MTP - Massive Transfusion Protocol EXPLAINED

Explaining the complexity and concepts for massive transfusion protocol 📝 Free Quiz: adv.icu/3oFikPY (💲Weekly Prizes)
In this lesson I do my best to explain the complexity that is massive transfusion protocol. When your patient is massively bleeding out, they need a lot of blood and fast! It is a high stress situation and thus it helps if you have an understanding of what this is and what to expect.
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Check out these other great lessons and series of lessons below!
✅ Hemodynamics: • Hemodynamic Principals
✅ Shock: • Shock
✅ ECG/EKG Rhythm Interpretation: • ECG/EKG Interpretation
✅ ICU Drips: • ICU Drips
✅ ECMO: • ECMO
✅ CRRT: • CRRT Explained!
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❗️❗️PLEASE NOTE: ICU Advantage medical videos, medical lectures, medical illustrations, and medical animations are for medical education and exam preparation purposes, and not intended to replace recommendations by your doctor or health care provider. The information is present here to give you a starting place to further look in to the proper treatments and recommendations for the care of your patient.
0:00 Intro
2:54 What is Massive Transfusion
5:12 Activation of MTP
10:07 Components of MTP
12:51 Source Control
14:15 Coagulapathies
13:06 Wrap up
#ICUAdvantage #Blood #MTP

[@BlueLineRider]

this is good value eddie. During my first MTPs one of the seasoned nurses told me to take a permanent marker and number the bags as we go... time saver on backtracking and documentation

[@ICUAdvantage]

Yes! Absolutely! I should have mentioned that in here. Def makes it easier to keep track of everything. Thanks for sharing that.

[@taylornelson3774]

Just wanna say I so appreciate these videos! New grad nurse in the ICU, these videos have helped me start to connect dots at work.

[@ICUAdvantage]

This is so great to hear Taylor. That is truly my goal in making these and its really great to know they are so well received. Congrats on the new ICU position and truly wishing you all the best!

[@TraceyStClair]

I am a consolidating RN student on the Neuro trauma unit. I love all of your videos and voice. Concise and easy to understand harder topics. A big THANK YOU for taking the time to do this. And please people thank him for the video before asking him to do another video/topic.

[@matthewmason7868]

I love your videos!! I’m an ED nurse but these critical care videos are just as important for us and they help me keep concepts fresh in my brain.

[@ICUAdvantage]

Awesome to hear Matthew! Yes, these concepts very much apply for you guys as well. Glad to hear you find these videos helpful!

[@ajlavanetwork5755]

I completely agree! (ED Nurse here too). I find it hard to find resus videos! So here i am :-)

[@skennedyrn]

This was awesome review and solidified prior learning. You made it really simple and basic to understand. Thanks!

[@RandomGrump]

These videos are amazing! Heading into the final quarter of nursing school and hoping to get into the ICU! I live for this stuff!

[@ICUAdvantage]

Thank you very much Margaret! How exciting! You are almost there, you got this!!! I totally get your sentiment and felt the same way myself coming out of school. I knew ICU was for me, without a doubt.

[@ShadowMoone]

I've watched several of your videos today, and I've learned so much! Thank you for doing this! I'm going to tell all of my coworkers about your channel.

[@ICUAdvantage]

So great to hear this! Really glad you found them helpful and thanks so much for spreading the word!

[@poincareconjecture5651]

THANK YOU EDDIE WISHING YOU ALL THE SUCCESS!!

[@irfaansaib4846]

Your videos are amazing! really appreciate how you simplify stuff!

[@ICUAdvantage]

So happy to hear this! Thank you!

[@SpecialK6685]

One of the best channels. Content and delivery are great!

[@ICUAdvantage]

Wow, thank you so much! Glad you think so! :)

[@blklionhawk]

I need to learn about MBT and didn’t feel like reading this was very helpful introducing the subject before I read the material. Thank you

[@VoiceofSincerity]

This was great. From a recently certified critical care nurse, your videos became a game changer for me

[@ICUAdvantage]

Wow, so great to hear that and congrats on getting certified Joseph!

[@alexhernandez-ns8yp]

great video as always. this is making me more confident at work, as i'm only a year into nursing and started in the icu. The notes available thru patreon are awesome too. I printed them out and keep them in my work backpack. Thanks bro!

