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Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
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Protocol guided bleeding management improves cardiac surgery patient outcomes.

B L Pearse1,2,3,4, I Smith1, D Faulke1

  • 1Department of Anesthesia, The Prince Charles Hospital, Brisbane, Qld, Australia.

Vox Sanguinis
|May 2, 2015
PubMed
Summary

A new bleeding management protocol using point-of-care coagulation testing (POCCT) significantly reduced blood product transfusions in cardiac surgery. This initiative also improved patient outcomes and lowered costs.

Keywords:
bleeding management protocolhaemostasispatient blood managementtransfusion - surgery

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Area of Science:

  • Anesthesiology
  • Cardiovascular Surgery
  • Transfusion Medicine

Background:

  • Excessive bleeding is a common risk in cardiac surgery, often necessitating blood product transfusions.
  • Transfusions, while necessary, can be associated with adverse postoperative outcomes.
  • An evidence-based approach to bleeding management is crucial for optimizing patient care.

Purpose of the Study:

  • To analyze the impact of a quality initiative implementing an evidence-based bleeding management protocol.
  • To evaluate the effectiveness of point-of-care coagulation testing (POCCT) in guiding transfusion decisions.

Main Methods:

  • Retrospective analysis comparing outcomes before and after protocol implementation.
  • Protocol utilized ROTEM and Multiplate for real-time coagulation assessment.
  • Data collected on blood product transfusion rates, patient outcomes, and costs.

Main Results:

  • Significant reductions in transfusions of packed red blood cells (PRBCs), fresh frozen plasma (FFP), and platelets.
  • Increased use of cryoprecipitate and tranexamic acid.
  • Decreased rates of re-exploration for bleeding, wound infections, and length of hospital stay.
  • Substantial cost savings in blood product acquisition.

Conclusions:

  • Implementation of a POCCT-supported bleeding management protocol in cardiac surgery is effective.
  • The protocol leads to reduced allogeneic blood product transfusion.
  • Improved patient outcomes and significant cost reductions were observed.