ﺑﺎﺯﮔﺸﺖ ﺑﻪ ﺻﻔﺤﻪ ﻗﺒﻠﯽ
خرید پکیج
تعداد آیتم قابل مشاهده باقیمانده : 3 مورد
نسخه الکترونیک
medimedia.ir

Blood product and extracorporeal procedure informed consent checklist

Blood product and extracorporeal procedure informed consent checklist
The following points can be documented:
Discussed the risks and benefits of accepting blood product transfusion.
Discussed the risks and benefits of NOT accepting blood product transfusion.
Discussed the risks and benefits of extracorporeal circulatory and salvage techniques.
Specify whether consent was obtained privately or with family members/others present.
Patient understands that if clinically significant bleeding cannot be stopped, then the patient will eventually die.
Patient is aware that blood product refusal may result in organ or tissue damage or even death.
Patient adamantly refuses the blood component therapies indicated below, even if faced with death.
Patient realizes that with these restrictions, the care team may be forced to proceed more quickly to definitive procedures that have a chance of stopping the bleeding (bowel resection, cesarean delivery, hysterectomy, amputation, etc) (this is due to the lack of a blood "buffer" that enables the treating team to replace the blood lost during preliminary attempts at hemostasis).
Patient understands that he or she may reverse these restrictions at ANY time and accept blood. If this occurs, the care team will abide by all patient privacy standards and not discuss the acceptance of blood products in front of family or clergy without patient consent.
Patient was given the option to allow blood transfusion in extremis if two physicians agree that death is likely imminent.
Another health care provider was present during the consent process or, alternatively, was present when the patient verbally acknowledged the summary of acceptable and unacceptable products and interventions.
Patient acceptance (Yes) or refusal (No) of the following items can be documented:
Allogenic human blood and blood components
  • Whole blood
  Yes  No
  • Red blood cells
  Yes  No
  • Plasma
  Yes  No
  • Platelets
  Yes  No
  • White blood cells (granulocytes)
  Yes  No
  • Blood from specific donor(s)
  Yes  No
Human blood fractions and medications that contain human blood fractions
  • Cryoprecipitate
  Yes  No
  • Cryosupernatant ("cryo-poor plasma")
  Yes  No
  • Albumin
  Yes  No
  • Plasma protein fraction
  Yes  No
  • Human immunoglobulin (eg, Rh immune globulin, IVIG)
  Yes  No
  • Plasma-derived clotting factor concentrates (eg, fibrinogen, factor VIII [F8], factor IX [F9])
  Yes  No
  • Tissue adhesives/fibrin glue
  Yes  No
Intravenous fluids and medications not derived from human blood
  • Hydroxyethyl starch (eg, hetastarch, pentastarch)
  Yes  No
  • Balanced salt solutions
  Yes  No
  • Recombinant clotting factor concentrates (eg, factor VIII [F8], factor IX [F9], recombinant activated factor VII [rFVIIa; rF7a])
  Yes  No
  • Recombinant erythropoietin
  Yes  No
  • Antifibrinolytic chemicals (eg, tranexamic acid, aminocaproic acid)
  Yes  No
  • Chemicals to improve clotting (eg, desmopressin [DDAVP], vitamin K)
  Yes  No
Extracorporeal techniques for blood conservation or treatment
  • Intraoperative hemodilution
  Yes  No
  • Intraoperative blood salvage (cell saver)
  Yes  No
  • Autologous banked blood (self donation)
  Yes  No
  • Cardiopulmonary bypass
  Yes  No
  • Chest drainage autotransfusion
  Yes  No
  • Plasmapheresis
  Yes  No
  • Hemodialysis
  Yes  No
  • Other: ____________________________________________
  Yes  No
This information is for use with patients who desire to restrict the use of blood products. Refer to UpToDate for futher information regarding the management of a patient who declines blood transfusion.
IVIG: intravenous immune globulin.
Courtesy of Kendall P Crookston, MD.
Graphic 106229 Version 5.0

آیا می خواهید مدیلیب را به صفحه اصلی خود اضافه کنید؟