[@ICUAdvantage]

This is so great to read Alex. Thank you so much for taking the time to leave this comment, as well as your support of me and this channel. I really appreciate you!

[@moritzwolle2141]

Watched your first video and I knew a lot of the topics already from other approaches and as separate topics, but you concluded it really on point :)

[@ICUAdvantage]

Awesome! Glad to hear you found some useful information in there :)

[@in.depth.productions]

Wow lots of good info, will need to watch several times to retain/absorb all this info. Thank you, very informative and well presented.

[@ICUAdvantage]

Thank you for that. Yeah, some of these concepts def require revisiting. Beauty of having them on KZbin :) Glad you liked it!

[@Stepho2Fierce]

A beautiful explanation, thank you!

[@ICUAdvantage]

Thank you so much! Glad you liked it!

[@jerryaddisababa]

You are such an awesome help!!!

[@ICUAdvantage]

Happy to be of help!

[@sportstours24]

This was great revision. In emergent conditions with minimal equipment, rapid IV push with a 50ml dispo works. A three way connected to the blood bag is very useful.

[@MaddyLee99]

im gonna work as a new grad nurse in a surgical trauma icu in March and this is so helpful thank you!

[@wesamzaen5463]

Great lecture. Thanks a lot

[@ICUAdvantage]

You are very welcome!

[@mariamgujuram1524]

Thank you so much it really helps me

[@ICUAdvantage]

My pleasure! Glad you liked it!

[@darrenlevy6656]

Very good review, thank you

[@ICUAdvantage]

Thanks Darren!

[@heartlessgamer_3242]

Another great video!

[@ICUAdvantage]

Thank you again! :) Appreciate you!

[@jennyposthumus3821]

Great information!! I'm an OB instructor and I'm going to share with my staff!!

[@ICUAdvantage]

Awesome! Really glad you liked it and thanks for sharing!

[@nurseeducatorpk8445]

Your all videos are very informative and i like your teaching way easy and understandable ....good efforts keep it up...

[@ICUAdvantage]

Thank you so much! I appreciate the kind words!

[@chadr2604]

I have respect for the nurses they do work I could never do. I don't have as much for most doctors there are a lot of crappy doctors. When I had to go to the icu i didn't see the doctor until the next day. I basically had a massive transfusion a nurse practitioner diagnosed the problem and sent me to the hospital the only people I saw were the nurses. I remember seeing 51/45 on the blood pressure with a pulse of 140

[@Malarvili]

Very informative. Thanks

[@ICUAdvantage]

Glad to hear it and youre welcome!

[@angelafranklin6333]

This is very helpful 🙂

[@ICUAdvantage]

Happy to hear this! 😊

[@jovannagutierrez6898]

Thank you, this help so much, just preparing for an increta case we have scheduled.

[@ICUAdvantage]

Glad you liked it!

[@shadypark78]

Great subject. Learning to transfuse Type 0 Low titer blood with TXA, and to do it without (TACO), (TRALI), and reactions. Stressful stuff.

[@nicholasthompson8772]

Had my first MTP the other week. Trauma with pelvic fractures etc etc. While in IR the IR doc goes "Ive never seen this before im not sure what to do" meanwhile you are just watching the contrast dye spilling out into her body. Long story short, IR doc stopped the art bleeds and shes doing good now, extubated, in a lot of pain, but alive and thankful for everyone's work

[@ICUAdvantage]

Very cool! Glad to pt made a good recovery. It really is cool what all they can do in IR!

[@doctorfaheemkhanbalouch6322]

Very good lecture. ❤️

[@ICUAdvantage]

Thank you! 🙂

[@kennedysakala1343]

Thank you

[@justinparker9892]

Thanks Eddie

[@ICUAdvantage]

And thank you as usual Justin!

[@majdakaddouri]

that was pretty helpful. thanks for your vigilant explanations

[@ICUAdvantage]

Glad it was helpful!

[@mervinhowe6881]

this has been super helful.

[@ICUAdvantage]

Glad to hear this!

[@smartnursingclasses1503]

Thank you sir

[@ICUAdvantage]

You are welcome

[@nehayalagachin7717]

amazingly helpful!!!! Thank you! -obgyn resident

[@najmiusman7028]

Great need something like this for picu

[@ICUAdvantage]

A massive transfuser? Do they not make smaller ones?

