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Massive Transfusion Protocols for small Critical Access Hospitals


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Howdy everyone!

 

We are a small critical access hospital with 25 beds, and we are looking at implementing a Massive Transfusion Protocol to stabilize a patient as much as possible before they are airlifted to a larger facility.

 

I have had very little luck finding any smaller hospitals that have such a protocol, and would love to hear from anyone regarding input on tailoring a MTP to a facility with limited resources.

 

We do currently have a protocol defining the utilization of O+ units for adult male patients and women over childbearing age.  We do not have the ability to provide platelets, rapid fibrinogen testing, TEG/ROTEM, or cryoprecipitate (though as a frozen product, we may decide to add that to the inventory).  The addition of Tranexamic Acid, KCENTRA, and PCCs has been discussed, but there doesn't seem to be much information about their use when a patient is going to be airlifted within 1-2 hours.

 

Thoughts? Links? Procedures anyone would like to donate?  As a night-shift generalist in a small facility, I am perfectly comfortable admitting that Blood Bank is not my specialty, though I really enjoy the work!

 

Thank you!

Leah

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  • 9 months later...


We are a rural facility - medium sized - with limited platelet stock and a long way from our blood supplier. I'll attach the process maps we use and our facility policy.

ERIII-47_Massive_Transfusion.docx

Massive Transfusion Adult Process Map.doc

Massive Transfusion Child 0-15 Years Process Map.doc

Massive Transfusion Blood Bank Process Map.doc

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Thanks for the new replies, all!

 

We are in the process of developing our current protocol, and strongly considering a long-term investment in the microwave plasma thawers for rapid plasma thawing.  It will be our best chance at coming closest to the 1:1 ratio currently recommended.  Especially, thank you for the attachments.  It really helps seeing different written procedures, and you both had some fantastic ideas that we are going to look at for incorporating into our protocol-in-progress.  Blee, even though we haven't finalized our setup yet, I will send you (and anyone else who is interested) my research files and the powerpoint presentation I used to outline some of the challenges we needed to address at our facility.  We had a very long lull when the primary provider responsible for deciding on the protocol details was derailed by other projects, but it's back in a priority position now.  I'll be happy to share the final product with any interested parties as well as soon as it is completed!

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Thanks for the new replies, all!

 

We are in the process of developing our current protocol, and strongly considering a long-term investment in the microwave plasma thawers for rapid plasma thawing.  It will be our best chance at coming closest to the 1:1 ratio currently recommended.  Especially, thank you for the attachments.  It really helps seeing different written procedures, and you both had some fantastic ideas that we are going to look at for incorporating into our protocol-in-progress.  Blee, even though we haven't finalized our setup yet, I will send you (and anyone else who is interested) my research files and the powerpoint presentation I used to outline some of the challenges we needed to address at our facility.  We had a very long lull when the primary provider responsible for deciding on the protocol details was derailed by other projects, but it's back in a priority position now.  I'll be happy to share the final product with any interested parties as well as soon as it is completed!

We have a microwave thawer; we like ours.  Very fast.

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Is anyone out there using liquid plasma for this?  We are strongly considering the use of the 26 day outdate never frozen liquid plasma just for our trauma and MTP patients to provider faster stability if possible.  We are also a critical care access hospital in a rural community over 2 hours from our blood supplier.   

 

Thanks for any information that you can provide.

 

 

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i can't imagine a 26 day old plasma.  I did donors for more than a few years and we sold a lot of plasma as recovered.  I would be interested in how it looks as it gets older.

All the studies so far show that liquid (never frozen)plasma is superior to thawed plasma up to the expiration date. I'm sure there will be further studies as interest is increasing. It does kind of make sense...would you rather eat a fresh steak or one that has been frozen for a year and thawed? :)

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  • 5 months later...

We have a microwave thawer; we like ours.  Very fast.

Is a microwave thawer the quickest plasma thaw technology currently on the market?

 

Is Tropitronics, Inc. the only vendor of this technology in the U.S.?

 

Thank you.

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Is a microwave thawer the quickest plasma thaw technology currently on the market?

 

Is Tropitronics, Inc. the only vendor of this technology in the U.S.?

 

Thank you.

