management of parturients who decline blood transfusion oaa national survey 122
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Management of Parturients Who Decline Blood Transfusion OAA National Survey 122 A Jennings & C Brennan. Introduction. Increased morbidity and mortality Require particular management. Methods. OAA National S urvey 122 Sent to lead obstetric anaesthetists. Survey Objective. - PowerPoint PPT PresentationTRANSCRIPT
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Management of Parturients Who Decline Blood Transfusion
OAA National Survey 122
A Jennings & C Brennan
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Introduction
• Increased morbidity and mortality
• Require particular management
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Methods
• OAA National Survey 122• Sent to lead obstetric anaesthetists
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Survey Objective
• To establish current UK anaesthetic practice when managing JWs – Consent– Pre-optimisation– Anaesthetic technique– Facilities available– Seniority of staff involved
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Response rate 70%
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Antenatal Care
Majority• Have a policy – 85%• Use specific “no blood”
consent form – 85% • See patients in clinic –
70%
Minority• Routinely administer
prophylactic haematinics – 36%
• Erythropoietin (if anaemic) – 20%
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In a ‘High Risk’ LSCS…
Empirical additional uterotonics
Prophylactic interventional radiology
Peri-operative cell salvage
General anaesthesia
Invasive monitoring
Transfer
49%
28%
78%
18%
8%
20%
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Senior Input
What is deemed mandatory in all cases?• Consultant anaesthetist-led
theatre care: 30%• Consultant obstetrician-led
surgery: 24% • Consultant haematologist
notified: 23%
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Facilities– Cell Salvage
‘Continuous connectivity’ mode• Discuss antenatally: 53%• Provide a 24hr service: 21%• No cell salvage at all: 25%
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Facilities– Interventional Radiology
24-hour access to interventional radiology service: 27%
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Postnatal Syntocinon Infusion
Routine use in:• Caesarean Section: 48%• All forms of delivery: 22%
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Centralisation of Services?
• 42% felt JWs should be managed in specified regional centres where appropriate facilities, staffing and expertise are guaranteed 24-7.
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Conclusion
• Substantial variation in management demonstrated
• Many units are not equipped to meet the JW care plan
• Substantial support for centralisation of services for JWs. This is worthy of further discussion.