times t prevent duplicate bld rders and unavailability f bld when needed by the patient. 6. N bld cmpnent will be issued withut a pickup slip with the recipient s medical recrd number and name. 7. Labratry tests shuld be drawn initially and then as clinically indicated (at least after each cler f prducts has been transfused). a. CBC, PT, aptt, Fibringen b. TEG, if available 8. Indicatins fr Pediatric MTP include, but are nt limited t: a. Massive bleeding/ trauma patient b. Massive bld lss with prfund hemrrhagic hypvlemic shck c. >50% f ttal bld vlume lss in 3 hurs with cntinuus bleeding 2

3 Table 1 Numbers f RBC s, FFP and Platelets t be prepared accrding t patient s weight 0-10 kg TBV < 800ml 3 units PRBC 3 units FFP ½ apheresis unit Platelet kg TBV ml 4 units PRBC 4 units FFP 1 apheresis unit Platelet kg TBV ml 5 units PRBC 5 units FFP 1 apheresis unit Platelet > 40 kg TBV > 3200ml 6 units PRBC 6 units FFP 1 apheresis unit Platelet Table 2 Pediatric Trauma Massive Transfusin Guidelines FFP As sn as the need fr massive transfusin is recgnized, n later than after 50% f patient s bld vlume has been replaced. Fr every RBCs, give FFP (1:1 rati) Platelets NOTE: 1 Jumb FFP = 3 FFP After 3 dses (30ml/kg) each RBC and FFP, give 1 dse platelets. 1 dse platelets cnsists f 20ml/kg Cryprecipitate Fibringen based: After ne ttal bld vlume has been replaced, check fibringen level. If <200 mg/dl, give 10ml/kg f cryprecipitate. Repeat as needed, depending n fibringen level, and request apprpriate amunt f cry. TEG based: If α < 60 n TEG give 10 ml/kg cryprecipitate. NOTE: FFP als cntains fibringen and thus cryprecipitate is nt frequently needed. 3

4 Table 3 PATIENT S WEIGHT (Kg) NUMBER OF RED CELL UNITS TO EQUAL TOTAL BLOOD VOLUME < >

5 PEDIATRIC MASSIVE TRANSFUSION PROTOCOL FLOWSHEET MEMORIAL HERMANN HOSPITAL HOUSTON, TEXAS Physician Initiating Prtcl: PATIENT INFORMATION Date/Time Initiated: Date/Time Discntinued: PATIENT S ABO/Rh (if knwn) Accessin #: RAB#: PATIENT S WEIGHT AGE TOTAL BLOOD VOLUME (TBV) BLOOD COMPONENT PREPARED BLOOD COMPONENT ISSUED = Issued RBCs Pick-up Time FFP Pickup Time PLT Pick-up Time 1. RBCs FFP 1 Dse Platelets(20ml/kg) 2. RBCs FFP 1 Dse Platelets(20ml/kg) 3. RBCs FFP 1 Dse Platelets(20ml/kg) 4. RBCs FFP 1 Dse Platelets(20ml/kg) 5. RBCs FFP 1 Dse Platelets(20ml/kg) 6. RBCs FFP 1 Dse Platelets(20ml/kg) 7. RBCs FFP 1 Dse Platelets(20ml/kg) 8. RBCs FFP 1 Dse Platelets(20ml/kg) 9. RBCs FFP 1 Dse Platelets(20ml/kg) MTP initiated by physician Prepare RBCs, FFP, Platelets fr 1 st Prepare Numbers f RBCs, FFP, and Platelets accrding t patient s weigh; RBCs & Platelets shuld be leukcytereduced PrePre Cntinue t prepare an additinal set RBCs, FFP, & PTLs (20 ml/kg) with secnd and all further sets after each set is issued Cry will be requested as needed by the physician 5

6 Numbers f RBC s, FFP and Platelets t be prepared accrding t patient s weight PATIENT S WEIGHT # f RBCs # f FFP # f Platelets 0-10 kg TBV < 800ml 3 units PRBC 3 units FFP ½ apheresis unit Platelet kg TBV ml 4 units PRBC 4 units FFP 1 apheresis unit Platelet kg TBV ml 5 units PRBC 5 units FFP 1 apheresis unit Platelet > 40 kg TBV > 3200ml 6 units PRBC 6 units FFP 1 apheresis unit Platelet 6