scholarly journals 10 Years of Experience with the First Thawed Plasma Bank in Germany

2021 ◽  
pp. 1-7
Author(s):  
Kathleen Selleng ◽  
Andreas Greinacher
Keyword(s):  
Storage Time ◽  
Massive Transfusion ◽  
Just In Time ◽  
First Year ◽  
Blood Products ◽  
Large Hospital ◽  
Laboratory Staff ◽  
University Medicine ◽  
Time Availability ◽  
Transfusion Ratio

<b><i>Background:</i></b> Plasma is stored at –30°C, which requires thawing before transfusion, causing a time delay between ordering and issuing of at least 30 min. In case of bleeding emergencies, guidelines strongly recommend a 2:1 transfusion ratio of RBCs and plasma. In addition, each minute delay in issuing of blood products in bleeding emergencies increases the mortality risk. To provide plasma in time in bleeding emergencies, a thawed plasma bank was introduced in 2011. <b><i>Summary:</i></b> The thawed plasma bank of University Medicine Greifswald has provided 18,924 thawed stored plasma units between 2011 and 2020. The workflow in the laboratory as well as in the emergency room, the operating room, and the intensive care unit have been optimized by thawed stored plasma. In case of emergencies, the stress factor for the transfusion medicine laboratory staff has been reduced substantially. The thawed plasma bank allows to transfuse patients with massive transfusion demand at a 2:1 ratio of RBCs and plasma according to guidelines. To reduce storage time, we issue all plasma requests from the thawed plasma bank except for pediatric patients. This results in a median storage time in the thawed plasma bank of 24 h. The “just in time” availability of plasma within the entire hospital based on the thawed plasma bank has reduced precautionary ordering of plasma, and hereby the unnecessary use of plasma. After introduction of the thawed plasma bank, plasma usage decreased substantially by 24% within the first year and by 60% compared to 2019/2020. However, as the overall approach to using blood products has changed over the last 10 years due to the patient blood management initiative, quantification of the effects of the thawed plasma bank in reduction of plasma transfusion is difficult. <b><i>Key Messages:</i></b> (1) A thawed plasma bank for the routine supply of blood products in a large hospital is feasible in Germany. (2) The thawed plasma bank allows to supply RBCs and plasma in a 2:1 ratio in bleeding emergencies. (3) The beneficial logistical effects of the thawed plasma bank are optimal if all plasma requests are supplied from the thawed plasma bank. This results in a median storage time of 24 h for thawed plasma.

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 A chronicle of just-in-time information: The secret to building first year university student wellbeing and resilience based on a three year initiative

2016 ◽  
Vol 8 (1) ◽  
Author(s):  
Donnalee Taylor
Keyword(s):  
Biomedical Science ◽  
Just In Time ◽  
First Year ◽  
First Year Students ◽  
James Cook ◽  
Body Of Knowledge ◽  
Student Resilience ◽  
First Year University ◽  
Time Information ◽  
Support Information

<p class="Body"><em>To date, little has been published on the provision of student-driven just-in-time information to support first year students. This chronicle of just-in-time curricular and extra-curricular student support information was designed early in 2014 and successfully disseminated to first year biomedical science students over three years at James Cook University, Townsville, Queensland, Australia. In 2016, the information was redeveloped to make the support information electronically available to a much broader student audience. This article provides a dissemination template of what just-in-time curricular and extra-curricular information is required by first year university students. In addition, it outlines how students’ need for this information was determined and how information was successfully created and disseminated over these three years to assist the students in their transition to and through university. The intention of this article is to contribute to the growing body of knowledge on student resilience and wellbeing and to provide a guide for anyone interested in supporting their students in a similar manner.</em></p>

Massive Transfusion in a Child

2018 ◽  
Author(s):  
Rachel Chapman ◽  
Stefano Sabato
Keyword(s):  
At Risk ◽  
Liver Transplantation ◽  
Blood Transfusion ◽  
Blood Loss ◽  
Massive Transfusion ◽  
Vascular Structure ◽  
Blood Products ◽  
Process Knowledge ◽  
Massive Blood Transfusion ◽  
Laboratory Results

Massive transfusion in a child is likely to occur in cases of trauma or during surgeries that are at risk for severe blood loss such as liver transplantation and craniofacial procedures. It may also occur when least expected, if inadvertent injury to a vascular structure occurs during surgery. Ability to enlist assistance with administration of the various blood products required and also with checking frequent laboratory results will facilitate the process. Knowledge of the different factors that rapidly become depleted as well as lab values that need to be closely monitored is necessary to avoid further complications during massive blood transfusion.

scholarly journals A PRODUCT DEVELOPMENT APPROACH TO TEACHING INTRODUCTORY ENGINEERING DESIGN

2011 ◽  
Author(s):  
L. M. Lye ◽  
A. D. Fisher
Keyword(s):  
Engineering Design ◽  
Just In Time ◽  
First Year ◽  
Design Problems ◽  
New Approach ◽  
Approach To Teaching ◽  
Development Approach ◽  
Business Engineering ◽  
Realization Process ◽  
Product Realization

This paper describes a new approach to teaching first year design at Memorial University. Students are introduced to engineering design using the product realization process (PRP) as a platform. The course integrates the business, engineering design, and prototyping functions of the PRP. The just-in-time structured delivery of background tools and theory complement the relatively unstructured nature of the design problems. Lab exercises are used to intoduce the basic practicalities of mechanical, electrical and electronic design. Projects are completed in teams with emphasis placed on teamwork, project management and communication skills. Student enthusiasm has been very high and this aides significantly in the learning process.

