A prospective assessment of the time required to obtain one unit of fresh whole blood by civilian phlebotomists and Army laboratory technicians (68 K).
blood
donation
phlebotomy
skill
time
transfusion
whole
Journal
Transfusion
ISSN: 1537-2995
Titre abrégé: Transfusion
Pays: United States
ID NLM: 0417360
Informations de publication
Date de publication:
05 2023
05 2023
Historique:
revised:
15
02
2023
received:
29
12
2022
accepted:
15
02
2023
medline:
18
5
2023
pubmed:
18
4
2023
entrez:
17
4
2023
Statut:
ppublish
Résumé
Resuscitation with blood products improves survival after major hemorrhage. Blood product administration at or near the point-of-injury (POI) amplifies this benefit. Size, weight, and cold-chain management challenges all limit the amount of blood medics can carry. Warm fresh whole blood (WFWB) transfusions from a pre-screened donor within the unit represent an alternative source of blood at the POI. We measured the time required for civilian and Army technicians performing phlebotomy frequently to obtain one unit of blood to serve as a goal metric for combat medics being trained in this skill. We gathered demographic and experience data along with proportion of first intravenous cannulation attempt success, time to blood flow initiated, and time to unit draw complete. We prospectively enrolled 12 civilian phlebotomy technicians and 10 Army laboratory technicians performing whole blood collections on 50 and 68 donors respectively. The mean time from setup to needle insertion was 3.7 min for civilians versus 4.2 min for Army technicians. The mean time from blood flowing to the bag being full was 10.7 min versus 8.4 min for civilians versus Army technicians respectively. The mean bag weights were 514 g versus 522 g. First-pass intravenous cannulation success was 96% versus 98% respectively. We found a high first intravenous cannulation attempt success among both the civilian and Army technicians. Medians times were <5 min to obtain venipuncture and <11 min to obtain one unit. These findings provide time-based benchmarks for potential use during transfusion training among military medics.
Sections du résumé
BACKGROUND
Resuscitation with blood products improves survival after major hemorrhage. Blood product administration at or near the point-of-injury (POI) amplifies this benefit. Size, weight, and cold-chain management challenges all limit the amount of blood medics can carry. Warm fresh whole blood (WFWB) transfusions from a pre-screened donor within the unit represent an alternative source of blood at the POI. We measured the time required for civilian and Army technicians performing phlebotomy frequently to obtain one unit of blood to serve as a goal metric for combat medics being trained in this skill.
METHODS
We gathered demographic and experience data along with proportion of first intravenous cannulation attempt success, time to blood flow initiated, and time to unit draw complete.
RESULTS
We prospectively enrolled 12 civilian phlebotomy technicians and 10 Army laboratory technicians performing whole blood collections on 50 and 68 donors respectively. The mean time from setup to needle insertion was 3.7 min for civilians versus 4.2 min for Army technicians. The mean time from blood flowing to the bag being full was 10.7 min versus 8.4 min for civilians versus Army technicians respectively. The mean bag weights were 514 g versus 522 g. First-pass intravenous cannulation success was 96% versus 98% respectively.
CONCLUSIONS
We found a high first intravenous cannulation attempt success among both the civilian and Army technicians. Medians times were <5 min to obtain venipuncture and <11 min to obtain one unit. These findings provide time-based benchmarks for potential use during transfusion training among military medics.
Types de publication
Journal Article
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
S77-S82Informations de copyright
Published 2023. This article is a U.S. Government work and is in the public domain in the USA.
Références
Eastridge BJ, Mabry RL, Seguin P, Cantrell J, Tops T, Uribe P, et al. Death on the battlefield (2001-2011): implications for the future of combat casualty care. J Trauma Acute Care Surg. 2012;73(6 Suppl 5):S431-7.
Ezeibe C, McCarty JC, Chaudhary MA, et al. Haemorrhage control in the prehospital setting: a scoping review protocol. BMJ Open. 2019;9(7):e029051.
