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ksmith

Massive Transfusion Protocol - 400 bed non-trauma hospital

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We are updating our Massive Transfusion Protocol.  We are a 400 bed non-trauma facility that does not keep FFP thawed.  We would probably have 2-4 MTPs per year.    How are other similar sized facilities handling these?  Do you include only blood products in the initial phases?  At what point do you add other labs or meds to the protocol?  Who do you designate to contact the BB of the initiation & to stop the MTP?  If anyone has a flowsheet or process map that they are willing to share, it would be much appreciated.   Also interested if anyone has designed a review form to evaluate each MTP after the event to look for ways to improve the process.  Thanks. 

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In general, an MTP policy is set up between ER, OR and the Lab.  Here it was the OR and ER physicians who decided  what it should include.  We started with an MTP partly directed by lab results, but found it unnecessarily cumbersome in practice.  For our BB, an MTP includes setting up sets of blood products until the MTP is called off.

If you search here with the word "massive" you will see a number of threads that may give you a few ideas.

Scott

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400 bed level 1 trauma center which just changed the mtp protocol which seems to be working well. Previously, 4 red cells were sent out every 15-20 minutes with platelets, plasma and cryoprecipitate being sent base on lab results. As Scott mentioned above cumbersome and it seem like we couldn't keep up. Now every 15 minutes; 6 red cells, 6 plasmas (usually low titer A) and a platelet pheresis is dispensed. If the patient is an OB then a pooled cryo is also sent.

Part of the MTP start order includes lab orders that can be pulled 6 times during one start order. I don't have any idea how that works or what happens when the 6 orders are used up. But the orders are PT-INR, fibrinogen, platelet , ROTEM and H &H.

The other level 1 trauma center is using whole blood low titer O which they send out 6 units every 15 minutes. Which sounds heck of a luck easier than what we do. But they use a different blood supplier than we do (ours doesn't have low titer O). Also we are AABB accredited and there is some issue with AABB and giving low titer O   whole blood to non-O patients.

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We are a level 2 trauma center. Our original MTP order includes FFP (including liquid plasma) x 6, packed cells x 6, and pltph x 1.  Blood tests drawn with that original order are ABG, CBC, PT, PTT, Fibrinogen, D-Dimer, TEG, Chem 7, and Ionized Calcium.  Every hour for 3 hours (if the protocol goes that long), we order ABG, CBC without diff, PT, PTT, Fibrinogen, D-Dimer, TEG, Chem 7 and Ionized Ca.

After the first pack of blood products is taken, blood bank orders in the next pack if told to continue.  Second pack and every other pack is the same products but also includes pooled cryo x 2.  If the MTP is an OB patient, the pooled cryo are sent with the first pack.

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As a smaller hospital with 2-4 MTPs a year anticipated - you might find it easier to go with smaller loads in the rotations.  I  will try attach our policy.  Smaller loads let you respond faster - when you probably do not want to keep this stuff "ready to go" as a Level 1 trauma center has to.  You also lose less when they stop the MTP, but you don't hear from them in time to stop thawing the FFP and/or Cryo pool.  

 

Massive Transfusion Protocol -MTP- - Blood Bank Procedure - Adult.pdf

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