Trauma Blood Transfusion

911fltrn · Jan 7, 2003

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911fltrn · Jan 7, 2003

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pointhope · Jan 7, 2003

Thanks for the reply. I work in a non-Trauma hospital and we rarely have the need to transfuse so quickly. We have the "luxury" of waiting to watch for transfusion reactions with each unit given to the patient. I knew that it was possible to give many units quickly, but had never really thought about it much.

Trauma Columnist · Jan 7, 2003

Actual guidelines vary by hospital. For written policy - our level one trauma center uses a lot of policy and procedure from the Emergency Nurses Association (ENA).

BTW I sure hope that 911's post was in jest - someone who doesn't follow p&p will soon find themselves w/o a job. Especially ER and flight RNs.

Liann · Jan 7, 2003

I am a blood bank medical technologist in a Level 1 trauma center. Our ER docs and surgeons can call for 20-30 units of RBCS, FFP, Cryo, platelets in the blink of an eye. We try to save EVERYONE who gets through the door. I have no idea what the policy is on rapid infusing, but it seems that if theres the remotest chance of saving a life, we are gonna take it. It can be a real chaotic time in the BB to get all those products ready, but if a patient makes it...we feel pretty darn good.

Of course we also have those situations where theres more than one trauma going on....theres a real test of character...:)

montroyal · Jan 7, 2003

Four units of blood in twenty minutes thru a 32 french foley which was placed thru a stab wound in the left ventricle of a patient. There is no way you can write a P&P for every situation, especially trauma. In the above situation, a patient presented with a stab wound to the left chest. No pulse which meant no access. The trauma surgeon cracked the pt's chest and found the stab wound had penatrated the pt's left venticle. I thought he was crazy when he yelled for the biggest foley we had. He then proceded to place the foley into the stab wound and inflated the 30cc ballon. He pulled the foley back, which sealed the wound and we started running blood thru the foley as he sutured the wound. Once the wound was sutured, he deflated the ballon and pulled the foley, then sutured were the foley was. It was the coolest thing I had ever seen. The surgeon used quick thinking and the available resources to treat the patient. Unfortunately, the patient had been down to long and did not respond to our efforts. Emergency situations require quick and sometimes unconvetional treatments. As long as you live by " Do no harm" philosephy, your actions cannot be perceived as wrong.

OzNurse69 · Jan 7, 2003

The thing you have to remember too, is with multi-trauma pts, there is so much more going on with them, that if they happen to develop a rash or slight temp as a result of the blood transfusions, who the hell is going to notice or care?? It's a case of the end justifying the means....

dawngloves, BSN, RN · Jan 7, 2003

Originally posted by montroyal
Four units of blood in twenty minutes thru a 32 french foley which was placed thru a stab wound in the left ventricle of a patient.

No sh*t!!!! :eek:

What was the outcome?

cmggriff · Jan 7, 2003

Dude! The Foley thing is awesome! I once infused 2 units in 10 minutes using the little squeeze bulbs on blood tubing. You try for a mean arterial pressure of 60 in most instances. We changed a patients blood type in the Gulf from O pos to A pos. You do what you have to to keep 'em breathing. Gary

cactus wren · Jan 7, 2003

My personal record is 5 min...by squeezing like he$$, was faster than pressure bag....was anplacenta previa who was bleeding out...she made it ,babe didn`t....

p.s. Montroyal.....way neat avatar...Almost Daytona time...YIPEE!!

Liann · Jan 7, 2003

The hospital transfusion committee requires followup on massive transfusions (among all their other stuff to monitor) and transfusion related lung injury and hepatitis are a necessary risk that is taken to save a life.

We have had to occasionally change a pts type when either we could not get a spec for typing, or the pt was drinking down all our stock and we couldnt order in blood from our supplier quick enough.

We have a high risk population that routinely comes thru the ER and when looking up cards for previous typings, I often see notations that he pt has been given a trauma number several times before...sigh...