Öz
Amaç: Kan, canlı bir dokudur ve kan transfüzyonu transplantasyon gibi kabul
edilir. Bu nedenle transfüzyon kararı verirken her hasta ayrı ayrı
değerlendirilmelidir. Bu araştırmamızın amacı hastanemizde cerrahi bölümlerde
çalışan hekimler arasında kan transfüzyon uygulamalarındaki farklılıkları, bu
konudaki eksiklikleri saptamak ve yeterli eğitimin verilmesi açısından
farkındalık oluşturmaktır.
Gereç ve
Yöntem: Pediyatrik ve kardiyovasküler cerrahi dışındaki
cerrahi bölümlerde çalışan hekim grubuna (asistan, uzman ve öğretim
görevlileri) çalışmanın amacı anlatılarak 10 sorudan oluşan bir anket formu
dağıtıldı. Bu formda verilen yanıtlar değerlendirilerek istatistiksel analiz
yapıldı.
Bulgular: Anket çalışmasına 93 kişi (%78.8) asistan, 25 kişi (%21.2) uzman ve
öğretim üyesi olmak üzere toplam 118 kişi katıldı. Bunların %77.2’si (n: 91)
kliniklerinde “sıklıkla” kan transfüzyonu uygulandığını, %66.1’i (n: 78) kan
transfüzyonları ile ilgili hiçbir eğitime, kursa ya da seminere
katılmadıklarını bildirdi. Asistan ve uzman/öğretim üyeleri
karşılaştırıldığında asistanların eğitim, kurs ve seminer katılım oranları daha
düşüktü (p=0.002). Transfüzyon kararını 17 kişi (%14.4) kıdemli asistan, 63
kişi (%53.4) uzman /öğretim üyesi, 38 kişi (%%32.2) ise her ikisi yanıtını
verdi. Uzman ve öğretim üyesi tarafından transfüzyon kararı verildiğini
belirten kişilerin, hemoglobin ile birlikte diğer klinik bulguları göz önünde
bulundurduğu saptandı (p˂0.0001). Mesleki deneyim olarak ise 10 yıl ve üzeri
hekimlik yapanların transfüzyon için hematokrit ve diğer klinik bulguları göz
önünde bulundurduğu görüldü (p=0.038).
Sonuç: Hastanemizde cerrahi bölümlerde çalışan hekimler arasında kan
transfüzyon uygulamaları ile ilgili farklı yaklaşımların olduğu ve bu konuda
yayınlanan transfüzyon kılavuzları göz önünde bulundurularak seminer, kurs gibi
eğitim faaliyetlerinin arttırılması gerektiği sonucuna varıldı.
Anahtar Kelimeler
Kaynakça
- Beatttie WS, Karkouti K, Wijeysundera DN, Tait G. Risk associated with preoperative anemia in noncardiac surgery: Single-center cohort study . Anesthesiology 2009;110 (3):574-81.
- Choorapoikayil S, Zacharowski K, Meybohm P. Patient blood management: is it worth to be employed? Curr Opin Anesthesiol 2016;29(2):186-91.
- Worldwide prevalence of anaemia 1993-2005: WHO global database on anaemia. Benoist B, McLean E, Egli I, Cogswell M (eds). Available from: http://whqlibdoc.who.int/publications/ 2008/9789241596657_eng.pdf.
- Hébert PC, Carson JL. Transfusion threshold of 7 g per deciliter-the new normal. N Engl J Med 2014:371(15);1459-61.
- Likosky DS, Al-Attar PM, Malenka DJ, et al. Geographic variability in potentially discretionary red blood cell transfusions after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2014;148 (6):3084-9.
- Shander A, Javidroozi M, Ozawa S, Hare GM. What is really dangerous: Anaemia or transfusion? Br J Anaesth 2011;107(Suppl 1):i41-59.
- Mazer CD. Blood conservation in cardiac surgery: Guidelines and controversies. Transfus Apher Sci 2014;50(1):20-5.
- Hasler S, Kleeman A, Abrams R, et al. Patient safety intervention to reduce unnecessary red blood cell utilization. Am J Manag Care 2016;22 (4):295-300.
- Hébert PC, Wells G, Blajchman MA, et al. A multicenter randomized controlled clinical trial of transfusion requirements in critical Care. N Engl J Med 1999;340(6):409-17.
- Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: A clinical practice guideline from the AABB. Ann Intern Med 2012;157(1):49-58.
- Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology, Bassand JP, Hamm CW, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J 2007;28(13):1598-660.
- Napolitano LM, Kurek S, Luchette FA, et al. Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care. J Trauma. 2009;67(6):1439-42.
- Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G, Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) Working Party. Recommendations for the transfusion management of patients in the peri-operative period. I. The pre-operative period. Blood Transfus 2011;9(1):19-40.
- Chung KW, Basavaraju SV, Mu Y, et al. Declining blood collection and utilization in the United States. Transfusion 2016;56(9):2184-92.