[@tressaanderson2888]

Thank you for the valuable info. I am a new RN who will be starting in the ICU in 3 weeks.

[@ICUAdvantage]

Woohoo!! Congrats on finishing school as well as they new ICU gig. Wishing you the best!

[@henriquelopes9596]

Thanks.

[@ICUAdvantage]

You're welcome!

[@shivjain]

Thanks

[@ICUAdvantage]

Thank you so much Shiv!

[@simoned.6993]

I agree with you about the stress. I have done MTP with post op hearts and exsanguinations using rapid infuser. I was primary nurse and I do remember that a nurse saying that blood was not going in so I think it may have been on a standard central line. So I learned from you video those are too small. Intensivist was inserting a cordis during event. Also roles, that is so important. Even though it is chaos, it needs to be controlled. I was thinking 2 nurses to check all units and once ready, arrange the round to be infused. I also think 2 nurses on R.T. since it goes in so fast. Return all units, and calcium empty bags in the same basin or large plastic bag to review that a full round has been completed. This can be done by the nurses checking compatibility, they would also control the blood slips and keep with that round. Sometimes numbering can get lost as they add up. Another nurse infuses cal doses, platelets, assesses temp, and draws blood. It is a memorable experience that rarely goes as planned.

[@ICUAdvantage]

Very great description of events! It really is chaos but certainly can be controlled when people know what they are doing and don't let the adrenaline get to them. Once comfortable, 1 RN can definitely run the RT, but with a good line, you've got to be Johnny on the spot for the changes. Doesn't hurt to have a 2nd if available. Def trying to keep track of everything for charting and recording later is a pain. The worst is when the RT is not "working" and you've got to try and figure out why. Thats where the most stress comes from I think.

[@jdeharo4731]

Great video with a wealth of Knowledge!! I was curious if you knew of any videos that are great at explaining EVD set up along with understanding the whole process of head bleeds? Again, Great video!!!

[@ICUAdvantage]

Thank you so much. I haven't gotten around to making an EVD video yet, but I do have a good video on various traumatic bleeds here: kzbin.info/www/bejne/ZmTSY6xvr7eVb68

[@sethmoldenhauer6403]

Fantastic video. Just started in the SICU as a new grad this past week, and second day on the job we ended up calling an MTP. I was simply a runner during the process, but I tried to soak in as much as I could. This video was super helpful in reviewing the case/connecting the dots of what I saw. Thanks much!

[@kharioka10]

I’m

[@kharioka10]

Tr

[@mufasa2899]

Thanks for all your videos. Can you do something on Target Temperature Management? Thanks

[@ICUAdvantage]

Happy to be able to help! And yes, I have that on the todo list!

[@Unstopabowlski]

I love your vids, would love if you made more emergency related vids like this :) but I know you are targeting more icu rather than er

[@dsfnful]

Awesome video! Can you do a series on Targeted Temperature Management? I'm an ICU nurse who really loves neuro and its my favorite therapy to date.

[@ICUAdvantage]

Glad you liked it Fatima! I do plan to cover TTM in a future video!

[@bonniehuang8696]

Second to that! Also post-cardiac arrest temp management.

[@andrewd4438]

Considering the results of TTM2, hopefully hospitals stop cooling patients very soon.

[@jasoncotterill3033]

Desmopressin is also a good adjunct to platelet administration in hemorrhagic shock

[@ICUAdvantage]

Thanks for sharing. I feel like that rang a distant bell somewhere so I did a quick search and its pretty interesting. I'll have to dig more into that.

[@chuckedgerton8555]

Awesome

[@chadr2604]

This was at a rual hospital the rapid transfuser was hands. Its not a single package in a rural hospital i remember the nurse telling me the platelets were being flown in.

[@magemage9370]

Kindly give some points regarding MTP during oncological emergencies

[@lamyaazeyada554]

Marvelous But kindly how many rounds of MTP can pt receive in 24 hr And can you kindly make a lecture for DIC and primary fibronoltsis

[@PJ-gj9wk]

Great video. If you don't mind, can you add RSI on your "todo list"? That would be awesome!.

