Trauma Blood Transfusion - page 2

Anyone out there ever had the need to give multiple units in an emergency situation where the time for each unit to infuse was less than 15 minutes. I need to know where to find written rules for... Read More

  1. by   Liann
    Zoe --your story made me think of a time we had a bad trauma like that and were begging for a blood specimen to type in hopes we ccould give type specific instead of giving out all our O negs. Every hand was needed to push blood in, but some clever nurse got us a specimen from a small puddle on the gurney...at least thats what she said
  2. by   CashewLPN
    ok... not to sound stupid... but, how does one go about changing blood type? exchange all the blood?
    (feeling about an hour behind)

    --Barbara
  3. by   Liann
    In cases where type cant be determined, our policy is to give women of childbearing age type O neg. Men and older women get O pos. After 10 units of RBCS have been given ( thats called massive transfusion) we keep on giving the new type since thats all thats in the patient at that time. We will get a new specimen in 3 days and will go back to the patients original type when their reverse blood typing stops showing anti A or anti B (depends on what their original type is of course)
  4. by   DIPLOMATICRN4HIRE
    Oh there was so much blood puddled everywhere we didnt start hanging this patients type until like 20 minutes in the OR. The Charge Nurse in the ER yelled to the UC to call every hole possible and snatch every O bag they could find. We had blood coming from everywhere and when we got into the OR we were hooked up on(2) cell savers as soon as we moved the patient to the table. No telling how many times we reinfused.
    Zoe
  5. by   Liann
    And the thing about changing from O pos to A pos that cmggriff says happened in the Gulf must have been a plasma thing. If you gave A cells to an O person they would not have made it too long.....can you say hemolytic transfusion reaction?????
  6. by   Sally_ICURN
    On my CT surgery unit we get patients from the OR, who within an hour post-op, are bleeding out so profusley through their chest tubes that it's necessary to use the Level 1 rapid infuser just to keep up with the output. That infuser pushes a unit of blood into a patient in the blink of an eye and that's not to mention the cryo, platelets, and plasma that aren't infusing through the rapid infuser but being pushed in manually or with a pressure bag. The Level 1 can deliver up to 24 units of blood in an hour and in most cases, there is NO WAY to even get the initial set of VS's before you hang the bag in this situation let alone 15 minutes later! There's just too much going on.

    We have computerized charting in my ICU and fortunately, after all is said and done, we can go back and fill in vital signs on the paper that comes with the units of blood from the lab (which I think is a waste of the RN's valuable time because there is usually a nurse charting vitals on the computer q 5-15 minutes in this situation anyway, why must we write them on the paper as well! argh!). Each and every unit number transfused is documented and the input volume is always recorded, but there's no way to correlate which vitals go with which unit. It's basically an overall massive transfusion assessment.

    You do the best you can.

    ~Sally
    Last edit by Sally_ICURN on Jan 7, '03
  7. by   Sally_ICURN
    I also wanted to mention that when the rapid infuser is used in the OR, anesthesia DOES NOT write vitals on the paper from the lab. They make a note to "see OR flowsheet." What's up with that?!?! Why can't we as nurses just write on that sheet, "see computer (CareVue in my case) flowsheet"?!?!?

    ~Sally
  8. by   pointhope
    I can't tell you guys how valuable all the replies have been. I envy you and your stamina. If you guys are not young and vital you must be young at heart to live daily in those stressful trauma hospital ERs. Maybe someday I will join you, cause you sound like lots of fun. For now I'll keep my spot in non-trauma and let the movies be made about you guys. Keep it up. Thanks
  9. by   Liann
    Not sure what computer system your BB has, but I suspect that you need a sheet from the lab because your Carevue does not interface with the BB. In case of transfusion reaction or a blood recall, the BB needs to have the complete documentation. I think its a waste of my time to have to remember to send a sheet to the OR because anesthesia does not bother to record vitals or have 2 signatures on the chart when transfusing.

    I have also had nurses from ICU call me to ask how many units their patient got because no one recorded stuff during a bad GI bleeding episode. I have the whole hospital to deal with and they wanted me to look up each and every unit number on that one patient (who died , sadly) because of their neglect to record or even to rip off the tags for gods sake. Sorry to vent, but I was PO'd because I was swamped that day and the "nurse wanted to go home" Me too!!!!!!! I did make the time to look them up...but it was later in the day. my priority had to be with the living who were in surgery at the time......
  10. by   Sally_ICURN
    Originally posted by Liann
    Not sure what computer system your BB has, but I suspect that you need a sheet from the lab because your Carevue does not interface with the BB. In case of transfusion reaction or a blood recall, the BB needs to have the complete documentation.
    Our computers do interface. Even if they didn't, if there was some reaction, we do have complete documentation. We even keep the empty bags/tubings in a seperate bio-bag when giving multiple units at a time.

    What I'm saying is if 2 RN's/MD's sign the "paper," and the vitals, unit #'s, and volumes are readily available from the computer flowsheet (and btw, more readable), why oh why do we have to write the vitals on the paper as well? Is it a law, if it is a law to hand-write this information, then it's a dumb law. It just doesn't make sense to me...it's a waste of time. Eventually, at the end of the patient's ICU stay, the flowsheet gets printed out and placed in the medical record right along with those "papers." It's duplicate information, with the exception of the signatures on the papers. All I want to do is write "see flowsheet for vital signs" on the paper and sign it. Sounds good doesn't it?

    The OR has handwritten flowsheets completed by the anesthesiologist. Those flowsheets also have a least q 15 vitals but they don't write the unit #'s on their flowsheets...they just send the paper to us to place in the medical record. Sometimes it's signed by two licensed people, sometimes by one, and sometimes not signed at all.

    I and nobody I work with would ever do what you describe about calling the BB to find out how many units were given to a patient. That's just irresponsible nursing practice in my opinion.

    I'll bet this thing of nurses duplicating this work is just a hospital policy that needs a major overhaul.

    ~Sally
    Last edit by Sally_ICURN on Jan 7, '03
  11. by   Liann
    Thanks for clarifying that situation. If your computer systems do interface, then there is no reason I can see to duplicate the info. Perhaps the policy does need to be updated. Staff is way too busy to do double the work if its not necessary!

    Thanks also for the consideration for us med techs in the BB. We appreciate a kind word now and then. We work short staffed and often get no break or lunch.....and yet I love my job!!
  12. by   Sally_ICURN
    Originally posted by Liann
    Thanks also for the consideration for us med techs in the BB. We appreciate a kind word now and then. We work short staffed and often get no break or lunch.....and yet I love my job!!
    You're welcome!! Been there done that! Was a med tech (chemistry/hematology) for 8 years before becoming an RN!

    ~Sally
  13. by   parklandtrauma
    approx 35 units prbcs and about 7 ffp via level one infuser a 9 french chordis and a 14 gauge AC piv in about 35 minutes. blunt trauma with major vascular injury to both thoracic and abd. that is just what i infused. i had to leave early and let the anesthesiologists finish final count over 80 blood products in under two hours

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