- American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: An updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology. 2015;122(2):241-75.
Öz
Aim: Blood is a living tissue and blood transfusion is
considered as transplantation. Therefore, every patient should be evaluated
separately when making transfusion decision. This study aims at determining
differences between blood transfusion practiced by the physicians working in
surgical departments of our hospital, detecting deficiencies and creating
awarenesss to provide adequate education.
Materials and Methods: A questionnaire was
distributed to the physician group working in surgical departments except
pediatric and cardiovascular surgery. The responses were evaluated and
analyzed.
Results: A total of 118 people participated in the
questionnaire, 93 of whom (78.8%) were assistants, 25 (21.2%) were experts and
faculty members. Seventy seven percent (n: 91) of attendees reported that they
"frequently" perform blood transfusions in their clinics and 66.1%
(n: 78) haven’t participated in any training or seminar on blood transfusions.
When compared to the specialists’/lecturers’, the assistants’ attendance rate
to the trainings and seminars was lower (p=0.002). Seventeen patients (14.4%)
were senior assistants, 63 patients (53.4%) were experts/academics, and 38
patients (32.2%) were both responding. Those who stated that the transfusion
decision was made by the expert and the lecturer, took into consideration other
clinical findings together with hemoglobin (p˂0.0001). It was seen that those
who worked for more than 10 years considered hematocrit and other clinical
findings for transfusion (p=0.038).
Conclusion: It was concluded that there
are different approaches to blood transfusion practices among physicians
working in surgical departments in our hospital and training activities such as
seminars and courses should be increased considering transfusion guidelines.
Anahtar Kelimeler
Kaynakça
- Beatttie WS, Karkouti K, Wijeysundera DN, Tait G. Risk associated with preoperative anemia in noncardiac surgery: Single-center cohort study . Anesthesiology 2009;110 (3):574-81.
- Choorapoikayil S, Zacharowski K, Meybohm P. Patient blood management: is it worth to be employed? Curr Opin Anesthesiol 2016;29(2):186-91.
- Worldwide prevalence of anaemia 1993-2005: WHO global database on anaemia. Benoist B, McLean E, Egli I, Cogswell M (eds). Available from: http://whqlibdoc.who.int/publications/ 2008/9789241596657_eng.pdf.
- Hébert PC, Carson JL. Transfusion threshold of 7 g per deciliter-the new normal. N Engl J Med 2014:371(15);1459-61.
- Likosky DS, Al-Attar PM, Malenka DJ, et al. Geographic variability in potentially discretionary red blood cell transfusions after coronary artery bypass graft surgery. J Thorac Cardiovasc Surg 2014;148 (6):3084-9.
- Shander A, Javidroozi M, Ozawa S, Hare GM. What is really dangerous: Anaemia or transfusion? Br J Anaesth 2011;107(Suppl 1):i41-59.
- Mazer CD. Blood conservation in cardiac surgery: Guidelines and controversies. Transfus Apher Sci 2014;50(1):20-5.
- Hasler S, Kleeman A, Abrams R, et al. Patient safety intervention to reduce unnecessary red blood cell utilization. Am J Manag Care 2016;22 (4):295-300.
- Hébert PC, Wells G, Blajchman MA, et al. A multicenter randomized controlled clinical trial of transfusion requirements in critical Care. N Engl J Med 1999;340(6):409-17.
- Carson JL, Grossman BJ, Kleinman S, et al. Red blood cell transfusion: A clinical practice guideline from the AABB. Ann Intern Med 2012;157(1):49-58.
- Task Force for Diagnosis and Treatment of Non-ST-Segment Elevation Acute Coronary Syndromes of European Society of Cardiology, Bassand JP, Hamm CW, et al. Guidelines for the diagnosis and treatment of non-ST-segment elevation acute coronary syndromes. Eur Heart J 2007;28(13):1598-660.
- Napolitano LM, Kurek S, Luchette FA, et al. Clinical practice guideline: Red blood cell transfusion in adult trauma and critical care. J Trauma. 2009;67(6):1439-42.
- Liumbruno GM, Bennardello F, Lattanzio A, Piccoli P, Rossetti G, Italian Society of Transfusion Medicine and Immunohaematology (SIMTI) Working Party. Recommendations for the transfusion management of patients in the peri-operative period. I. The pre-operative period. Blood Transfus 2011;9(1):19-40.
- Chung KW, Basavaraju SV, Mu Y, et al. Declining blood collection and utilization in the United States. Transfusion 2016;56(9):2184-92.
- American Society of Anesthesiologists Task Force on Perioperative Blood Management. Practice guidelines for perioperative blood management: An updated report by the American Society of Anesthesiologists Task Force on Perioperative Blood Management. Anesthesiology. 2015;122(2):241-75.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Sağlık Kurumları Yönetimi |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 14 Eylül 2018 |
| Gönderilme Tarihi | 2 Haziran 2017 |
| Yayımlandığı Sayı | Yıl 2018Cilt: 57 Sayı: 3 |
