MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE

Transcription

1 Ref: CG268 Issue 1 Authorised by : Hospital Written by: Lesley Hough Transfusion Committee Hospital Transfusion practitioner Date: Next review date: June 2012 MAXIMUM SURGICAL BLOOD ORDERING SCHEDULE Recommendations for pre-operative cross-matching in elective procedures Approved by the Hospital Transfusion Committee 20 th June

2 CONTENTS 1. Introduction Page 3 2. Development and consultation Page 3 3. Scope Page 3 4. Electronic issue Page 4 5. Laparoscopic procedures Page 4 6. Blood ordering schedule Page 5 2

3 1.Introduction: The maximum surgical blood ordering schedule (MSBOS) is a table that lists the number of units of blood routinely requested and cross matched for a number of surgical procedures. The MSBOS is based on the likelihood of transfusion being required in each procedure after consultation with the anaesthetists and clinical teams for each speciality. In many cases where blood is seldom used peri-operatively no red cell issue is required but a valid group and save serum request must have been processed by the laboratory in the case of unforeseen bleeding. The list is not exhaustive, nor does it supersede clinical judgement. If a patient has known antibodies, is anaemic or complications are envisaged, extra units of blood may be required. Clinical decisions that override this schedule must be discussed with blood transfusion staff at the time of the request. Procedures not included in this list do not require a transfusion sample to be processed. Please note: a routine group and save and full cross match takes up to 2 hours. If further blood is required during surgery a follow up cross match takes 30 minutes. Pre-operative group and save samples sent to the laboratory will be processed and serum saved for 14 days. If the patient has been transfused within the last 3 months prior to admission please see the chart below for when the sample is required. The timing of the sample is important to allow detection of any new developing red cell antibodies that may have been produced by the previous transfusion. Patient last transfused within 3 14 days within 15 days 28 days Sample to be taken a maximum of 24 hours before start of transfusion 72 hours before start of transfusion 29 days 3 months 7 days before start of transfusion 2. Development and Consultation Process The SMBOS has been developed by constant review over a number of years. Audits have been performed on clinical blood use by the transfusion department and the clinical specialities. The figures in the SMBOS table have been circulated to clinical leads and their comments have been absorbed into the document. 3.Scope: This document provides all staff requesting red cells the standard amount of blood cover a procedure usually requires. 3

4 4.Electronic issue of red cells (EI): Many patients for elective surgery will be suitable for electronic issue of red cells. The advantage of electronic issue is that no cross match is required and blood can be issued for the patient at the point of need by a telephone request to the transfusion laboratory. Blood will be issued and available within 5 minutes. If further blood is needed during surgery then this will also be issued within 5 minutes. Patient requirements for electronic issue A patient must have 1.A. historical blood group and a negative antibody screen 2. A current matching blood group and negative antibody screen. Patients who have known irregular blood group antibodies or have a positive antibody screen will need a full cross match and are NOT suitable for electronic issue. Process for electronic issue: sample taken at pre-op assessment ( not necessary if there is a blood group and negative antibody screen result on the ICE system) sample taken prior to admission ( please refer to chart in section 2) If both samples are ABO compatible and both antibody screens are negative the patient is suitable for electronic issue. A comment is placed on the ICE system to inform you of the patients transfusion status i.e. this patient is suitable for electronic issue or you will see that blood has been issued for this patient. It is the surgical teams responsibility to check the blood status of the patient prior to surgery Note: The pre-op assessment clinic plays a pivotal role in the timely provision of samples to the transfusion laboratory Laparoscopic procedures: Laparoscopic procedures whilst not usually requiring blood cover for the procedure may rarely result in blood being needed urgently. It is important that consideration for electronic issue is given to these patients at pre-op assessment. 4

5 Maximum Surgical Blood Ordering Schedule Procedure / ICE Request Quantity / Request Abdominal aortic aneurysm 6 Abdomino-perineal excision of rectum ( open or 2 laparoscopic) Above knee amputation Adrenalectomy 2 Ante-partum haemorrhage 2 Anterior resection (open) 2 Below knee amputation Bilateral breast reduction Birmingham hip replacement Bleeding Caesarean section (routine) Caesarean section multi para Caesarean grade 3 or 4 placenta praevia Carotid endarterectomy Total / subtotal colectomy ( open or laparoscopic) 2 Cystectomy 2 Dynamic hip screw Ectopic pregnancy Embolectomy 2 Evacuation of retained products of conception(erpc) Fem pop bypass 2 Fem distal bypass 2 Fractured neck of femur Gastrectomy 2 Gastrectomy (partial) 2 Hemiarthroplasty Hemicolectomy ( right or left) open Ileo-anal pouch 3 Ileal conduit 2 Laminectomy (thoracic) 5

6 Procedure / ICE request Laparotomy (gynea) Laparotomy( non gynae) Quantity / Request Laparotomy for cancer 4 Laryngectomy 2 Liver (general) Lumbar fusion Mastectomy bilateral 2 Mastectomy radical 2 Mastectomy simple Myomectomy 2 Nephrectomy 2 Ovarian cyst PCNL (PCL) Perforated duodenal ulcer Proctectomy ( open or laparoscopic) 2 Proctocolectomy 2 Profundoplasty 2 Prostatectomy(radical /open) 2 Rectopexy ( open or laparoscopic) Reversal of Hartmanns procedure Rev THR 2 Rev TKR Road traffic accident Shoulder replacement Sigmoid colectomy ( open) 2 Small bowel obstruction 2 Spinal decompression Spinal Fusion Spinal Tumour 2 Splenectomy 3 Termination of pregnancy Thoraco-abdominal aortic aneurysm 6 Thyroidectomy 6

7 Procedure / ICE request Total abdominal hysterectomy(simple) Total elbow replacement Total hip replacement Total knee replacement Total shoulder replacement Quantity / Request Total/subtotal colectomy (open or laparoscopic) 2 Tracheostomy Trans-urethral resection of bladder tumour Trans-urethral resection prostate Ureterectomy 2 Vaginal hysterectomy Vascular surgery (not aorta) 2 Vulvectomy 2 Wertheims hysterectomy 3 Wide lump excision Wrist replacement Y graft/aorta bifem 4 Laparoscopic procedures EVAR Lap. anterior resection Lap.cholecystectomy Lap.hemicolectomy Lap.hernia Lap.sigmoid-colectomy Lap. Other 7