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02.08 Massive Transfusion Protocol

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Overview

Massive transfusion protocols exist when patients require more than 10 units of PRBC in a 24 hour period or 5 units of PRBC 1 hour. Patients with massive blood transfusions are at an increased risk for coagulopathies.

Nursing Points

General

   

  1. Indications for Massive Transfusion Protocol
    1. Trauma
    2. Hypovolemic shock
    3. Hemorrhage
    4. Surgery
  2. Complications
    1. Coagulopathies
    2. Electrolyte abnormalities
    3. Hypothermia
  3. Administration
    1. 1:1 or 2:2 ratio
    2. 2 units of PRBC: 2 Units of Plasma
    3. Replace/Manage electrolytes as needed

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Video Transcript

Hey guys, in this lesson we’re going to talk about massive transfusion protocols. So knowing what an MTP is, that’s another term, just abbreviation MTP, massive transfusion protocols. It is usually initiated when a patient needs 10 units of packed RBCs in a 24 hour period or five units of packed RBCs in one hour. Some hospitals will activate an MTP when components of blood products are administered within 30 minutes. Remember that when we give one unit of blood, one unit of packed red blood cells, we usually do this in about two hours. Four would be the max, but in about two hours. And when somebody needs 10 or more in a 24 hour period, that’s when you have to take other precautions. So why would somebody need MTP? We’ll obviously trauma would be a big cause. Think of somebody that’s in a motor vehicle accident and has had pretty significant trauma and they are bleeding everywhere or somebody who is in hypovolemic shock because of hemorrhage.

Somebody who has had a GI bleed or a ruptured aortic aneurism. I recently had a patient, they came in with a pretty significant GI bleed and her hemoglobin was four. Remember that normal hemoglobin is usually between 12 and 16. Again, these can vary depending on the book and whether it’s male or female, but that’s a pretty average number. Hers was four. So you know that her organs were not getting the perfusion that they needed. She had altered LOC, she was in hypovolemic shock because she was bleeding. So we needed to get as much blood in her. Not as quickly as you would think cause she was still okay kind of hemodynamically stable. Another example of indications would be surgery, cabbage. Patients who come out after open heart surgery, they’re at high risk for bleeding. So we have to be ready to activate, we call it a code heart at the hospital when it’s a bypass patient that’s bleeding and we need to get as much blood in them as possible or as quickly as possible.

So these are some of the indications. Again, it would be just a situation where you need to rapidly replace blood products, in order to perfuse vital organs. So of course you typically activate a protocol and the first thing you would do when you know that you need, if you have a patient with hemoglobin of two and they are hemodynamically unstable, we call the lab. Remember that usually you get a type and screen to determine the patient’s blood type and to make sure that it’s compatible with the blood they’re going to send you when, well, in an MTP you usually don’t have that time. So O negative blood is the blood that they usually try to send up. And you called the lab and the lab starts bringing it up as you go so that you can quickly infuse this into people.

So because patients are usually actively bleeding in, they’re hemorrhaging. This can cause coagulopathy. These meaning, um, they’re bleeding. So their blood is not clotting like they should. So they’re going to be bleeding out. So one thing with MTPs is that the more blood you give them, the more they can potentially bleed. So a lot of the times they get plasma along with the blood that they’re gonna need. You have to be able to monitor for electrolyte abnormalities, people who get massive blood transfusions, are at higher risk for complications for having potassium problems and calcium. Usually they can become hypocalcemic or hypo, hyperkalemic. So you have got to watch these and remember that calcium has clotting factors in it and stuff to make us help clot up. So another reason why we start to bleed, another reason why we need plasma.

And so you have got to watch electrolytes when somebody is having an MTP and hypothermia, remember that blood is cold and when they keep it down in the lab, they keep it in the freezer. So when you don’t have time for them to warm it up, usually you get it cold. There are some machines that you can warm it up really quickly, and as you’re giving it to patient patients, it tries to warm up. But depending on how fast you’re given it, you can cause some hypothermia. So you gotta watch out for that. So again, as soon as you know that you need blood and you’ve activated it and the blood bank is bringing it to you, a lot of hospitals will do either one to one ratio or a two to two ratio, meaning for every packed red blood cell that they give you gotta give some plasma.

If you give 2 packed red blood cells, two units of packed red blood cells, and you would give ’em two units of plasma, or if you do two units of packed red blood cells, then you can do one unit of plasma. Again, it just depends on the facility. The point is you give this so that they don’t bleed out on you. And then you obviously have to watch those electrolytes and you fix them or replace them as needed. So to recap on this little lesson regarding massive blood transfusion protocols, you have to quickly identify the patients that need it. If you know somebody has a hemoglobin of one or two and they are hemodynamically unstable and they’re bleeding, we need to get as much blood in them as quickly as possible. So you activate it, make sure that you understand, depending on your facility, you’re going to give blood or packed RBCs.

And you’re usually going to give plasma to go along with it to prevent them from bleeding. And then of course, you monitor labs. You want to monitor your potassium, your calcium to make sure that they’re okay and you monitor for hypothermia.

So I do hope that this little lesson has helped you guys give you just kind of a basic understanding of the massive transfusion protocol and what it is and why you would give it. As always, make sure you guys go out and be your best selves today and happy nursing.

 

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