Drug Therapy Protocols: Packed Red Blood Cells

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Drug Therapy Protocols: Packed Red Blood Cells
Drug Therapy Protocols: Packed Red Blood Cells
Disclaimer and copyright
©2016 Queensland Government
All rights reserved. Without limiting the reservation of copyright, no person shall reproduce, store in a
retrieval system or transmit in any form, or by any means, part or the whole of the Queensland Ambulance
Service (‘QAS’) Clinical practice manual (‘CPM’) without the priorwritten permission of the Commissioner.
The QAS accepts no responsibility for any modification, redistribution or use of the CPM or any part
thereof. The CPM is expressly intended for use by QAS paramedics whenperforming duties and delivering
ambulance services for, and on behalf of, the QAS.
Under no circumstances will the QAS, its employees or agents, be liable for any loss, injury, claim, liability
or damages of any kind resulting from the unauthorised use of, or reliance upon the CPM or its contents.
While effort has been made to contact all copyright owners this has not always been possible. The QAS
would welcome notification from any copyright holder who has been omitted or incorrectly acknowledged.
All feedback and suggestions are welcome, please forward to:
[email protected]
Date
October, 2015
Purpose
Scope
Author
To ensure a consistent procedural approach to Packed Red Blood Cells administration.
Applies to all QAS clinical staff.
Clinical Quality & Patient Safety Unit, QAS
Review date
October, 2017
URL
https://ambulance.qld.gov.au/clinical.html
This work is licensed under the Creative Commons
This work is licensed under the Creative Commons
Attribution-NonCommercial-NoDerivatives 4.0
Attribution-NonCommercial-NoDerivatives 4.0
International License. To view a copy of this license,
International License. To view a copy of this license,
visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Packed Red Blood Cells
October, 2015
Drug class
Side effects
Haemoglobin replacement
UNCONTROLLED WHEN PRINTED
Pharmacology
• Acute haemolytic transfusion reaction
Packed red blood cells (PRBC) replace lost haemoglobin, aiming to improve oxygen carrying capacity of the blood and volume replacement.[1,2]
• Acute febrile transfusion reaction
Metabolism
• Infection (bacterial, viral including low risk for HIV, Hep C and other blood borne viruses)
• Anaphylaxis/allergic reactions
N/A
• Fluid overload
UNCONTROLLED WHEN PRINTED
• Acute lung reaction
Indications
• Electrolyte imbalances
• Ongoing haemodynamic instability secondary to
haemorrhage (only following an appropriate volume
resuscitation strategy) AND the patient meeting the
criteria according to the QAS blood administration
checklist
• Hypothermia
• Acidosis
UNCONTROLLED WHEN PRINTED
Presentation
Contraindications
• 200–400 mL bag, Group O negative PRBC
• Non-consenting conscious patient (e.g. Jehovah Witness)
Onset (INF)
Duration (INF)
Half-life
UNCONTROLLED WHEN PRINTED
Precautions
Immediate
Variable
N/A
• Previous transfusion reaction
• Immunosuppressed patients
• Hyperkalaemia
Figure 4.43
QUEENSLAND AMBULANCE SERVICE
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Packed Red Blood Cells
Schedule
Special notes (cont.)
• Unscheduled.
Routes of administration
• Vital signs (temperature, pulse, respirations and blood pressure) shall be measured and recorded at the beginning and during each transfusion at a minimum of 15 minute intervals.
Intravenous infusion (IO INF)
E CCP
Intravenous infusion (IV INF)
E CCP
UNCONTROLLED WHEN PRINTED
• The bag numbers of all PRBC transfusions administered to the patient must be documented on the e-ARF.
• All transfusion reactions must be immediately reported to the QAS on-call medical officer.
• All completed PRBC infusion bags are to be left with the medical/nursing staff at the receiving hospital.
UNCONTROLLED WHEN PRINTED
Special notes
• Each unit contains enough haemoglobin to raise the haemoglobin
concentration in an average size adult by approximately 10 g/L.
• PRBC should be mixed thoroughly by gentle inversion before use and then transfused through an intravenous line approved for blood administration incorporating a standard 170 – 200 micrometre filter.
