- Joined
- Jun 3, 2014
- Messages
- 851
- Reaction score
- 653
When do your perfusionists run TEGs during your cardiac cases (assuming they do)? At what points?
Currently, we run one for a baseline just after induction. Nice to have a baseline. Then, after bypass. The problem is that it takes so long that depending on how long it takes to close, we don't get numbers back in time for transport to ICU. So we don't have time to really take focused blood product action in the event of a coagulopathy while still in the room..... So, in the event of some residual oozing, we'll often (after addressing ACT with additional protamine) just give platelets.... But, it feels like throwing darts to some extent though I realize that's the most probable disfunction in the absence of any real data from a TEG..... We do run Amicar as standard.
Thoughts? Solutions? Same experiences?
Also, where I trained we did not renal dose the Amicar. Do you guys either not use Amicar or lower the dose in cases of GFR<60?? This seems to be the culture where I'm at, but I usually override it, and maybe just go with a lower bolus and infusion if GFR lower....
Currently, we run one for a baseline just after induction. Nice to have a baseline. Then, after bypass. The problem is that it takes so long that depending on how long it takes to close, we don't get numbers back in time for transport to ICU. So we don't have time to really take focused blood product action in the event of a coagulopathy while still in the room..... So, in the event of some residual oozing, we'll often (after addressing ACT with additional protamine) just give platelets.... But, it feels like throwing darts to some extent though I realize that's the most probable disfunction in the absence of any real data from a TEG..... We do run Amicar as standard.
Thoughts? Solutions? Same experiences?
Also, where I trained we did not renal dose the Amicar. Do you guys either not use Amicar or lower the dose in cases of GFR<60?? This seems to be the culture where I'm at, but I usually override it, and maybe just go with a lower bolus and infusion if GFR lower....