MASSIVE HAEMORRHAGE POLICY. ABMU HB Transfusion Team

Transcription

1 MASSIVE HAEMORRHAGE POLICY ABMU HB Transfusion Team

2 To define the and roles of the Clinical team and the Haematology Department in the management of MASSIVE HAEMORRHAGE To describe the process for delivering the transfusion (including prescribing and checking blood products) To review use of tranexamic acid

3 Key Principles remain the same as other major acute event Appropriate Assessment by a doctor Implement communica@on Delegate role ( team leader)* Ac@vate

4 / Review Appropriate Reassessment or communica@on Nominated lead changes on pt transfer or de-ac@vate

5 TELL BLOOD BANK REMEMBER!!

6 Criteria for Systolic BP< 90mmHg and/ or presence of perfusion + evidence of significant chest/ abdomen/ pelvic/ long bone trauma. Caveats: children, elderly, co-morbidi@es. Ideally before pa@ents arrives

7 of on going Massive Haemorrhage Massive Haemorrhage may be defined as the loss of one blood volume over a 24 hour period... Or in the acute situa@on... 50% blood volume loss in 3 hours, Or Blood loss at a rate > 150ml per minute

8 and The Clinical Team Leader determines MASSIVE HAEMORRHAGE They will nominate a team member who will contact Switchboard, giving details of: Ø Clinical area Ø A contact name ( team leader) * Ø Contact telephone number.

9 Role of Switchboard To no4fy: Blood transfusion laboratory (or on call BMS) Porter Supervisor Relevant senior medical staff Consultant Haematologist on call Relay to the above: Ø Clinical Area Ø A contact name Ø Contact telephone number

10 Clinical of team leader/senior nurse Ensure the has a unique iden@fier or NHS number Ensure correct blood samples and request forms are sent immediately: Ø FBC/biochemistry screen Ø Group and save Ø Coagula@on screen

11 requirements for pretransfusion known Unique Iden4fier Hospital/NHS?/ED number Last name First name Date of birth Age is not enough Address Minimum first line Requester ID Signature of sample taker and date and 4me of collec4on IN URGENT SITUATIONS INFORMATION REQUIREMENTS ARE THE SAME

12 requirements for pretransfusion unknown Hospital/ED number Last name stated as UNKNOWN First name for example: Male 1 / Female 3 Indica@on of age child, young adult, elderly of admission Signature of sample taker

13 of the Blood Transfusion Staff The lab contacts the named person in the clinical area to establish criteria. The lab assumes that the emergency O Rh (D) Nega@ve units in the issue fridge have been taken (unless otherwise specifically no@fied by the assessing clinician) The lab will issue: Ø A further 4 units of O Rh (D) Nega@ve blood (O Rh (D) posi@ve depending on availability) Ø 4 units of Fresh Frozen Plasma (FFP ) will be issued.

14 Suitability of Blood Not all O neg Blood is without risk allows and you are able to do a group and save (approx 20mins) the Lab will be able to provide blood specifics The ultimate responsibility for use of any component lies with the Clinical Team/ Consultant Haematologist

15 Role of the Porters A dedicated porter will be iden@fied and sent to the blood transfusion laboratory to collect: Ø 4 units of emergency O Rh (D) Nega@ve for immediate use. So called flying squad blood The porter will then: Ø Collect 4 units of blood and 4 FFP (MHP) Ø Deliver grouping blood samples request to lab

16 quality Inadequately labelled samples and request forms will be discarded

17 Transfusion Details Blood MUST be warmed. In shocked BLOOD is first line treatment NOT crystalloid. Give blood through thick/short line (Trauma line). The trauma leader is responsible for standing down the MHP and ensuring that the O neg blood is back in blood bank in 30 minutes. Check Haemoglobin, Potassium, Calcium and Clonng aoer transfusion of first blood series Give 10ml 10% calcium chloride aoer first 4U blood MHP ac@va@on can occur at including based on pre-hospital vitals/mechanism

18 TRANEXAMIC ACID IN TRAUMA

19 What is tranexamic acid? It is an Fibrin provides the skeleton of the clot Plasmin degrades fibrin Tranexamic acid stops the of plasmin from plasminogen So tranexamic acid protects the clot

20 Research CRASH 2 trial used > 20,000 pa@ents and found that all cause mortality was significantly reduced with tranexamic acid. Risk of death from bleeding significantly reduced Main risk: vascular occlusion ( Myocardial infarc@on, pulmonary embolism and stroke)

21 Why use tranexamic acid? To reduce the risk of death due to bleeding in trauma. It is used in to standard and should not be used as a subs@tute for surgical interven@on to control bleeding. Purpose is to stabilise the clot in the context of damage control resuscita@on (keep the systolic BP at 90 mmhg.)

