using TEGs

Specialties CRNA

Published

Any experienced or new grad CRNAs using TEGs to guide their fluid resuscitation in cases involving large volume loss?

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Specializes in CTICU.

I'm not a CRNA, but I'm fascinated by this question. Do you mean deciding which blood products/factors to give? I can't imagine how else TEG would guide fluid resuscitation!

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I have over 12 years experience w/ TEG's. I work at a Level I Trauma/Transplant center, which includes liver transplants. We don't do a big case without TEG's.

TEG's=thromboelastograph. Definition-measures elasticity of the thrombocyte(platelet). But it does so much more!

What it is: .36 ml of whole blood placed into a cup, into a "well" at body temp. A "pin" slowly rotates to stimulate clot formation, enhanced by kaolin. This speeds up the process for quicker results. You get a picture of clot formation, which is what is actually happening in the pt.'s system. It is both qualitative and quantitative. There is a certain normal picture; and then there are variances which correspond to specific factor deficiences. Or real simple, is the pt just cold? Or is it SURGICAL?! Another plus-traditional (PT/PTT/INR) ignore fibrinolysis...It is a guideline to CORRECT factor transfusion-we use less FFP/platelets,etc... I LOVE the TEG.

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Stryker1,

What is the turn around time for TEGs at your facility? Is it quick enough for traumas and other resuscitation scenarios?

One complaint I've heard is that it takes too long for it to be helpful.

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You have been misinformed re "too long of a turnaround..."

We do them right in the OR.(Several of our OR's are oufitted with the TEG machines.QC testing, normal range values, etc. are maintained as per ASCP standards.) Its FASTER than the labs can do any coag test.

So-Blood drawn, taken to machine....sample starts...You get a pretty good idea of coag function in about 15 minutes, and you can watch it in REAL time.

We also add FFP, amicar, protamine, platelets, or heparinase to the sample to rule out/find out what treatment would work. With a normal whole blood sample as a "control", of course. (Same sample for all tests/additives)

And how long does a PT/PTT/INR FDP, etc take?!!!

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Specializes in CTICU.
I'm not a CRNA, but I'm fascinated by this question. Do you mean deciding which blood products/factors to give? I can't imagine how else TEG would guide fluid resuscitation!

So that's a yes, then.

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