Estimation of blood loss is inaccurate and unreliable

Rothermel, Luke D.; Lipman, Jeremy M.

doi:10.1016/j.surg.2016.06.006

Cited by 101 publications

(75 citation statements)

References 18 publications

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“…One proposal was dismissed in the first round feedback that standardized visual estimation training should be canceled for its inaccuracy. 21 While it is true that objective measurements are favored, 22 we should not deny that visual estimation is widely used as a rapid way to suspect PPH and activate the patient assessment, 23 especially when obstetrical workload is so prominent for such an enormous population. That is why we are currently processing a systematic training protocol, and designing the evaluation method.…”

Section: Discussionmentioning

confidence: 99%

Development of an assessment and intervention protocol for postpartum hemorrhage in the mainland of China: an evidence-based method and Delphi consult

Liu

Fan²,

Zhuang

et al. 2019

Frontiers of Nursing

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Objective Postpartum hemorrhage (PPH) is a leading cause of maternal death. Although guidelines have been updated, those with detailed protocols are limited for nursing practice. This study aims at establishing an early assessment and intervention protocol as a toolkit for PPH for midwives and obstetrical nurses. Methods Employing the evidence-based method, a systematic Internet search of guidelines was conducted and appraisal of literatures was conducted with AGREE system and Oxman-Guyatt Overview Quality Assessment Questionnaire (OQAQ), according to which a protocol draft was therefore developed. Then, a two-round modified Delphi method was utilized to reach a consensus of the protocol built on best practices. Selection criteria for each intervention measure included consensus level with a threshold of 70%, mean of importance (M) >3.5, and coefficient of variation (CV) <0.25. Reliability of experts’ opinion was calculated by positive coefficient and authoritative coefficient. Items without consistency were enlisted in the second-round consult. When all items met the selection criteria, the protocol would be finally formulated. Results A 122-measure protocol was established, including prevention, assessment, and intervention of PPH. With a panel of 14 experts participated in the consult, the positivity coefficient was 0.93 and 1.00 for two rounds, respectively, and the authority coefficient was 0.88. After a two-round consult and revision of the draft, the final program was formulated, containing 5 first-level indexes and 14 second-level indexes with a total item of 120. Conclusions The PPH protocol, based on high-quality evidences, was formulated with a two-round Delphi method, which can provide insight for midwives and obstetrical nurses to effectively deal with PPH.

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Section: Discussionmentioning

confidence: 99%

Development of an assessment and intervention protocol for postpartum hemorrhage in the mainland of China: an evidence-based method and Delphi consult

Liu

Fan²,

Zhuang

et al. 2019

Frontiers of Nursing

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“…On one hand, evidence-based practice clearly favors limiting transfusions while, conversely, transfusion avoidance can result in inadequate oxygen delivery to vital organs and resultant morbidity and mortality. While visual estimates of surgical blood loss can theoretically be used to keep track of red cell mass, these determinations are known to be inaccurate [10].…”

Section: Discussionmentioning

confidence: 99%

“…Changes in blood volume due to anesthetic agents, fluid administration, insensible losses, positioning, temperature and other factors leads to poor correlation between the measured hemoglobin and decreased red cell mass from surgical blood loss [6][7][8]. Moreover, both the amount and rate of bleeding are difficult to estimate leaving surgeons and anesthesiologists with little meaningful data to help decide whether a red cell transfusion is appropriate [9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Accurate Measurement of Intraoperative Blood Loss Improves Prediction of Postoperative Hemoglobin Levels

Thurer¹,

Castro²,

Javidroozi³

et al. 2017

J Anesth Clin Res

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Background: Restrictive red cell transfusion is preferable to liberal transfusion in most clinical situations. However, intraoperative transfusion decisions are challenging due to uncertainty about the amount and rate of bleeding, the poor correlation of hemoglobin levels with blood loss and the effects of anesthetics on blood volume and physiologic responses. Clinicians frequently use hemoglobin levels to guide transfusion. While these "triggers" assume that the patient is normovolemic, they are often applied in situations confounded by hemodilution or hemoconcentration. We postulated that accurate measurement of surgical blood loss would facilitate prediction of postoperative hemoglobin levels, potentially leading to more accurate intraoperative transfusion decisions.

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“…The data we obtained from our study were based on anaesthetists' and surgeons' estimates of blood loss, which may vary considerably from the actual figure. 18 These effects are mitigated by reviewing individual sources of blood loss such as from swab weights and suction devices. Inaccuracies in recording volume of blood or non-blood products transfused are reduced by comparing the volume documented to the electronic record of blood dispensed by BloodTrack.…”

Section: Limitationsmentioning

confidence: 99%

<p>A Single-Centre Review of Transfusion Practices and Blood Wastage in Liver Transplantation</p>

Gan¹,

Nwankiti²,

Milan³

2019

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Background: Liver transplantation is associated with massive blood loss due to a combination of coagulopathy, portal hypertension, and multiple vascular transection and anastomoses. Multiple blood transfusions over a short time frame may result in significant blood and component wastage due to over-ordering of blood products and component time expiry. Blood wastage in the setting of liver transplantation is yet to be reviewed. We reviewed transfusion practices during liver transplantation and audited blood component and product wastage. Methods: We performed a single-center retrospective review of all adult patients aged >16 years over a period of a year. A total of 181 cases were included in the review. Results: Eighty-seven percent of liver transplants were first transplants and were mainly due to chronic liver failure. Our cohort had a median blood loss of 4249 mL (IQR 2830, 6576) per transplant. Patients having redo procedures or have acute liver failure as a presenting aetiology bled significantly more. Nearly all our patients received blood products during the perioperative period. Fresh frozen plasma (FFP) was transfused in 91.2% of our cohort, followed by packed red cells (PRC, 64.2%), platelets (52.5%) and cryoprecipitates (32.0%). A total of 142 units of blood and blood product were wasted. This equates to a wastage rate of 4.6%. This is higher than the target of 3% set by our institution. Highest wastage rates were seen in FFP (8.6%), followed by PRC (2.2%), cryoprecipitates (1.0%) and platelets (0.9%). The commonest cause of wastage was "time expired". The total cost of wastage is £9800, which represents 3.3% of the total cost of blood products transfused. Conclusion: Changing blood component ordering habits, staff training, and awareness may help reduce wastage of this precious commodity.

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Estimation of blood loss is inaccurate and unreliable

Cited by 101 publications

References 18 publications

Development of an assessment and intervention protocol for postpartum hemorrhage in the mainland of China: an evidence-based method and Delphi consult

Development of an assessment and intervention protocol for postpartum hemorrhage in the mainland of China: an evidence-based method and Delphi consult

Accurate Measurement of Intraoperative Blood Loss Improves Prediction of Postoperative Hemoglobin Levels

<p>A Single-Centre Review of Transfusion Practices and Blood Wastage in Liver Transplantation</p>

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