• Informed consent for transfusion means a dialogue has occurred between the patient and the clinician. The significant risks, benefits and alternatives to transfusion, including the patient’s right to refuse the transfusion, will have been discussed. As a result of the discussion the patient should:
UNCONTROLLED WHEN PRINTED
• An external pressure device should only be used in an emergency situation.
• Patients receiving transfusions shall be monitored for signs of the potential complications of transfusions and any suspected problems will be dealt with swiftly and efficiently. evere reactions are most likely to occur within the first 15 minutes of the transfusion. If any reaction occurs cease infusion immediately and discuss with clinical coordinator. Clinical presentation of
transfusion reactions include: tachycardia, hypertension, fever, rigors, headache, myalgia, altered level of consciousness,
bronchospasm, pulmonary oedema, and worsening coagulopathy.[1] - understand what medical action is recommended
- be aware of the risks and benefits associated with the transfusion
- appreciate the risks, and possible consequences of not receiving the recommended therapy
- be given an opportunity to ask questions
UNCONTROLLED WHEN PRINTED
- give consent for the transfusion.
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Packed Red Blood Cells
October, 2015
Adult dosages
Adult dosages (cont.)
UNCONTROLLED WHEN PRINTED
Ongoing haemodynamic instability secondary to haemorrhage (only following an appropriate volume resuscitation strategy) AND the patient meeting the criteria according to the QAS blood administration
checklist.
Ongoing haemodynamic instability secondary to haemorrhage (only following an appropriate volume resuscitation strategy) AND the patient meeting the criteria according to the QAS blood administration
checklist.
CCP ESoP aeromedical – RSQ consultation and approval required in all situations.
1 bag of PRBC (Group O negative)
E CCP
E CCP
UNCONTROLLED WHEN PRINTED
IV INF
IO INF
CCP ESoP aeromedical – RSQ consultation and approval required in all situations.
1 bag of PRBC (Group O negative)
Repeated as required in addition to
consideration of crystalloid fluid
resuscitation, whilst the patient is
haemeodynamically unstable due to ongoing blood loss. Every attempt should be made to minimize the amount of fluid resuscitation administered whilst
rapidly transporting the patient to definitive
surgical care in keeping with current
advanced trauma life support guidelines.
Repeated as required in addition to
consideration of crystalloid fluid
resuscitation, whilst the patient is
haemeodynamically unstable due to ongoing blood loss. Every attempt should be made to minimize the amount of fluid resuscitation administered whilst
rapidly transporting the patient to definitive
surgical care in keeping with current
advanced trauma life support guidelines.
No maximum dose.
No maximum dose.
UNCONTROLLED WHEN PRINTED
UNCONTROLLED WHEN PRINTED
QUEENSLAND AMBULANCE SERVICE
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Packed Red Blood Cells
October, 2015
Paediatric dosages
Paediatric dosages
UNCONTROLLED WHEN PRINTED
Ongoing haemodynamic instability secondary to haemorrhage (only following an appropriate volume resuscitation strategy) AND the patient meeting the criteria according to the QAS blood administration
checklist.
Ongoing haemodynamic instability secondary to haemorrhage (only following an appropriate volume resuscitation strategy) AND the patient meeting the criteria according to the QAS blood administration
checklist.
CCP ESoP aeromedical – RSQ consultation and approval required in all situations
10 mL/kg of PRBC (Group O negative)
E CCP
E CCP
UNCONTROLLED WHEN PRINTED
IV INF
IO
INF
CCP ESoP aeromedical – RSQ consultation and approval required in all situations
10 mL/kg of PRBC (Group O negative)
Repeated as required in addition to consideration of crystalloid fluid
resuscitation, whilst the patient is
haemeodynamically unstable due to ongoing blood loss. Every attempt should be made to minimize the amount of fluid resuscitation administered whilst
rapidly transporting the patient to definitive
surgical care in keeping with current
advanced trauma life support guidelines.
Repeated as required in addition to consideration of crystalloid fluid
resuscitation, whilst the patient is
haemeodynamically unstable due to ongoing blood loss. Every attempt should be made to minimize the amount of fluid resuscitation administered whilst
rapidly transporting the patient to definitive
surgical care in keeping with current
advanced trauma life support guidelines.
Total maximum dose 1 bag.
Total maximum dose 1 bag.
UNCONTROLLED WHEN PRINTED
UNCONTROLLED WHEN PRINTED
QUEENSLAND AMBULANCE SERVICE
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