[@ICUAdvantage]

It's there! 😊

[@openyourmindtomedicine]

Please do a video on all the types of lines

[@ICUAdvantage]

Thanks for the suggestion and yes, I do have them on the todo list!

[@andrewd4438]

Any thoughts on giving significantly more calcium? Like, 1g of chloride on initiation of MTP, another 1g every 2-4 units of product, then PRN with low ionized calcium levels?

[@daisy-from_]

Can u explain balance 1:1:1ratio?

[@bonniehuang8696]

Super hepful video again! I just wanted to share that we also use ROTEM to determine what blood products pt may need other than PRBC: TXA? Fibrinogen? Platelets? I am not sure if you have already, but a video on ROTEM test and how to interpret it would be great! :) Thank you again .

[@ICUAdvantage]

Glad you liked it! And YES I do have a video already on it. Search for “TEG”

[@bonniehuang8696]

@@ICUAdvantage oh thank you! Will check it out!

[@srinithya7680]

can u plz explain about MTP complications

[@ICUAdvantage]

I'm not sure theres enough to talk much about. Blood transfusion related stuff is primarily the concern. We do risk blowing veins with the high flow rates, and we also run the risk over over resuscitating our patients.

[@sunshine6183]

Hey jus wanted to let you know that you make awesome videos. Keep up the good work 💖 N dnt get disheartened by d number of likes or comments because as you know most of us are always in a hurry😁

[@ICUAdvantage]

Thank you so much! I certainly don't get discouraged. I am honestly shocked at the number of views, likes and comments that my videos get. Actually getting kind of hard to keep up with all of them! 😊

[@thebearded_guardian3671]

You say HD access can work? Is this exclusive to a vas cath or can a PD port work? I’d assume not on the PD, but no idea.

[@francishubertovasquez2139]

Blood transfusion is lifesaving during emergencies, this makes me think of something, there are those who believe in full name listings and give them new names unknown to others but the beholder of that new given name and there are those who believe in encoding names and match those names to their corresponding numbers of identity code, high intelligent beings or spiritual beings in polarity could be in contest against each others using their particular numbered tools coded persons versus new spiritual name identity persons in a usage of their long trainings and commitment to their group and test for their capability, something like that.

[@kakashihatake169]

How is a cordis preferable to a regular central line for transfusion? Also, what's the science behind just letting the platelets hang and to not "push" them?

[@ie6767]

Hey question, are MTPs a 1:1 nurse to pt ratio?

[@assemelshora8796]

one round of MTP means 1:1:1 or 3 to 5 packed rbc's that we will give calcium?

[@ariellara2498]

Thank you so much for your content! Never fails to be amazing. Question regarding blood type administration. Is it that makes can receive O negative and females can receive O positive? If so, could you explain further

[@faithjohnson5587]

This is very informative! Any opinion on using whole blood instead of blood components? I suppose it would depend on facility protocol. I'm new to the ER and new to MTP's, just a thought that could save time for the nurse and the help the patient!

[@ICUAdvantage]

In MTP it certainly would be easier to use whole blood, but the storage and longevity of it isn't the same as the different components and there is much more use for components in hospital care that I wouldn't see a big push for using it in hospital. Besides half the fun of MTP is trying to keep up with the rapid transfuser! :)

[@bindujoseph7808]

Could you please explain how to prime the level one and Belmont rapid transfuser ?

[@ICUAdvantage]

It'd be hard to do without a video of the actual equipment

[@chandelier4615]

On my first week (day 2) in trauma ICU a patient had this. It was really cool did not realize I was that much of an adrenaline junkie. Glad the patient made it through the day. What I liked was how organized it was. The primary nurse made sure to organize every paperwork for each unit of blood, she did the documenting part while the rest of us did the actual MTP (I learnt a lot). I mean we were literally administering blood products like every 2 minutes on the level 1.

[@ICUAdvantage]

Haha, yes you can dump the blood in quick with the level 1! Glad to hear things turned out good for your patient and happy that you got the exposure to this early on in your orientation. It def is quite an exhilarating experience, especially when things turn out well for the patient.

[@karimzaghloul1]

can someone elaborate min 10:53,why AB positive used if blood group is unknown?why we dont use O-/O+ as we do in PRBC?

