Urgent Delivery - Validation and Operational Implementation of Urgent Blood Delivery by Modern High Speed Hospital Pneumatic Tube System to Support Bleeding Emergencies Within a Hospital Massive Transfusion Protocol

Abstract Background Timely blood delivery to patients with critical bleeding poses logistic challenges. A modern, high speed hospital pneumatic tube system (PTS) is one solution, but blood units may be subjected to high-speed torque and acceleration/deceleration forces. Objective To validate a new PTS system for potential use at our 1,400-bed hospital in Singapore. Method Our validation included red blood cells, platelets, thawed plasma, and cryoprecipitate units transported from the blood bank for a distance of 820 meters (PTS track), at a velocity of 3–6 meters per second. Transit time, temperature, bag integrity, and blood quality were assessed visually and through analytical testing on pre- and post-PTS specimens. Results Blood units arrived physically intact in less than 8 minutes. The temperature for each was within the acceptable range. Comparative testing of pre-PTS and post-PTS specimens showed no significant difference in physical quality and analyzed parameters (P> .05). Conclusions High speed PTS transportation of blood components has satisfactory fidelity and speed, without significant impact on quality. As a result, we incorporated PTS blood delivery into the hospital massive-transfusion protocol and successfully operationalized that new system.

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What's in the Box? the Effectiveness of a Low-Volume Massive Transfusion Protocol

The American Surgeon ◽

10.1177/000313481608200725 ◽

2016 ◽

Vol 82 (7) ◽

pp. 602-607 ◽

Cited By ~ 1

Author(s):

Katherine Baysinger ◽

Merry E. Barnett ◽

Mickey Ott ◽

William Bromberg ◽

Katherine McBride ◽

...

Keyword(s):

Trauma Patient ◽

Injury Severity ◽

Massive Transfusion ◽

Vital Signs ◽

Study Cohort ◽

Trauma Patients ◽

Packed Red Blood Cells ◽

Massive Transfusion Protocol ◽

Significant Difference ◽

Transfusion Protocol

Transfusion ratios approaching 1:1:1 of packed red blood cells (PRBCs) to fresh frozen plasma (FFP) to platelet have been shown to improve outcomes in trauma. There is little data available to describe in what quantity that ratio should be delivered. We hypothesized that lowering the total volume of products delivered in each protocol round would not adversely affect outcomes in the bleeding trauma patient. A retrospective review of 9732 trauma patients admitted to a rural Level I trauma center over a 3-year period was performed. Patients who received a massive transfusion (greater than 10 units of blood product transfused in the first 24 hours), between January 2012 and April 2015 were identified as the study cohort. In May of 2014, our institution switched from a massive transfusion protocol (MTP) that included 6 PRBCs:6 FFP:1 platelet to a lower volume massive transfusion protocol (LVMTP) that included 4 PRBG4 FFP:1 platelet. Data collected included patient demographics, vital signs, and outcomes. A total of 131 patients met study criteria. MTP was activated on 65 per cent of patients (57/88), receiving a massive transfusion during the 28 months before implementation of the new protocol. In contrast, LVMTP was activated in 100 per cent of patients (43/43) receiving a massive transfusion in the 12 months after implementation of the new protocol. There was no significant difference in age (36.6 vs 37.2, P = 0.87), injury severity score (29.8 vs 32.3, P = 0.45), or per cent penetrating mechanism (43.9 vs 37.2%, P = 0.503) when comparing MTP to LVMTP. In addition, there was no significant difference in mortality (47.4 vs 41.9%, P = 0.584), lengths of stay (13.5 vs 17.1, P = 0.258), or vent days (6.4 vs 8.2, P = 0.236) when comparing MTP to LVMTP. A LVMTP is safe and effective for the resuscitation of the trauma patient.

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PNEUMATIC TUBE TERHADAP DARAH RUTIN DAN LAKTAT DEHIDROGENASE

INDONESIAN JOURNAL OF CLINICAL PATHOLOGY AND MEDICAL LABORATORY ◽

10.24293/ijcpml.v21i2.1087 ◽

2018 ◽

Vol 21 (2) ◽

pp. 111

Author(s):

Liong Boy Kurniawan ◽

Asvin Nurulita ◽

Uleng Bahrun

Keyword(s):

Cross Sectional Study ◽

Test Results ◽

Tube System ◽

Cross Sectional ◽

Pneumatic Tube ◽

Routine Blood ◽

Paired Samples ◽

Significant Difference ◽

Velocity Changes ◽

Pneumatic Tube System

The transportation of laboratorial samples with pneumatic tube system spends less time than when were handled by courier.Pneumatic tube system produces minor vibrations on sample due to the velocity changes during transportation and may cause changeson the blood cells and haemolysis. The aim of this study is to know the effect of sample transportation with pneumatic tube on bloodcells and its effect on hemolysis. A cross sectional study was performed at Dr. Wahidin Sudirohusodo Hospital, Makassar in July 2013.Routine blood, electrolyte and LDH were tested in 12 out-patients. The researchers collected two (2) samples, for each EDTA tube (routineblood tests) and serum (electrolyte and LDH). The samples were transported using pneumatic tube and the paired samples were sentby courier. The result then were analyzed with Paired T-Test. There were no significant difference of routine blood test results betweensamples sent by pneumatic tube and courier except RDW. RDW were higher in samples which were sent by pneumatic tube comparedto those brought by the courier (18.72±2.70% vs 17.83±2.36%, p=0.007). The electrolyte levels sent by both methods there were nosignificant difference, but the LDH levels were higher in samples sent by pneumatic tube (472.08±100.44 U/L vs 331.25±94.19 U/L,p=0.000). Based on this study, in common can be concluded that the pneumatic tube system does not effect on the routine blood testresults, except on RDW and does not cause changes due to haemolysis (on electrolyte) except the LDH levels elevates. So based on thisstudy, it is recommended to send samples for LDH test only by courier.

