Transcript collaborate.uw.edu

Transfusion Related Acute Lung Injury:
A Simulation Case
Experience For Nurse Educators
Becky Piper, MN RN
Pierce College
Nursing Program
Objectives
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Provide a brief overview of transfusion reactions
Provide a definition of TRALI
Describe the steps used to build the TRALI
SCE
TRALI
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1.
2.
3.
4.
TRALI defined
Pathophysiology
4 primary causes
HNA/HLA antibodies
Multiparous donors (>3pregnancies)
Lipid priming agents from older PRBC
products
First hit-second hit model
TRALI Fatalities
100
90
80
70
60
50
40
30
20
10
0
TRALI Fatalities
Total Transfusion
Fatalities Reported
1996
1998
2000
2002
2004
Recent Trends TRALI
40
35
30
Deaths
25
TRALI
TACO
20
15
10
5
0
FY 2005
FY 2006
TRALI vs. TACO
Comparison
TRALI
TACO
Blood Pressure
Hypotension
Hypertension
Onset
Up to six hrs post
transfusion
Usually occurs during or
immediately after a
transfusion
Chest X-Ray
Bilateral pulmonary
infiltrates, normal
heart
Bilateral pulmonary
infiltrates, enlarged
heart
<250pg/ml
Normal
>250 pg/ml
Elevated
Lab tests
BNP
TNI
TRALI vs. Normal Lung
Treatment
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Symptoms may be mild to severe
If severe may need intubation to support respiratory
system - treatment in ICU
 Use of steroids
 Lasix (Furosimide) is NOT appropriate
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Symptoms may subside within 96 hrs.
Knowledge Gaps
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Lack of information on TRALI for nurses and
transfusionists in peer review journals
Few nursing text books mention it!
Building the TRALI Simulation
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Research – TRALI and Simulation in Nursing
Writing the simulation using UWSON template
First review by Simulation experts at UWSON
Review by two Medical Directors
Dr. Tom Baker, Cascade Regional Blood
Services – Tacoma
Dr. Bob Ranlett, Inland Blood Centers - Spokane
 Trial runs for debugging
TRALI Case Study
Case Description:
Your patient is Lucy Leardal, a 72 yr old female
who tripped over her cat and was subsequently
admitted in the evening through the Emergency
Room with a left hip fracture. Lucy has a history
of A-Fib and takes 5 mg of Coumadin daily.
TRALI Case study
You have just come out of shift report. Your
patient is scheduled for hip surgery tomorrow
(ORIF). She is receiving the first of three units
of FFP ordered to reverse the effects of
Coumadin prior to the surgery. She has received
approximately 50 ml of the first unit of FFP.
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References
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Fatalities reported to FDA , Annual summary for fiscal years 2005 and 2006
http://www.fda.gov/cber/blood/fatal0506.htm
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Bradley, P. (2006). The history of simulation in medical education and
possible future directions. Medical Education, (40), 254-262.
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Issenberg, S.B., McGaghie, W., Petrusa, E., Gordon, D. & Scalese, R. , (2005).
Features and uses of high fidelity medical simulation that lead to effective
learning: a BEME systematic review. Medical Teacher,(27) 1, 10 - 28.
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Jeffries, P.R., (Ed.), (2007). Simulation in Nursing Education, New York:
National League for Nursing.
 Perkins, G. (2007). Simulation in resuscitation training. Resuscitation, (73), 202211.