[@chadr2604]

The cause was never determined but it was a plant i ate. I used to have a bad habit of eating wild plants out in the pasture. I came across aplant i had never seen and thought ill try it.

[@user-iw7sb9oq9n]

I have a question. Massive blood loss usually leads to hypovolemic shock. We usually challenge normal saline. However, in the video you said not to use crystalloids. What should I do

[@ICUAdvantage]

If known massive blood loss, if possible I would avoid crystalloids. Our patients oxygen carrying capacity is already massively reduced and saline will only dilute things further. What is really needed is blood for volume and RBCs for oxygen carrying capacity. If profoundly hypotensive and no blood yet, we can use crystalloids to try and support pressure until blood can arrive. Hope that makes sense.

[@bindusneha01]

What is HD line ?

[@oxfd611]

What about the heart Inotrope & bromotrope that is effected by the decreased calcium level. How detrimental can that be to the patient that’s in hypovolemic shock?

[@ICUAdvantage]

Calcium certainly plays an important role in cardiac functioning. Any decreased levels are going to decrease perfusion and contribute to the worsening of the shock state. So definitely added importance to our calcium level, but with hypovolemic shock, the biggest contributor is loss of volume and the effects of citrate are going to have a significant effect on coagulation and prevention of the correct of this.

[@billyborton5136]

Hey there! It's me again guy that asked about whole blood and TXA know this is a little old but thought I could maybe get a question answered. I been doing research on fluid resuscitation and been seeing alot of stuff about Permissive hypotension or hypotensive resuscitation and seen recent article saying that this way of fluid resuscitation is very beneficial when a patient is still bleeding to help control that bleeding so i was wondering what you thought. Is it to risky to micro managing blood pressure and vitals with how much blood you have flowing into a patient to keep that permissive hypertension or is it possible? Or is aggressive fluid resuscitation needed to keep someone alive due to the chaos of the emergency room/ICU.

[@ICUAdvantage]

Good question. There definitely is validity in not brining the pressure too high due to risks of rebreeding from a weak clot. It is something that is watched, especially with MTP as so much volume goes in quickly, that BP can rapidly rise when the loses are decreasing. Its not an exact science but something we are definitely aware of and looking for to try and prevent from happening.

[@user-px1wo3fl1q]

Can you run FFP on the same tubing as the RBCs

[@ICUAdvantage]

Yes

[@andreawong5225]

Do we use blood warmer for blood transfusion? If there's blood reaction occurs,we stop the bag . Do we need to send back to the lab to check on the bag? Thank you so much for such good lesson.

[@ICUAdvantage]

Great questions. We typically don't use blood warmers for normal transfusions. There are some rare cases where the patient NEEDS the blood warmed, but I've only seen it once or twice. For the reaction question, yes the bag will go back per your hospital policy. I believe it should be blood bank that gets it.

[@andreawong5225]

@@ICUAdvantage thank you,Eddie.

[@tomatomi8041]

"Overall clinical picture" is not an indication for the activation of MTP. There are many clinical pictures, you should tell us specifically which ones warrant the activation of this protocol. That is very important, you don't want a patient to get clots.

[@gretchenanderson4728]

How quickly can I give blood to a symptomatic pt who needs 2u PRBC’s & Platelets?

[@ICUAdvantage]

It really depends on different factors, but many times we 999 blood on the pump or hand squeeze it in (if not needing MTP and rapid transfuser).

[@mariambadawy1487]

why using plasma of AB+ blood type

[@ICUAdvantage]

Good question. Plasma is what contains antibodies. Given the AB+ blood type, they will have no A and no B antibodies and no Rh ones as well. The red blood cells are the opposite and we want the cells that have no antigens hence O- Hope that makes sense!

[@francishubertovasquez2139]

If the match battles of 2 type of polarity groups to be carried out really in any paths of our existence into the time loops of existence repititions with a cause, then those contestants for that or players they can call or whatever could be engaging themselves into mastery of different professions and knowledge and to be a contestant/ player of such grand design those would to be contestants have to battle against each other in a particular polarity so that the bests of them shall battle the bests of the other polarity, something like that, Im thinking in a very advanced manner, I dont know if you can understand what I meant to say.🎉

[@baldwintheleper]

Instead of transfusing individual blood products, would it be better to transfuse whole blood?

