Blood Product Distribution in Massive Transfusion Situation

[Ellis M. Frohman]

We are reviewing our processes for releasing blood products in a massive transfusion situation (10+ units of RBCs). We currently issue each unit with its own paperwork requiring signatures for each unit. This process replaced the use of a Massive Trandfusion distribution form where all units in a box of 10 were listed on a single sheet. We found that OR personnel were not completing the form to indicate which units were used or they just drew lines down the page and signed at the bottom.

How do other organizations handle these type of situations? Please share your SOP or form with us. Thanks.

[Mary]

Each unit will have different start times, vital signs, transfusionist, etc. I think it is best to use single sheets.

[David Saikin]

I worry about the paperwork "after the fact" when transfusions are uncrossmatched in emergent transfusion situations. The transfusions are documented on the chart and the team is not going to bother with the paperwork, as they are more interested in the patient at those times.

[MGYog]

We have an MTP Protocol for Trauma, which has been quite successful and been in place for 2 years We have a very active Trauma Department. It really needs close and complete cooperation with the Trauma department. If you are interested, email me directly at [email address removed by admin to help prevent spam - please contact this member by clicking on their name on the left, and selecting Send Email To...]

[A BURGESS]

Due to the geopgraphy of the site and location of laboratories in relation to key areas we have a number of O negtive units issued to "EMERGENCY ISSUE". The units have their own individual paperwork and labels for insertion in the patient's notes. The laboratory has a record sheet of the Key locations and units issued for "emergency". When blood has been used paperwork is returned with details of the patient recieving the unit(s) and replacem,ent made.

Where a patient's unique identifiers are known units (group specific where time permits) are issued with labelling which conations facility to return an acknowledgement of use.

Edited December 29, 2009 by A BURGESS
spelling errors

[tbostock]

I agree with David Saikin. In a truly massive transfusion, they will not complete each individual form (at least they don't at my place). We get a stack of them back, all partially filled in. The transfusionist should be the same (usually the anesthesiologist) and the vitals for the whole case are documented on the chart, so they will not (and shouldn't in my opinion) take the time during the crisis to document the vitals for each single unit. We consider this "one" transfusion of multiple units, and keep all of the forms stapled together.

I'm sure an inspector would have a problem with this, but, again, in a true MTP situation, the goal is to get the right blood type, match to their ID band, and get the unit in quickly.

[adiescast]

We issue each unit with an individual tag. Signatures that the unit was checked against the patient ID are required on all units. We have a check box on the tag for ER and OR to check that says "Blood given in emergency situation, see chart for vitals" or "Blood given in OR, see anesthesia flowsheeet for vitals." This has been through multiple inspections by CAP, AABB, and FDA without comment.