Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood...
Transcript of Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood...
![Page 1: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/1.jpg)
Perioperative Blood Perioperative Blood Conservation: Conservation:
A NurseA Nurse’’s Perspectives Perspective
Lucia J Evans, RNPerioperative Blood Conservation Coordinator
University Health Network,Toronto Ontario
![Page 2: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/2.jpg)
Perioperative Blood Perioperative Blood Conservation Conservation
MOH - ONTraC
Integral part of Transfusion Medicine
Close links and support from surgery and anesthesia
![Page 3: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/3.jpg)
TRANSFUSION MEDICINEMEDICAL DIRECTOR
Preadmission Clinic
Out patient Pharmacy
Medical Day Unit
PABDProgram
PBCP Medical DirectorBlood Bank Manager
ONTraC Nurse CoordinatorONTraC
![Page 4: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/4.jpg)
PrePre--Operative Role Of Operative Role Of CoordinatorCoordinator
EducationEvaluation of the anemiaTreatment of anemiaPre-Operative Autologous Blood DonationRe-Evaluation of Program EffectivenessExpansion of Program
![Page 5: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/5.jpg)
PrePre--Operative Role Of Operative Role Of CoordinatorCoordinator
EducationEvaluation of the anemiaTreatment of anemiaPre-Operative Autologous Blood DonationRe-Evaluation of Program EffectivenessExpansion of Program
![Page 6: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/6.jpg)
PrePre--Operative Role Of Operative Role Of CoordinatorCoordinator
EducationEvaluation of the anemiaTreatment of anemiaPre-Operative Autologous Blood DonationRe-Evaluation of Program EffectivenessExpansion of Program
![Page 7: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/7.jpg)
![Page 8: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/8.jpg)
EPO: EfficacyEPO: EfficacyRCT, multi-centre, x 4 weekly doses starting 4
weeks before total joint arthroplasty
Placebo (n=78)
20,000 U (n=79)
40,000 U (n=44)
Retic. count 1.8 x109 cells/L
37 x109 cells/L
59 x109 cells/L
↑ Hb conc. 1.2 g/L 17.2 g/L 19.5 g/L
Transfusion rate 45% (n=35)
23% (n=18)
11% (n=5)
Feagan et al. Annals Int Med 2000; 133: 845.
![Page 9: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/9.jpg)
EPO: Clinical EffectivenessEPO: Clinical Effectiveness
At UHN: – < 70 Kg: 20,000 IU; > 70 Kg: 40,000 IU– skip day of surgery dose
Adequate iron stores required– iron supplementation mandatory (oral or IV)
![Page 10: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/10.jpg)
Clinical Experience in TJA Patients: Clinical Experience in TJA Patients: # of EPO Injections and # of EPO Injections and HbHb ResponseResponse
02468
101214161820
0 Inj. (n= 1372) 1 Inj. (n=23) 2 Inj. (n=93) 3 Inj. (n=105)
Karkouti, McCluskey, Evans et al. Can J Anesth. 2005; 52 (4): 362.
![Page 11: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/11.jpg)
TJA Patients at UHN 2000TJA Patients at UHN 2000--2003; 2003; HbHb <130 g/L (770/1611 or 48%)<130 g/L (770/1611 or 48%)
EPO No EPO P
ABT 16.4% (35/214)
56.1% (312/556)
<0.0001
Hb (g/L) 119.5 ± 12.0135.6 ± 12.0
118 ± 10 NC
<0.0001
Nadir Hb (g/L) 95.2 ± 13.7 83.1 ± 11.4 <0.0001
Discharge Hb (g/L) 100 ± 10.3 96.5 ± 10.6 <0.05
Karkouti, McCluskey, Evans et al. Can J Anesth. 2005; 52 (4): 362.
![Page 12: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/12.jpg)
Clinical Experience in Clinical Experience in AnemicAnemic TJA TJA Patients: PET and Blood TransfusionPatients: PET and Blood Transfusion
0%
10%
20%
30%
40%
50%
60%
% Transfused
0
0.2
0.4
0.6
0.8
1
1.2
1.4
Karkouti, McCluskey, Evans et al. Can J Anesth. 2005; 52 (4): 362.
