Massive Transfusion

Warm all fluids to be administered during a massive transfusion.

  1. Ensure that a blood specimen has been sent for typing and crossmatching and that the patient has a hospital identification band. 
  2. Attempt to establish peripheral IV access using short large-bore (14-gauge) catheters, or largest possible, before considering a central line. If the peripheral circulation has collapsed, then proceed to a cutdown, a percutaneous femoral approach, a central approach, or an intraosseous approach. 
  3. While establishing IV access, have an assistant prime the IV tubing (Y blood or trauma tubing) with a normal saline solution. If the IV fluid is to be infused under pressure, the air in the fluid bag should be removed with a needle and a syringe to avoid an air embolism. 
  4. Facilitate informed consent, if situation permits. 
  5. When the crystalloid infusion exceeds 30 ml/kg (2-3 L) for the adult patient, blood should be administered. 
  6. Warm all blood and IV fluids to prevent hypothermia. 
  7. Blood from the chest may be autotransfused, if it is available, in patients with a thoracic injury. 
  8. Vital signs, skin perfusion, end-tidal carbon dioxide concentration, pulse oximetry, and urinary output should be monitored frequently. 
  9. The cause of the fluid or blood loss must be identified and corrected as soon as possible. 
  10. For purposes of the transfusion, minimumally assess cardiopulmonary status and vital signs prior to beginning the transfusion, 15 minutes into the transfusion, then after the transfusion is complete. However, assessment of these parameters must be dictated by the patient's condition.