Resuscitation and massive transfusion are rapidly changing areas in healthcare. Acute hemodilution of platelets and clotting factors is a major problem associated with massive transfusion. In a massive transfusion setting, I like to say: If it doesn’t carry oxygen or make a clot, don’t give it. Therefore it is critical to establish large-bore IV access. The reason I have MTP second is that without adequate IV access you can have all the blood products you need and not be able to administer them fast enough. Once you have established large-bore IV access, you can start administering blood products. Part 2: Massive Transfusion Protocols (MTP) READ that article! It’s very well done and goes into great detail on why you should not use needless connectors on your IVs for resuscitation or massive transfusion. There is a great article in Anesthesiology News about this called: Goodbye, Large-Bore IV Access which you can find here. Attached your IVs directly to the catheter without anything in between. Key Point: Once you place your large-bore IV access, DON’T place needless connector caps on the catheters. Sign up for our Free Ultrasound-Guided Subclavian Course If you want to learn how to place ultrasound-guided subclavian central venous catheters look at our post or even better sign up for our free course below: The best central venous catheter for massive transfusion protocols are going to be your Introducer Catheters or Rapid Infusion Catheters (RIC) You need the right CVC for the situation and your basic triple lumen CVC is not enough. Using values from a table provided by Smiths Medical you can see that: The actual gravity flow rates differ based on exact size, length, and brand. Some people like to call an 18g IV large bore but in a true massive transfusion situation, the flow rates from an 18g IV are just not enough. For the bleeding patient, you need large bore IV access. Here are the items you have to get right or you will be left in a very challenging situation. Like most high acuity problems in healthcare, the details are critical. IV Access + Massive Transfusion Protocol + Mechanical Transfusion Device A well-executed massive transfusion protocol (MTP) consists of 3 parts: Most of these situations are best handled with massive transfusion protocols (MTP) but a massive transfusion protocol alone won’t lead to a great outcome.įrom a patient safety perspective, there is a great opportunity to improve patient safety through the development and implementation of massive transfusion protocols at your institution. It can be the ED trauma patient, the OB with a placenta accrete, an open aortic aneurysms repair or even your GI bleed patient in the ICU. The exsanguinating patient, it’s a problem we don’t want to experience and can be found all over healthcare.
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