How to verify patient identity and blood product compatibility using an electronic bedside transfusion system

Transfusion ◽  
2020 ◽  
Author(s):  
Sophie Staples ◽  
Clare O'Callaghan ◽  
Sue Pavord ◽  
Julie Staves ◽  
Michael F. Murphy
Keyword(s):  
Blood Product ◽  
Product Compatibility

Predictive Factors for High Blood Product Use in Patients with Acute Stanford Type A Dissection

2020 ◽  
Author(s):  
M. J. Schafigh ◽  
M. Hamiko ◽  
W. Schiller ◽  
H. Treede ◽  
C. Probst
Keyword(s):  
Predictive Factors ◽  
Blood Product ◽  
Type A ◽  
Product Use ◽  
Type A Dissection

Management of Intraoperative Fluid Balance and Blood Conservation Techniques in Adult Cardiac Surgery

2011 ◽  
Vol 14 (1) ◽  
pp. 28 ◽  
Author(s):  
George Vretzakis ◽  
Athina Kleitsaki ◽  
Diamanto Aretha ◽  
Menelaos Karanikolas
Keyword(s):  
Cardiac Surgery ◽  
Blood Cell ◽  
Fluid Balance ◽  
Blood Product ◽  
Blood Donation ◽  
Autologous Blood ◽  
Small Body ◽  
Risk Indicators ◽  
Blood Transfusions ◽  
Blood Conservation

Blood transfusions are associated with adverse physiologic effects and increased cost, and therefore reduction of blood product use during surgery is a desirable goal for all patients. Cardiac surgery is a major consumer of donor blood products, especially when cardiopulmonary bypass (CPB) is used, because hematocrit drops precipitously during CPB due to blood loss and blood cell dilution. Advanced age, low preoperative red blood cell volume (preoperative anemia or small body size), preoperative antiplatelet or antithrombotic drugs, complex or re-operative procedures or emergency operations, and patient comorbidities were identified as important transfusion risk indicators in a report recently published by the Society of Cardiovascular Anesthesiologists. This report also identified several pre- and intraoperative interventions that may help reduce blood transfusions, including off-pump procedures, preoperative autologous blood donation, normovolemic hemodilution, and routine cell saver use.A multimodal approach to blood conservation, with highrisk patients receiving all available interventions, may help preserve vital organ perfusion and reduce blood product utilization. In addition, because positive intravenous fluid balance is a significant factor affecting hemodilution during cardiac surgery, especially when CPB is used, strategies aimed at limiting intraoperative fluid balance positiveness may also lead to reduced blood product utilization.This review discusses currently available techniques that can be used intraoperatively in an attempt to avoid or minimize fluid balance positiveness, to preserve the patient's own red blood cells, and to decrease blood product utilization during cardiac surgery.

scholarly journals Transfusion Medicine Informatics: Analysis of User Burden from Clinical Decision Support Alerts in Promoting Patient Blood Management

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S123-S124
Author(s):  
H C Tsang ◽  
P Mathias ◽  
N Hoffman ◽  
M B Pagano
Keyword(s):  
Decision Support ◽  
Clinical Decision Support ◽  
Blood Product ◽  
Clinical Decision ◽  
Blood Products ◽  
Blood Management ◽  
Before And After ◽  
Blood Utilization ◽  
Transfusion Ratio ◽  
Major Project