Schauer SG, April MD, Simon E, Maddry JK, Carter R, Delorenzo RA. Prehospital interventions during mass-casualty events in Afghanistan: a case analysis. Prehosp Disaster Med. 2017;32(4):465-8.
Schauer SG, April MD, Naylor JF, et al. A descriptive analysis of data from the department of defense joint trauma system prehospital trauma registry. US Army Med Dep J. 2017;3-17:92-7.
Schauer SG, April MD, Fisher AD, Cunningham CW, Gurney JM. Junctional tourniquet use during combat operations in Afghanistan: the prehospital trauma registry experience. J Spec Oper Med. 2018;18(2):71-4.
Schauer SG, April MD, Naylor JF, Fisher AD, Cunningham CW, Ryan KL, et al. QuikClot® combat gauze® use by ground forces in Afghanistan the prehospital trauma registry experience. J Spec Oper Med. 2017;17(2):101-6.
Schauer SG, April MD, Naylor JF, Maddry JK, Arana AA, Dubick MA, et al. Prehospital application of hemostatic agents in Iraq and Afghanistan. Prehosp Emerg Care. 2018;22(5):614-23.
Paulson MW, Hesling JD, McKay JT, et al. A descriptive analysis of battlefield first responder and combat lifesaver interventions during the role 1 phase of care. Med J (Ft Sam Houst Tex). 2021(Pb 8-21-07/08/09);25-30. https://pubmed.ncbi.nlm.nih.gov/34449857/
Schauer SG, April MD, Naylor JF, Wiese J, Ryan KL, Fisher AD, et al. Prehospital Administration of Tranexamic Acid by ground forces in Afghanistan: the prehospital trauma registry experience. J Spec Oper Med. 2017;17(3):55-8.
Schauer SG, April MD, Becker TE, Cap AP, Borgman MA. High crystalloid volumes negate benefit of hemostatic resuscitation in pediatric wartime trauma casualties. J Trauma Acute Care Surg. 2020;89(2S Suppl 2):S185-s191.
Fisher AD, April MD, Cunningham C, Schauer SG. Prehospital vasopressor use is associated with worse mortality in combat wounded. Prehosp Emerg Care. 2021;25(2):268-73.
Shackelford SA, Del Junco DJ, Powell-Dunford N, et al. Association of Prehospital Blood Product Transfusion during Medical Evacuation of combat casualties in Afghanistan with acute and 30-day survival. JAMA. 2017;318(16):1581-91.
Anonymous A. Tactical combat casualty care (TCCC) guidelines for medical personnel 15 December 2021. J Spec Oper Med. 2022;22(1):11-7.
Schauer SG, Naylor JF, Oliver JJ, Maddry JK, April MD. An analysis of casualties presenting to military emergency departments in Iraq and Afghanistan. Am J Emerg Med. 2019;37(1):94-9.
April MD, Fisher AD, Hill R, et al. Adherence to a balanced approach to massive transfusion in combat casualties. Mil Med. 2021. https://pubmed.ncbi.nlm.nih.gov/34347081/
Clarke EE, Hamm J, Fisher AD, April MD, Long BJ, Mdaki KS, et al. Trends in prehospital blood, crystalloid, and colloid Administration in Accordance with Changes in tactical combat casualty care guidelines. Mil Med. 2022;187(11-12):e1265-70.
Keenan S, Riesberg JC. Prolonged field care: beyond the “Golden hour”. Wilderness Environ Med. 2017;28(2s):S135-s139.
Martin SM, Fisher AD, Meledeo MA, et al. More sophisticated than a drink cooler or an old sphygmomanometer but still not adequate for prehospital blood: a market review of commercially available equipment for prehospital blood transport and administration. Transfusion. 2021;61(Suppl 1):S286-s293.