Intraoperative Resuscitation by Specialized Trauma Nurse Clinicians Improves Adherence to Massive Transfusion Protocol

2020 ◽  
Vol 86 (1) ◽  
pp. 35-41
Author(s):  
L. Andrew May ◽  
Kevin N. Harrell ◽  
Christopher M. Bell ◽  
Angela Basham-Saif ◽  
Donald E. Barker ◽  
...  
Keyword(s):  
Blood Product ◽  
Trauma Registry ◽  
Massive Transfusion ◽  
Blood Products ◽  
Packed Red Blood Cells ◽  
Massive Blood Loss ◽  
Massive Transfusion Protocol ◽  
Nurse Clinicians ◽  
Level I ◽  
Transfusion Protocol

A massive transfusion protocol (MTP) was implemented at a Level I trauma center in 2007 for patients with massive blood loss. A goal ratio of plasma to pheresed platelets to packed red blood cells (PRBCs) of 1:1:1 was established. From 2007 to 2014, trauma nurse clinicians (TNCs) administered the MTP during initial resuscitation and anesthesia personnel administered the MTP intraoperatively. In 2015, TNCs began administering the MTP intraoperatively. This study evaluates intraoperative blood product ratios and crystalloid volume administered by anesthesia personnel or TNCs. A retrospective review of trauma registry patients requiring MTP from 2007 to 2017 was performed. Patient data were stratified according to MTP administration by either anesthesia personnel (2007–2015) or TNCs (2015–2017). Ninety-seven patients were included with 54 anesthesia patients and 44 TNC patients. Patients undergoing resuscitation by MTP administered by TNCs received less median crystalloid (3000 mL vs 1500 mL, P < 0.001). The ratio of plasma:PRBC (0.75 vs 0.93, P = 0.027) and platelets:PRBC (0.75 vs 1.04, P = 0.003) was found to be significantly closer to 1:1 for TNC patients. MTP intraoperative blood product administration by TNCs reduced the amount of infused crystalloid and improved adherence to MTP in achieving a 1:1:1 ratio of blood products.

scholarly journals Using "just in time" online feedback to improve first year undergraduate nursing students' essay writing performance

2019 ◽  
Vol 16 (4) ◽  
pp. 91-109
Author(s):  
Lisa Beccaria ◽  
◽  
Megan Kek ◽  
Henk Huijser ◽  
◽  
...  
Keyword(s):  
Nursing Students ◽  
Just In Time ◽  
First Year ◽  
Undergraduate Nursing Students ◽  
Writing Performance ◽  
Online Writing ◽  
Essay Writing ◽  
Undergraduate Nursing ◽  
Online Feedback ◽  
The Impact

Undergraduate nursing students often find essay writing challenging, and feel underprepared, yet the impact of using online feedback to support essay writing has been underexplored. First-year nursing students from a regional university were involved in a project that encouraged them to access an online tutoring service, as part of their development of an essay task. Significant differences were found in students’ final essay marks for those who accessed the online writing support. Students who accessed online writing support were also more likely to be deep, rather than surface learners. The findings indicate that the provision of prompt or ‘just in time’ feedback, using an online feedback mechanism, can greatly enhance students’ essay writing performance.

Blood products and fluid therapy

2016 ◽  
Author(s):  
Richard Telford
Keyword(s):  
Fluid Therapy ◽  
Massive Transfusion ◽  
Fresh Frozen Plasma ◽  
Red Cells ◽  
Cell Salvage ◽  
Blood Products ◽  
Blood Conservation ◽  
Jehovah’S Witnesses ◽  
Fresh Frozen ◽  
Frozen Plasma

This chapter discusses the anaesthetic uses of blood products and other fluids. It begins with a discussion of blood products (red cells, platelets, fresh frozen plasma, and so on). It goes on to describe blood conservation techniques such as cell salvage. Massive transfusion is discussed with its protocol. The problems posed by Jehovah’s Witnesses who refuse blood products are explored. The chapter concludes with a discussion of fluid and electrolyte therapy.

Neonatal Dieulafoy Lesion Requiring Massive Transfusion Protocol and Surgical Intervention

Neonatology ◽  
2020 ◽  
Vol 117 (3) ◽  
pp. 380-383
Author(s):  
Derek Leaderer ◽  
Nicholas Laconi ◽  
Jamie Brown ◽  
J. Lauren Ruoss ◽  
Diomel de la Cruz ◽  
...  
Keyword(s):  
Surgical Intervention ◽  
Massive Transfusion ◽  
Blood Products ◽  
Severe Condition ◽  
Surgical Ligation ◽  
Massive Transfusion Protocol ◽  
Life Threatening ◽  
Timely Fashion ◽  
Dieulafoy Lesion ◽  
Transfusion Protocol

Neonatal Dieulafoy lesion is a rare but severe condition that can be life-threatening if not intervened upon in a timely fashion. In the general population, the majority of lesions are successfully treated with endoscopic or angiographic intervention. Surgery is usually reserved for cases that fail endoscopic or angiographic intervention. We present a case of neonatal Dieulafoy lesion that occurred less than 24 h after delivery with hematemesis. The patient required large volume resuscitation and massive transfusion of blood products for acute blood loss. The lesion was successfully treated with surgical ligation after a failed attempt at endoscopic intervention.

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