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The Effects of Sample Transport by Pneumatic Tube System on Routine Hematology and Coagulation Tests

Advances in Hematology ◽

10.1155/2018/6940152 ◽

2018 ◽

Vol 2018 ◽

pp. 1-4 ◽

Cited By ~ 5

Author(s):

Devi Subbarayan ◽

Chidambharam Choccalingam ◽

Chittode Kodumudi Anantha Lakshmi

Keyword(s):

Platelet Count ◽

Blood Count ◽

Complete Blood Count ◽

Red Cell ◽

Tube System ◽

Cell Parameters ◽

Pneumatic Tube ◽

Paired Samples ◽

Significant Difference ◽

Pneumatic Tube System

Background. Automation helps improve laboratory operational efficiency and reduce the turnaround time. Pneumatic tube systems (PTS) automate specimen transport between the lab and other areas of the hospital. Its effect on complete blood count (CBC) and coagulation is still controversial.Aim. To study the effects of pneumatic tube system sample transport on complete blood count and coagulation parameters to compare them with hand delivered samples.Methods. 75 paired samples for complete blood count and 25 paired samples for coagulation analysis were compared between samples sent via pneumatic tube system and hand delivered system.Results. PTS showed significant decrease in red cell indices such as MCV and RDW and increase in MCHC. Other red cell parameters and WBC parameters showed no statistical significant difference. Statistically significant increase in platelet count was observed with PTS samples. However, these differences were clinically insignificant. No significant effect of PTS was found in PT and APTT samples compared to the hand delivered samples.Conclusion. Despite statistically significant changes in RBC parameters such as MCV, RDW, and MCHC and platelet count, these changes were clinically insignificant. Hence, blood samples for CBC and coagulation assay can safely be transported via our hospital’s PTS. However, further studies on platelet count are warranted to ensure safe transport and accuracy of the results.

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Faculty Opinions recommendation of Massive transfusion practices around the globe and a suggestion for a common massive transfusion protocol.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1115127.572094 ◽

2008 ◽

Author(s):

Osvaldo Chiara

Keyword(s):

Massive Transfusion ◽

Massive Transfusion Protocol ◽

Transfusion Protocol

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Faculty Opinions recommendation of Improvements in early mortality and coagulopathy are sustained better in patients with blunt trauma after institution of a massive transfusion protocol in a civilian level I trauma center.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1287960.755060 ◽

2009 ◽

Author(s):

Jonathan Waters ◽

Jay S Raval

Keyword(s):

Blunt Trauma ◽

Trauma Center ◽

Massive Transfusion ◽

Early Mortality ◽

Massive Transfusion Protocol ◽

Level I ◽

Transfusion Protocol

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Blood Provision for Cardiac Ablation (CA) Procedures in the Catheterization Laboratory; a Veteran Affairs Medical Center (VAMC) Experience in a Non-Trauma Center Setting

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.365 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S167-S168

Author(s):

J M Petersen ◽

V Patel ◽

D Jhala

Keyword(s):

Quality Assurance ◽

Massive Transfusion ◽

Medical Center ◽

Case Series ◽

Blood Bank ◽

Cardiac Ablation ◽

Cardiac Perforation ◽

Catheterization Laboratory ◽

Massive Transfusion Protocol ◽

Transfusion Protocol

Abstract Introduction/Objective Cardiac perforation is a life-threatening complication (~1% risk, with reported rates between 0.2% to 5%) of CA procedures. As cardiac perforation may lead to extensive bleeding, it would be reasonable for a medical center carrying out CA to be capable of arranging for a massive transfusion protocol and for surgical repair as required. However, there is sparse literature to guide a non-trauma medical center implementing a CA program on what the number of red blood cell (RBC) units for crossmatch should be for each case. Methods In interdisciplinary collaborative meetings, the CA program logistics were agreed to between the multiple clinical services. Given the case series on the amount of drained blood in complicated cases, there was agreement that three units of RBCs would be crossmatched for each case. Education was provided on the massive transfusion protocol and on blood bank procedures. As part of quality assurance/quality improvement, records were reviewed from the beginning of the CA program (10/1/2019) to 1/31/2019 to determine number of patient cases, crossmatched units, and transfused units for quality assurance purposes. Results A total of fifteen patients underwent CA procedures, for which three units were crossmatched for each patient. As there were no cardiac perforations with the cardiac ablation procedures so far, no units were transfused. The organized approach for ensuring adequate blood bank support and education led to the reassurance, alleviation of clinical anxiety, and building of a successful CA program. Education sessions completed with thorough understanding of blood bank procedures including the massive transfusion protocol, labeling of blood bank specimens, and on ordering of blood for crossmatch. Conclusion This study provides a reference that may provide helpful guidance to other blood banks on what the number of RBCs to be crossmatched prior to each CA procedure. Multidisciplinary collaborative meetings in advance are an essential component for ensuring adequate support for CA procedures or any new service that requires blood product support. Thorough education of clinical staff on blood bank procedures particularly the massive transfusion protocol is also recommended. This procedure for massive transfusion should be available to be referred to in real time.

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