Lauby RS, Johnson SA, Fisher AD, et al. Incidence of expired blood product use in the US central command theater of operations. Med J (Ft Sam Houst Tex). 2022(Per 22-04/05/06);40-5. https://pubmed.ncbi.nlm.nih.gov/35373320/
Schauer SG, Naylor JF, April MD, Fisher AD, Cunningham CW, Fernandez JRD, et al. Prehospital resuscitation performed on hypotensive trauma patients in Afghanistan: the prehospital trauma registry experience. Mil Med. 2019;184(5-6):e154-7.
Schauer SG, Long BJ, Rizzo JA, Walrath BD, Baker JB, Gillespie KR, et al. A conceptual framework for non-military investigators to understand the joint roles of medical Care in the Setting of future large scale combat operations. Prehosp Emerg Care. 2022;1-8:67-74.
Naumann DN, Boulton AJ, Sandhu A, Campbell K, Charlton W, Gurney JM, et al. Fresh whole blood from walking blood banks for patients with traumatic hemorrhagic shock: a systematic review and meta-analysis. J Trauma Acute Care Surg. 2020;89(4):792-800.
Spinella PC, Perkins JG, Grathwohl KW, Repine T, Beekley AC, Sebesta J, et al. Risks associated with fresh whole blood and red blood cell transfusions in a combat support hospital. Crit Care Med. 2007;35(11):2576-81.
Gurney JM, Staudt AM, del Junco DJ, Shackelford SA, Mann-Salinas EA, Cap AP, et al. Whole blood at the tip of the spear: a retrospective cohort analysis of warm fresh whole blood resuscitation versus component therapy in severely injured combat casualties. Surgery. 2022;171(2):518-25.
Skube ME, Witthuhn S, Mulier K, Boucher B, Lusczek E, Beilman GJ. Assessment of prehospital hemorrhage and airway care using a simulation model. J Trauma Acute Care Surg. 2018;85(1S Suppl 2):S27-32.
Schauer SG, Mabry RL, Varney SM, Howard JT. Emergency department patients support the use of combat medics in their clinical care. J Spec Oper Med. 2015;15(2):74-8.
Schauer SG, Cunningham CW, Fisher AD, DeLorenzo RA. A pilot project demonstrating that combat medics can safely administer parenteral medications in the emergency department. Prehosp Disaster Med. 2017;32(6):679-81.
Ngo A, Masel D, Cahill C, Blumberg N, Refaai MA. Blood banking and transfusion medicine challenges during the COVID-19 pandemic. Clin Lab Med. 2020;40(4):587-601.
Jacobs JW, Booth GS. Blood shortages and changes to massive transfusion protocols: survey of hospital practices during the COVID-19 pandemic. Transfus Apher Sci. 2022;61(1):103297.
Stanworth SJ, New HV, Apelseth TO, et al. Effects of the COVID-19 pandemic on supply and use of blood for transfusion. Lancet Haematol. 2020;7(10):e756-64.
Nessen SC, Eastridge BJ, Cronk D, Craig RM, Berséus O, Ellison R, et al. Fresh whole blood use by forward surgical teams in Afghanistan is associated with improved survival compared to component therapy without platelets. Transfusion. 2013;53(Suppl 1):107S-13S.
Spinella PC. Warm fresh whole blood transfusion for severe hemorrhage: U.S. military and potential civilian applications. Crit Care Med. 2008;36(7 Suppl):S340-5.
Martinaud C, Scorer T, Lozano M, Miles A, Fitchett G, Ba A, et al. International forum on walking blood Bank Programmes: summary. Vox Sang. 2021;116(8):924-9.
Holcomb JB, Spinella PC, Apelseth TO, et al. Civilian walking blood bank emergency preparedness plan. Transfusion. 2021;61(Suppl 1):S313-s325.
Fisher AD, Dunn J, Pickett JR, Garza J, Miles EA, Diep V, et al. Implementation of a low titer group O whole blood program for a law enforcement tactical team. Transfusion. 2020;60(Suppl 3):S36-s44.