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Master's Dissertation
DOI
10.11606/D.17.2019.tde-08012019-154356
Document
Author
Full name
Renata Vernay Lopes
E-mail
Institute/School/College
Knowledge Area
Date of Defense
Published
Ribeirão Preto, 2018
Supervisor
Committee
Simoes, Belinda Pinto (President)
Pinto Neto, Jorge Vaz
Pinto, Ana Cristina Silva
Rodrigues, Maria Carolina de Oliveira
Title in Portuguese
Elaboração de um manual de reserva de concentrados de hemácias para cirurgias eletivas no Hospital de Base do Distrito Federal
Keywords in Portuguese
Manual de reserva de hemocomponentes ; Cirurgias eletivas ; Índice de pacientes transfundidos ; Hemoterapia ; Banco de sangue
Abstract in Portuguese
O maior consumo de concentrados de hemácias está relacionado a pacientes que enfrentam procedimentos cirúrgicos. A solicitação de reserva de concentrados de hemácias para cirurgia em quantidades muito além do necessário sobrecarrega a Agência Transfusional, configura desperdício de recursos humanos, danos ao erário e prejuízo ao paciente, haja vista que muitos hemocomponentes são reservados para cirurgias, mas poucos são utilizados. A dificuldade no transporte e armazenamento dos hemocomponentes em condições adequadas fora da Agência Transfusional é fato que agrava essa situação e aumenta o desperdício, pois muitos hemocomponentes são solicitados, não são utilizados e retornam ao Serviço de Hemoterapia sem condições de serem reintegrados ao estoque. Tendo em vista que o Hospital de Base do Distrito Federal é a unidade hospitalar com o maior quantitativo em solicitação de reservas de concentrados de hemácias, e por ser recomendável que cada Serviço de Hemoterapia desenvolva seu protocolo específico e personalizado, o objetivo desse estudo é criar um manual de reserva de concentrados de hemácias para procedimentos invasivos, com o quantitativo de hemocomponentes a serem reservados para cada tipo de cirurgia, visando promover o uso racional do sangue no referido hospital. Para isso foi realizado um levantamento dos dados de cirurgias realizadas no Hospital de Base do Distrito Federal nos meses de fevereiro a julho de 2015. Em cada cirurgia foi analisado se houve solicitação e utilização de reserva de hemocomponentes. Com os dados obtidos foi calculado o índice de pacientes transfundidos para cada tipo de cirurgia, sendo confeccionado o manual, que consiste em um quadro com a conduta hemoterápica a ser adotada em cada tipo de cirurgia, se nenhuma, ou realização de tipagem e pesquisa de anticorpos irregulares, ou realização de prova de compatibilidade e reserva de concentrado de hemácias. Foi calculada a quantia aproximada de recursos com insumos que seria economizada caso fosse adotada a conduta sugerida no ano estudado. Para que o manual seja efetivamente aplicado tanto no momento de realizar a solicitação da reserva quanto no momento de preparar a reserva, deve haver uma sistemática de implantação do manual no ambiente hospitalar, com orientações quanto ao correto preenchimento do tipo de cirurgia no mapa cirúrgico e na requisição de reserva ao Banco de sangue. É importante a reavaliação periódica e comparação das solicitações de reservas de concentrados de hemácias para cirurgias eletivas com o cenário do ano anterior. O sucesso na implementação deste manual depende da compreensão e colaboração de uma equipe multidisciplinar de cirurgiões, anestesistas e colaboradores da Agência Transfusional.
Title in English
Development of a packed red blood cell ordering schedule for elective surgeries at Hospital de Base of the Federal District
Keywords in English
Blood ordering schedule ; Elective surgery ; Crossmatch to transfusion ratio ; Hemotherapy ; Blood bank
Abstract in English
Optimizing blood ordering and transfusion has been largely discussed because of patient's safety and money constraints. The highest use of red blood cells in a hospital is related to surgical procedures. The preoperative blood order in quantities much higher than necessary, overloads the Blood bank, which configures wasted human resources, wasted public resources and can cause injury to the patient. In most hospitals many blood components are reserved for surgeries, but few are used. The difficulty in transporting and storing the blood components in suitable conditions outside the Blood bank aggravates this situation and increases the costs. Many blood components are requested but not used and return to the blood transfusion service without conditions to be reintegrated into the stock. Considering that Hospital de Base of the Federal District Brazil is the one with the highest quantity of preoperative crossmatching orders in our state, the purpose of this study was to create a maximum blood ordering schedule (MBOS) for elective surgeries. MBOS has been established since 1977 and should be based on recommendation that each hospital may develop for its specific needs. This MBOS should recommend the maximum packed red blood cell quantity to be reserved for each type of surgery, aiming to promote the rational use of blood in the hospitals. For that, a survey of the data of surgeries performed at the Hospital de Base was carried out from February to July 2015. For each surgery, we analyzed if there was a request and use of a packed red blood cell. With the data obtained, the index of patients transfused for each type of surgery was calculated, and the manual was elaborated, consisting of a chart with hemotherapy decision to be adopted in each type of surgery. The manual included 3 types of recommendations for blood bank staff: none, type and screen only, or crossmatch units of packed red blood cells. The approximate amount of resources that would be saved if the suggested strategy were adopted in 2015 were also calculated. The idea is to have a systematic implementation of the manual in the hospital considering the moment of ordering blood products and the moment of adopting the strategy proposed at the blood bank. Some improvements are needed such as guidelines with suggestions including the complete and accurate filling of the surgical map (exact type of surgery) and implementation of a better blood ordering system with more information about patients and surgeries. This kind of manual most be reviewed periodically since surgical procedures can change over time with new techniques been included in the therapeutic strategies. The success in implementing this manual depends on the consent and collaboration of a multidisciplinary team including surgeons, anesthesiologists, and blood bank staff.
 
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Publishing Date
2019-02-14
 
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