![Page 13: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/13.jpg)
EPO: SummaryEPO: Summary↑ Hb levels by 15 ± 10 g/L
i.e., can potentially eliminate 1-2 unit transfusions>50% reduction in allogeneic blood transfusion when compared to placebo
Benefits compared to PAD↓ overall transfusion↓ postoperative anemia more accessiblepreferred by patientspredictable response
![Page 14: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/14.jpg)
PrePre--Operative Role Of Operative Role Of CoordinatorCoordinator
EducationEvaluation of the anemiaTreatment of anemiaPre-Operative Autologous Blood DonationRe-Evaluation of Program EffectivenessExpansion of Program
![Page 15: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/15.jpg)
PADPAD
Expansion of the RBC Mass No RCT-Double Blind Study↑ Number of transfusions (Allo & PAD)Pre-Operative AnemiaNeeds to be managed to be cost effective
![Page 16: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/16.jpg)
MultiMulti--modality Blood Conservation in modality Blood Conservation in Spine Surgery at UHNSpine Surgery at UHN
n=15/21
n=24/73
n=9/52
n=2/25
0%
10%
20%
30%
40%
50%
60%
70%
80%
% transfused
0 1 2 3# of blood conservation modalities used (PAD +/- EPO +/- Cell Saver)
![Page 17: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/17.jpg)
PrePre--Operative Role Of Operative Role Of CoordinatorCoordinator
EducationEvaluation of the anemiaTreatment of anemiaPre-Operative Autologous Blood DonationRe-Evaluation of Program EffectivenessExpansion of Program
![Page 18: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/18.jpg)
TJA New DataTJA New Data
Overall Transfusion Data Preoperative AnemiaPreoperative Autologous Blood Donation
![Page 19: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/19.jpg)
TJA Patients at UHN 2004TJA Patients at UHN 2004--2005; 2005; HbHb <130 g/L (866/1814 or 48%)<130 g/L (866/1814 or 48%)
EPO No EPO P
ABT 25% (46/147)
46% (172/446)
<0.0001
Hb (g/L) 118 ± 9 132 ± 12.0
111 ± 20 NC
<0.0001
Nadir Hb (g/L) 89 ± 16 83 ± 14 <0.0001
Discharge Hb (g/L) 99 ± 14 93 ± 14 <0.0001
Evans June 20, 2006.
![Page 20: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/20.jpg)
Clinical Experience in Clinical Experience in AnemicAnemic TJA TJA Patients: PET and Blood TransfusionPatients: PET and Blood Transfusion
0%
10%
20%
30%
40%
50%
60%
0
0.5
1
1.5
2
2.5
.
Evans June 2006.
2000 - 2003
2004 - 2005
% TransfusedU/Pt Transfused
![Page 21: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/21.jpg)
AlyxAlyx
![Page 22: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/22.jpg)
PrePre--Operative Role Of Operative Role Of CoordinatorCoordinator
EducationEvaluation of the anemiaTreatment of anemiaPre-Operative Autologous Blood DonationRe-Evaluation of Program EffectivenessExpansion of Program
![Page 23: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/23.jpg)
Gynecology/OncologyGynecology/Oncology
![Page 24: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/24.jpg)
Overall Transfusion Data Overall Transfusion Data Jan 2002 Jan 2002 -- Mar 2004Mar 2004
Number of Procedures = 648
Procedures:TAH BSOLaparotomies
Overall Transfusion Rate =15.5%
![Page 25: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/25.jpg)
Transfusion DataTransfusion Data
Median # of units Tx = 2 units PRBC
25th percentile = 2 units PRBC
75th percentile = 4 units PRBC
Mean # of Units Tx / Pt Tx = 3.7 ± 3.1 units
![Page 26: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/26.jpg)
![Page 27: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/27.jpg)
Base/Discharge Base/Discharge HgbHgb ValuesValues
97 ± 13108 ± 11 ≤ 120
100 ± 13116 ± 12≤ 130
112 ± 13.5139 ± 7 > 130
Mean Discharge Hgb g/L
Mean Base Hgb g/L
Base HgbValue
![Page 28: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/28.jpg)
![Page 29: Perioperative Blood Conservation: A Nurse’s Perspective · PDF filePerioperative Blood Conservation: ... zPre-Operative Autologous Blood Donation ... Microsoft PowerPoint - EVANS](https://reader038.fdocuments.us/reader038/viewer/2022110222/5a9f68477f8b9a7f178cca33/html5/thumbnails/29.jpg)
AcknowledgmentsAcknowledgments
Dr. Stuart McCluskey
Dr. Keyvan Karkouti