[@ICUAdvantage]

I think in an MTP situation, yes.

[@Vervayne13]

Blood banker here. Absolutely not. When transfusing whole blood, the donors and patient ABO must be identical. Whole O blood contains anti-A and Anti-B in the plasma. By separating the blood into components, we can give the universal donor type of both plasma (AB) and packed RBCs (O)

[@rebeccamatthews3407]

Most blood banks do not carry whole blood unless you have donated for yourself for OR.

[@thekilobrain1798]

You sir❤🍫🍷

[@egglover9252]

The video start at 2:58

[@ICUAdvantage]

Thanks

[@tamikaaugustine2313]

Ventilation techniques

[@ICUAdvantage]

?

[@realzhella6817]

Do only nurses need to watch this or also medical students?

[@sajalaiims]

can (O+) brother donate blood to (O+) sister ? { what about Post-Transfusion Graft Versus Host Disease (PT-GVHD) }

[@mercygloria4299]

❤️❤️❤️

[@Phoenixmt799]

Pls respond: Q.Massive transfusion in a single transfusion is A. 3000ml B. 2500 ml C. 4000 ml D. 4500 ml

[@art230834]

If patient’s blood type is not known, you give O negative or O positive? I heard you saying giving O positive. Isn’t it O negative that can be given to any blood group patient?

[@rebeccamatthews3407]

I am a blood banker. Yes O neg is the universal but not all blood banks carry a lot. My facility right now only has 6 O negs on shelf(not a trauma hospital). We always stress to get us in the blood bank a type and screen as quickly as possible in order to give type specific. We give O neg for the first round then access the situation. If the patient is a male we switch to O pos. If the patient is a female but over child bearing age we switch to O pos, if the patient is a female of child bearing age we try to stay with O neg until we get that type and screen. If we can't get that type and screen at my facility we page the on call pathologist to get approval to switch to O pos.

[@cnlights2]

What do you do for ppl who dont take blood bc of religious reasons? Can you use a cell saver?

[@ICUAdvantage]

Sometimes yes, if they agree to it. Only helpful really for surgery. Some won’t take it though. Others will pre donate some too. But if that isn’t available and they won’t take blood there unfortunately not much we can do.

[@avantikadogra850]

❤️❤️

[@ICUAdvantage]

Thank you! ❤️

[@chadr2604]

Is there any protocol to give oxygen? I remember the nurses giving oxygen

[@rafaelsanchez2042]

Do you know all this by heart!?! Or how do you do your research?

[@ICUAdvantage]

It kind of depends on the topic, but after almost 10 years, much of what I talk about is stuff that I have learned over the years. I then look through online journals and some education text books to make sure that I cover all aspects and anything that I may be missing.

[@tenminutetokyo2643]

Bill that insurance.

[@ahmedsediek5045]

🌹🌹🌹🌹🌹🌹🌹🌹🌹

[@ICUAdvantage]

Thank you!

[@cnlights2]

How do you handle ppl that are Jehovahs Witnesses??

[@ICUAdvantage]

Unfortunately there is no handling that as they won't get blood.

[@cnlights2]

@@ICUAdvantage Have you heard of cell saver/salvage machine. Theyre small and can be used in surgery as well as post op for knee surgeries, etc. Glues, cauterization tools and other drugs can be used to increase rbcs, platelets, before, during and after surgery. JWs have a dvd out and its very interesting esp when docs or hospitals dont know this (and you should). Great info! ALWAYS look in their wallets as we carry a 'No Blood' card. It also lists contacts and things we will/wont take bc of our beliefs.

[@cnlights2]

@@ICUAdvantage if you find they are JWs and you give blood its against the law and you can be sued. I think someone should look for any ID stating what ANY person wants as treatment. Sometimes the simplest thing can be the most important.

[@ICUAdvantage]

@@cnlights2 Yup, definitely aware of the options for JW patients when it comes to surgery, including donation prior. But not everyone will take the blood once it leaves the body, so definitely a case by case. My answer was in response to your question on this video for MTP. Unfortunately these are not options in an MTP situation.

[@nclexstudio]

You are too much

[@bryansaylors1459]

Thanks

[@ICUAdvantage]

Thank you so much for that Bryan!