“Procedural Blood Loss in Infant Patients” for children < 5 kg undergoing procedures with potential significant blood loss.

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Prior to Procedure

• Clot is sent unless an exception is ordered by the medical team, except if an exemption is ordered by the team.
  • Pre-operative conference between the operating and anesthesia teams
• At the time the patient leaves the NICU or floor for an IR procedure, a member of the medical team will sign out to the anesthesiologist: Weight, (CBV) & Maximum Allowable Blood Loss (MABL).
• The anesthesiologist will share the weight and MABL with the IR team as part of the time out.
• PICC placement is excluded.

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During Procedure

• Periodic Hct + ABGs/VBGs from an existing arterial line or catheter/sheath when: 
  1. Visual cues are not reliable.
  2. Procedures > 1 hour.
• Blood transfusion should be considered if MABL is reached.
• A multidisciplinary pause and discussion should occur during multi-step procedures to determine blood loss, hemodynamic status and risk assessment.

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Calculation of Blood Loss

• Standard estimation of blood loss based on changes in Hct assume a strictly normovolaemic situation. The effect of hemodilution on Hct can be substantial but is not currently included in calculation of EBL.
• MABL = 10% of Circulating Blood Volume (CBV x 0.1).
• Needs initial hematocrit (Hi), current hematocrit (Hc) and weight (Wt).
• CBV (mL) = Wt (Kg) x Average blood volume (mL/kg).
• Average blood volume for infants = 80 mL/kg.
• Actual Hb Loss % = Hi-Hc/Hi
• Estimated Blood Loss (EBL) = CBV x Hb Loss % = CBV x (Hi-Hc/Hi)

 
Example:
A 4-month-old female weighing 4 kg with preoperative hematocrit of 40% and current hematocrit of 30%.
Circulating blood volume (CBV) = 4 x 80= 320 mL.
Maximum Allowable Blood Loss (MABL) = 320 x 0.1 =32 mL.
Estimated Blood Loss (EBL) = CBV x (Hi-Hc/Hi)= 320 x (40-30/40)= 80 mL.

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