Yes, it is the quickest and as far as I know Tropitronics is the only vendor in the US.

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  • 1 month later...

Can anyone elaborate on MTP without the use of coolers?

 

I already have 6 coolers validated 3 for OR and 3 for our cancer clinic. I do not want anymore!

 

I have a surgeon wanting to implement a MTP here with coolers.

 

We are steps away from the ER so we are really hoping we can talk them out of the coolers.

 

 

Do you just get the "pack" ready as in have the units ready but keep them in BB and issue you them as they come?

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I would recommend for coolers. We set up batches in the blood bank in the cooler before they arrive and hand it off when they show up, then prepare the next, so on. Frequently we'll get coolers back with products in them. We also affix Hemotemp stickers.

Edited by goodchild
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Can anyone elaborate on MTP without the use of coolers?

 

I already have 6 coolers validated 3 for OR and 3 for our cancer clinic. I do not want anymore!

 

I have a surgeon wanting to implement a MTP here with coolers.

 

We are steps away from the ER so we are really hoping we can talk them out of the coolers.

 

 

Do you just get the "pack" ready as in have the units ready but keep them in BB and issue you them as they come?

We're also close enough so we just run the blood.  We're also looking into other options.  We have not had success with coolers and the temp stickers.

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As far at the batches and ratios of blood products that you are preparing for the MTP.

Is someone actually ordering X number of RBC's on MTP patient, X number of FFP on MTP patient...

and who is responsible for ordering that ?

Edited by amym1586
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My staff of all generalists, though competent in BB, are not initiating a MTP. These events here are very rare (I can only think of 3 in the last 20 yrs). Our protocol is the MD running the show has to call it. Once initiated WE will take care of ordering product. Seems a moot point since we don't stock plts and they are at least 90 minutes away (if the police drive like banshees).

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My staff of all generalists, though competent in BB, are not initiating a MTP. These events here are very rare (I can only think of 3 in the last 20 yrs). Our protocol is the MD running the show has to call it. Once initiated WE will take care of ordering product. Seems a moot point since we don't stock plts and they are at least 90 minutes away (if the police drive like banshees).

I'm in the process or writing everyone's responsibilities after the Dr has initiated the MTP. We hope to have an average of only 1 a year. I'm just trying to think of every thing now so when it happens I don't get called at 2 in the morning.

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Our MTP protocol defines that lab can enter orders for any products needed once it is implemented.  In fact it also defines some lab tests (coag, iStats, plt counts) that can be ordered by lab based on the box checked on a label on the specimen bag. These are legal orders because they are all defined in the protocol.

 

Another thought for small places, we have had a speaker who was expert in treating Jehovah's Witnesses and many of them will take cryo.  She says that cryo can help platelets work better if you can't give platelets.  Because of its long storage time and its quick thawing time I have wondered if it could be used in small, remote places that can't get plts quickly.  We get it in pools of 5 so no pooling at the time of the crisis.  We have a heart surgeon that has been using more cryo lately.  I suspect there are some articles out there supporting this.

 

If you deliver babies, make sure you stock the Bakri balloons (check the spelling on that) to inflate in a hemorrhaging uterus.

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Another thought for small places, we have had a speaker who was expert in treating Jehovah's Witnesses and many of them will take cryo.  She says that cryo can help platelets work better if you can't give platelets.  Because of its long storage time and its quick thawing time I have wondered if it could be used in small, remote places that can't get plts quickly.  We get it in pools of 5 so no pooling at the time of the crisis.  We have a heart surgeon that has been using more cryo lately.  I suspect there are some articles out there supporting this.

 

We had a presentation from a Jehovah's Witness hospital liaison who also indicated that Cryo is 'acceptable.' Recognizing that refusal of blood products is a unique/personal choice for each individual and not a blanket for all Jehovah's Witnesses.

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  • 4 years later...
On 4/13/2015 at 8:12 AM, tbostock said:

Do you have a quick way to thaw plasma? Early use of plasma in your MTP will improve outcomes.

See attached for my MTP policy; it's probably more than what you need but use what's helpful.

Massive Transfusion Protocol, Feb 2014 rev, 5-8.doc

Thank you for posting this. It will be a HUGE help for my facility!

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