The 8 Rights of Transfusion Administration

Nurses have known and upheld the five rights of medication administration for decades. The Transfusion Medicine community quickly and readily adapted these rights to another high volume, high risk hospital procedure: transfusion administration. Recently, the five medication administration rights have been expanded to eight, all of which apply to blood product transfusion: right product; right patient; right dose; right time; right reason; right site; right documentation and right response.1  Continue reading

Some principles of pediatric blood management

We have all heard the phrase “it’s the principle of the thing.” This phrase reminds us that in everything we do, including the clinical management of patients, there are both precedents and principles to guide our decision making processes. The principle of “doing the right thing” should be utilized in pediatric blood management and in making evidence based transfusion decisions. Most of us are familiar with, and may well already be using, a Computerized Provider Order Entry (CPOE) system; which incorporates evidenced based practice (EBP) guidelines in an electronic order entry format. This EBP function is crucial in supporting the clinician’s decision to transfuse, and how much, if any, blood product is appropriate. Decision support systems can also help in areas such as pediatric blood volume management and anemia management. Some pediatric blood conservation centers utilize Electronic Medical Record (EMR) systems to monitor other blood management considerations such as intake and output, utilizing the output feature to monitor lab waste and sampling volumes. The EMR alerts the clinician when, based on the child’s body weight, and a 24-hour time period, the patient has reached maximum blood volume depletion due to sampling. Other centers have created a unique set of guidelines for pediatric lab sampling by which only the amount absolutely indicated is taken, lab tests are batched, and add-ons are encouraged. These strategies work together to promote blood conservation, maintain limited blood volume reserves, and conserve a very precious resource. Continue reading

Risky Business? The Relative Infectious Risks of Blood Transfusion

Every medical intervention has an inherent risk.  Blood transfusion is no exception. Physicians must know the risks versus benefits of therapeutic modalities for each specific patient treated.  Unfortunately, disproportionate emphasis is sometimes placed on the risks and potential infectious complications of transfusion, in part due to transfusion transmitted HIV in the 1980′s.  Continue reading

A Precarious Position

In July, Strategic Healthcare Group will be highlighting information on antiplatelet and anticoagulant medications, both old and new.  The webinar and the Ask-the-Expert segment, will focus not only on the pharmacological mechanisms of these drugs, but the controversies surrounding their benefits, risks and reversal strategies, if available or adequate. Continue reading

Cheap and Effective: the Tranexamic Acid Story

On March 20th the New York Times1 (NYT) reported on a study in BMC Emergency Medicine (http://www.biomedcentral.com/1471-227X/12/3/abstract) that use of tranexamic acid (TXA) in trauma patients could save up to 128,000 lives annually worldwide, 4,000 of them in the United States. Yet U.S. hospitals have been slow to adopt the use of TXA in trauma patients. The issue is not cost; TXA is quite inexpensive, averaging much less than $100 per treatment in most U.S. hospitals. And the issue isn’t that the drug lacks efficacy or is unsafe since safety and efficacy have been shown in the CRASH -2 trial2. Continue reading

Anemia Management in ESRD: On the Horns of a Dilemma

Recently, I have had several queries and personal communications regarding a perceived increase in RBC transfusions for patients with end-stage renal disease (ESRD) on dialysis.  The literature is replete with articles surrounding the management of anemia in this patient population, particularly involving the use of erythropoietin-stimulating agents (ESAs).  The literature is limited, however, when it comes to clear guidelines for transfusion.  In fact, transfusion is most often discouraged in this population if, in particular, the patient is awaiting a transplant where alloimmunization must be avoided. Continue reading

Who is truly ordering transfusions at your hospital?

As Blood Utilization Committees work to implement standardized transfusion order forms that encourage clinically appropriate transfusions, I am seeing that it is often nurses who are filling out the forms (whether on paper or electronically) after the physician writes the order on a blank form. Nurses and BUC’s need to recognize the potential legal implications of this practice.  Continue reading

The Storage Lesion: Soldier on and stay tuned!

Transfusion has been a mainstay of patient care for years.  It is identified as the #1 procedure performed in hospitals.1  The development and ultimate use of specific blood components has provided ways to tailor transfusion therapy to the patient’s clinical needs.  Processing and storage of blood components, although allowing for more targeted and diverse therapy, also may have its attendant downside.  Transfusion, of course, is certainly life-saving in many instances, however recent attention and scientific literature have highlighted the increased risk-to-benefit ratio associated with transfusion.  The so-called “storage lesion” may play a part in some transfusion-associated adverse events.

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Obstetric Hemorrhage

Obstetric HemorrhageTransfusion support for the obstetric patient is complex and demands a significant understanding of the peri-partum physiology, bleeding risk assessment and knowledge of other useful mechanical, pharmacological, and surgical interventions.  Variability in  obstetric transfusion practice mirrors that seen in general medical and surgical practices.  Even the definition  of what constitutes “significant hemorrhage” is plagued by the underlying difficulty in estimating blood loss and risk stratification. Continue reading