Massive Transfusion Orders

Massive Transfusion Orders

PLACE LABEL HERE

MASSIVE TRANSFUSION

ORDERS

The following orders will be implemented. Orders with a “” are choices and are NOT implemented unless checked.

Initial all handwritten order modifications and the bottom of each page when indicated (multipage).

DIAGNOSIS: ______

Massive transfusion:

Replacement or anticipated replacement of at least one blood volume (8-10 units of PRBC in a 70kg adult) within 24 hours, replacement of at least 50% of one blood volume (4-5 units of PRBC) within 3 hours, or blood loss >150 mL/min

Indications for activation of these orders:

Massive blood loss with profound hemorrhagic or hypovolemic shock; severe injury to, or ischemia, to liver; prolonged PT (INR > 1.5 seconds), depressed fibrinogen levels (<100 mg/dl), or depressed platelet count (<100,000/mL) with active bleeding

Upon initiating these orders, patient must be in or en route to ED, OR, or ICU, however these orders may be started in GWP, Interventional Radiology or Interventional Cardiology

Emergency Release (Physician or Advanced Practice Provider to Complete): I authorize emergency release of blood products. In my professional opinion, the patient’s life would be threatened by postponing transfusion until the completion of routine compatibility testing.

______(initials)I have confirmed the consent for transfusion has been obtained prior to ordering blood product(s).

______(initials)Patient consent for transfusion has not been obtained, but any delay in transfusion could reasonably be expected to jeopardize the life or health of the patient The consent for transfusion form contains a section for the provider to certify an emergency transfusion

1.Labs (all labs to be done stat):

As soon as possible upon initiation:CBC,PT/INR, PTT, Fibrinogen, Chem 7, Mg+, ionized Ca+, ABG,

DIC, Lactate, type and screen

Obtain after completion of every pack: CBC,INR, PTT, Fibrinogen, ionized Ca+, K+, Lactate

2.Obtain from Blood Bank and transfuse massive transfusion pack # 1

(includes 4 units PRBC, 4 units FFP and 1 pack of platelets)

  • Subsequent packs will include same number of PRBC and FFP
  • Platelets will be in every other pack
  • Physician may order more platelets or cryoprecipitate

3.Nursing Orders

Notify Blood Bank immediately upon initiation and discontinuation of these orders

  • If possible initiate 2 large bore INTs (18g or larger) or high flow central venous catheter
  • Temperature Management:
  • Administer all blood products through a warming device or rapid infuser
  • If possible, continually monitor core temperature. Insert temperature monitoring Foley or rectal probe as needed. If unable to do so, document temperature a minimum of every 30 mins.

______

DateTimePhysician SignaturePID Number

*1-32032* FORM 1-32032 REV. 05/2018 Page 1 of 1

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