Abstract Introduction/Objective To increase efficiency of blood product ordering and delivery processes and improve appropriateness of orders, a major project to implement clinical decision support (CDS) alerts in the electronic medical record (EMR) was undertaken. A design team was assembled including hospital and laboratory medicine information technology and clinical informatics, transfusion services, nursing and clinical services from medical and surgical specialties. Methods Consensus-derived thresholds in hemoglobin/hematocrit, platelet count, INR, and fibrinogen for red blood cell (RBC), platelet, plasma, and cryoprecipitate blood products CDS alerts were determined. Data from the EMR and laboratory information system were queried from the 12-month period before and after implementation and the data was analyzed. Results During the analysis period, 5813 RBC (avg. monthly = 484), 1040 platelet (avg. monthly = 87), 423 plasma (avg. monthly = 35), and 88 cryoprecipitate (avg. monthly = 7) alerts fired. The average time it took for a user to respond was 5.175 seconds. The total amount of time alerts displayed over 12 months was 5813 seconds (~97 minutes of user time) compared to 56503 blood products transfused. Of active CDS alerts, hemoglobin/RBC alerts fired most often with ~1:5 (31141 RBC units) alert to transfusion ratio and 4% of orders canceled (n=231) when viewing the alert, platelet alerts fired with ~1:15 (15385 platelet units) alert to transfusion ratio and 6% orders canceled (n=66), INR/plasma alerts fired with ~1:21 (8793 plasma units) alert to transfusion ratio and 10% orders canceled (n=41), cryoprecipitate alerts fired with ~1:13 (1184 cryoprecipitate units) alert to transfusion ratio and 10% orders canceled (n=9). Overall monthly blood utilization normalized to 1000 patient discharges did not appear to have statistically significant differences comparing pre- versus post-go-live, except a potentially significant increase in monthly plasma usage at one facility with p = 0.34, although possibly due to an outlier single month of heavy usage. Conclusion Clinical decision support alerts can guide provider ordering with minimal user burden. This resulted in increased safety and quality use of the ordering process, although overall blood utilization did not appear to change significantly.

scholarly journals The Effects of Oral Anticoagulant Exposure on the Surgical Outcomes of Patients Undergoing Surgery for High-Risk Abdominal Emergencies

2021 ◽  
Author(s):  
Woubet Tefera Kassahun ◽  
Tristan Cedric Wagner ◽  
Jonas Babel ◽  
Matthias Mehdorn
Keyword(s):  
Liver Cirrhosis ◽  
High Risk ◽  
Hospital Mortality ◽  
Oral Anticoagulant ◽  
Blood Product ◽  
Oral Anticoagulants ◽  
Blood Product Transfusion ◽  
Bleeding Rate ◽  
Abdominal Emergencies ◽  
Peripheral Arterial

Abstract Background In chronic anticoagulant users undergoing surgery, bleeding and thromboembolism are common and serious complications. Many studies on mainly elective or minor emergency surgical procedures with low associated risks have focused on these outcomes. In comparison, patients undergoing high-risk emergency abdominal surgical procedures have not received sufficient attention. This study aimed to compare outcomes between oral anticoagulant users and nonusers who required emergency laparotomy for high-risk abdominal emergencies. Methods Patients who underwent surgery for abdominal emergencies at our institution between January 2012 and July 2019 were retrospectively reviewed. Results There were 875 patients, including 370 anticoagulant users and 505 nonusers. Of the 370 anticoagulant users, 189 (51.3), 77 (20.8%), 45 (12.2%), and 59 (15.9%) were prescribed antiplatelets, a vitamin k antagonist, a direct oral anticoagulant, and a combination drug regimen, respectively. The most common high-risk emergencies requiring surgery in both groups were perforated viscus (25.7% vs 40.9%), mesenteric ischemia with enteric necrosis (27% vs 12.8%), and bowel obstruction (17.6% vs 28.1%). The overall bleeding rate was higher (29.2% vs 22%, p = 0.015) in anticoagulant users than in nonusers, but the major bleeding rate was similar (17.8% vs 14.1%, p = 0.129) between the two groups. The rates of thromboembolic events and mortality were significantly higher in anticoagulant users than in nonusers (25.7% vs 9.7%, p < 0.0001 and 39.7% vs 31.1%, p = 0.01, respectively). Liver cirrhosis, peripheral arterial diseases, reoperation, and blood product transfusion were independent predictors of the overall risk of bleeding or TEEs, according to the multivariate analysis. In this model, liver cirrhosis had the largest overall effect on mortality, followed by pneumonia, thromboembolism, peripheral arterial disease, blood product transfusion, and atrial fibrillation. The use of oral anticoagulants was not an independent predictor of either bleeding or in-hospital mortality. The use of oral anticoagulants was associated with a decreased risk of all-cause in-hospital mortality. Conclusion Based on our results, the continued use of oral anticoagulants is more protective than harmful considering the overall outcomes in this subset of patients.

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