22 Prescribing Consultant or middle grade directed by TTL 1g Tranexamic acid IV bolus (may be given IO). FLUSH the line before giving blood Repeat (same dose) aoer EVERY 10 Units of Blood Products (eg: 6 units packed red blood cells and 4 units FFP) Paediatric use unproven but consider Paeds Dosage: 15mg/ Kg to a max 1g over 10mins It is kept in the TRAUMA DRUG pack & drug cupboard

23 for use Adult trauma Consider in children Within 8 hours of injury Significant haemorrhage BP < 90 SYSTOLIC, PULSE >110 RISK OF SIGNIFICANT HAEMORRHAGE (COMPENSATED SHOCK OR REBLEEDING)

24 Management of haemorrhage Damage control Primary survey theatre Massive haemorrhage policy Tranexamic acid

25 Flow chart for Massive Haemorrhage Protocol Clinical Area Immediate assessment of cause of bleeding and appropriate management TEAM LEADER MUST DECLARE Massive Haemorhage- clinical area if: Clinical evidence of suspected massive haemorrhage Nominated member of team Generate emergency ID number for patient Call switchboard Notify massive haemorrhageclinical area and request Senior support Send porter for Emergency Blood 4 units Switchboard send out Massive Haemorrhage- clinical area- Alert blood bank by phone (day) or bleep (OOH), Porters Lodge, appropriate Specialist Consultant and Consultant Haematologist Take baseline blood samples prior to transfusion Including FBC, crossmatch, CloVng screen and fibrinogen Send porter direct to lab with samples And to collect FFP x 4 plus O Neg Red cells x 4 Immediate Transfusion Give Emergency : O Neg red cells x 4 units 4 units FFP and further 4 O Neg units red cells Senior review of management plan and appropriate interven4on to arrest bleeding If bleeding con4nues Contact lab to inform of need for ongoing support Send porter to collect: 4 units red cell, group specific, 4 units FFP, 1 platelet pool, Fibrinogen concentrate 4gms REPEAT FBC AND CLOTTING SCREEN Administer further products if: Platelets <80x109/l 1 pool platelets (2 if <30) Fibrinogen <2.0g/l 4gms fibrinogen APTT / PT ra4o >1.5 x normal 6 units (1.5 litre) FFP Laboratory protocol : Massive Haemorrhage Call for assistance Assume O neg used Thaw 4 A FFP Issue 4 O Neg (emergency use) Restock emergency O Neg Ensure Platelets available Check fibrinogen available

26 Nine steps for Successful Co-ordina4on in Massive haemorrhage (adults) Recognise trigger and pathway for management of massive haemorrhage. Send Porter for Emergency blood 4 units. Allocate team roles. Complete request forms/take blood samples-label samples correctly/recheck labelling before dispatch. Communica@on lead to be contacted by BMS (no@fied by switchboard). Request blood products. Effec@ve communica@on between the laboratory and clinical area. Communicate STAND DOWN of pathway to Laboratory and Porters. Ensure documenta@on is complete. REMEMBER ZERO TOLERANCE ON INADEQUATE LABELLING IDENTIFIERS LAB BMS CONTACT Morriston Ext 3054 during core hours ( & Saturday ) Bleep 3914 Out of hours (Saturday Monday) Bleep via switchboard if no answer Singleton Ext 5075 during core hours ( & Saturday ) Bleep 5716 Out of hours (Saturday Monday) Bleep via switchboard if no answer POW NPT 2585/2343 Bleep 253 OOH 2367 PORTER CONTACTS Morriston Bleep 3916 Ext 3098 Singleton Bleep 5643 Ext 5372 POW Bleep 270 Ext 2481 Cisco 6270 NPT Bleep 2921 Ext 7750

27 SUMMARY. Criteria for of massive haemorrhage policy Roles and ACCURATE IDENTIFICATION, COMMUNICATION AND REVIEW Use of tranexamic acid