saintboniface.ca

Massive Transfusion Protocol

Go-live: Tuesday, November 17, 2015

saintboniface.ca

Reason for Action

• Rapid Release protocol for urgent clinical

scenarios is unique to SBH.

• Since the creation of the MTP at HSC, some

physicians that provide coverage at both sites

have become confused between the two

protocols.

• Increased potential to compromise patient safety

during a life-threatening crisis.

saintboniface.ca

What is a Massive Transfusion

Protocol (MTP)?

• Massive Transfusion Protocols provide large

amounts of blood products in predefined ratios

to patients with life-threatening hemorrhage.

• A massive transfusion is an emergency situation

where there is an expected transfusion of 4 or

more units of Red Blood Cells within 1 hour and

on-going substantial need is expected.

saintboniface.ca

Background

• Hospital based protocols have been developed

across Canada & the USA based upon

recommendations of studies published by the

US military on massive bleeding occurring in

war.

saintboniface.ca

Why Use It?

• MTPs improve survival in patients with

exsanguinating hemorrhage

(Rajasehkar et. al, 2011).

• Uncontrollable hemorrhage is the most common

cause of preventable death under 44 (Cotton et.

al, 2009).

saintboniface.ca

Where will MTP be implemented @ SBH?

• Operating Room

• Post-Anaesthesia Recovery Room

• Labour & Delivery

• ICMS

• ICCS

• Emergency

saintboniface.ca

Who is eligible for MTP activation?

• Intended for use in patients 16 years of age or

greater.

saintboniface.ca

Components of the MTP

• INITIAL PACK

-5 units PRBC (ready in 15 minutes)

-1000ml Fresh Frozen Plasma (ready in 40)

The initial pack will be a split delivery. The PRBC

will be delivered prior to the Fresh Frozen Plasma.

• SUBSEQUENT PACKS (will arrive hourly)

-1000ml frozen plasma

-1 adult dose of platelets

-5 units of red blood cells

saintboniface.ca

Red Blood Cells Fresh Frozen Plasma

•Platelets will come in a bag attached to the blue cooler.

saintboniface.ca

Sample of Packed Coolers

saintboniface.ca

Sealed Cooler

This is an example of a sealed cooler.

This is how the cooler will come to the unit.

The coolers are sealed with a plastic wrapping or velcro strap.

Each cooler also has a packing slip on the top.

saintboniface.ca

Do you require additional Blood

Products?

• Use the Blood Products STAT order set in the

EPR to order any products that are in addition to

the MTP packs.

saintboniface.ca

Baseline Blood Work

• Type & Screen

• CBC

• Lytes/Biochemistry

• Fibrinogen

• INR/aPTT

STAT collection

saintboniface.ca

Haemostatic Monitoring during MTP

• Complete blood count – every 1 hour

• INR – every 1 hour

• Fibrinogren – every 1 hour

• Na, Cl, K, Ca, HCO, glucose, creatinine-q 2 hrs

• ABG PRN (at least hourly)

• Temperature every hour or continuously

saintboniface.ca

The RBC cooler can be returned to the Blood Bank as long as it has not been

opened. Once the seal is broken or the cooler is opened, the blood/plasma expires

in 4 hours. Write the time on the tag when you open the cooler.

saintboniface.ca

Activation of MTP

• Physician to complete MTP order set in EPR.

• Unit staff will dial “55” and state

“Transfusion 25 AND location.”

• Unit staff will use the MT package for documents

required during this event.

• Unit staff to fax for release of blood products to

Blood Bank with the addressograph & MTP

sticker.

saintboniface.ca

EPR Order Set

saintboniface.ca

saintboniface.ca

Massive Transfusion Package

• Is a pre-packaged envelope that includes all the

written materials necessary for a MT.

• A MT package is located on each unit where a

MT can be activated.

• The MT package is reordered through Print

Shop.

saintboniface.ca

Responsible Physician:

• Is the physician who has the primary

responsibility for the direct care of the patient

during the MT.

• The responsible physician completes the MTP

order set in the EPR when a MT emergency

arises.

saintboniface.ca

Transfusion Medicine Physician (on call):

• Will receive the “Transfusion 25” page

• Will call the nursing unit & request:

*full name of the responsible physician

*contact person for future call back

*patient demographics

• Following this, the transfusion medicine physician (on call) will:

1. Call Blood Bank & confirm patient demographics & preparation of

blood products.

2. Call Canadian Blood Services & confirm supply & notify if more

blood / blood products are needed.

saintboniface.ca

Blood Bank

• Upon receipt of paging notification and faxed

Request for Release of Blood/Blood

Component/Derivatives, the Blood Bank will

begin preparation of the Blood Cooler Packs.

• Preparation will continue as detailed in the MTP

order set until notified by the Responsible

Physician or designate that the protocol is

discontinued.

saintboniface.ca

Transportation of Blood Samples

• Where available, blood samples (for Crossmatch

and / or Chemistry / Hematopathology) will be

sent via pneumatic tube with the red Massive

Transfusion paper from the Massive Transfusion

package facing the exterior of the pneumatic

tube.

saintboniface.ca

Transportation of Blood Products

• Upon receipt of paging notification (overhead /

numeric), a messenger will respond to the

nursing unit to pick up a copy of the Release for

Blood/Blood Products form that was faxed to

Blood Bank. It must indicate “MTP” along with

the patient demographics.

• The form is required to validate correct patient

identification during pick up the blood coolers in

Blood Bank.

saintboniface.ca

Transferring an active MT patient

• During a massive transfusion event, a patient

may be transferred to another patient care unit

identified as part of MT and continue to receive

MT coolers.

• Communication is crucial with Blood Bank &

Patient Transport to assure a constant flow of

blood/blood products to the correct clinical unit.

saintboniface.ca

Transferring an Active MT patient

The Sending Unit:

-notifies the receiving unit

-phones Blood Bank with details (patient

demographics & location change info)

-notifies Transport of patient location change and

requirements

saintboniface.ca

Transferring an Active MT patient

• The Receiving unit:

-notifies the Transfusion Physician on-call of

change in patient location & physician contact

information.

• Blood Bank:

-receives phone call from Sending unit of patient

location & change.

saintboniface.ca

Discontinuation of the MTP

• Discontinue the MTP when the patient has

stopped bleeding, the bleeding is controlled, the

patient has died or resuscitation efforts have

been withdrawn.

• The unit staff will inform the Blood Bank &

Transport when the MTP has ended.

saintboniface.ca

After the MTP is Discontinued

• Return the Record of Transfusions to the Blood

Bank.

• Collaborate with the team to complete the

evaluation.

• Externally clean the blood cooler with Oxyvir®

TB wipes and return to the Blood Bank.

saintboniface.ca

MTP: Team Debrief

• Complete the form with the team and return to

the Patient Safety office through

interdepartmental mail.

saintboniface.ca

Thank-you HSC for sharing your MTP

documents & educational materials.

saintboniface.ca

Questions?