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Performance Improvement

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Performance Improvement: Joint Care Center
Matthew Arless
State University of New York Plattsburgh

Blood loss in a total joint replacement surgery may subject the patient to allogeneic blood transfusion. This places a patient at risk for the potential of transfusion reactions, graft-versus-host disease, hyperkalemia, fluid overload, and infections.( Qintong 2014) Not to mention the fact that most patient’s satisfaction or even more significant avoidance of the surgery increases with the fear of receiving an allergenic blood transfusion. This in all sense and purposes is an organ transplant. Cost of an allogeneic blood transfusion and having a sufficient blood supply are also a factor. Reduction of blood transfusions post operatively is an area that presents an opportunity for improvement here at the Joint Care Center Champlain Valley Physician Hospital.

The procedure that was traditionally implemented by most of the orthopedic surgeons at Champlain Valley Physician Hospital to reduce blood loss was with the use of a tourniquet during surgery to slow the loss of blood and the implementation of an auto transfusion device. This auto transfusion device would collect blood draining from the surgical site into a device that the nurses would then have to attach a
PALL filter to for re-infusion back into the patient. This procedure would be treated under the transfusion protocol, using up valuable nursing time and with the added expense of the devices and restriction of the patients mobility due to this device.

The latest literature on blood conservation for patients under going a total joint arthroplasty was pointing all providers towards the use of tranexamic acid (TXA). TXA is a synthetic derivative of lysine that exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. TXA is inexpensive and widely…...

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