2. Following this presentation, the participant will be able to discuss the importance of filling donor blood bags to the 450mL±10% target volume, including the complications from under-filling or over-filling donor blood bags.
3. Following this presentation, the participant will be able to describe the ruler designed to foster accurate target fill volumes, as well as the proper application of the ruler.
4. Following this presentation, the participant will be able to discuss the implications of standardizing the use of the ruler on reliably filling donor blood bags to the target volume, all towards preserving the life of the traumatically wounded warfighter in need of rapid and safe WBB transfusion.
Background: Hemorrhage remains the leading cause of preventable battlefield death and resuscitation with whole blood is superior to component therapy in reducing mortality. However, cold-stored whole blood (CS-WB) is often not available in austere forward-deployed environments. When CS-WB is not available, a walking blood bank (WBB) strategy can be employed, wherein fresh whole blood is obtained directly from a pre-screened on-site donor for immediate transfusion into the casualty. It is crucial that the WBB donor blood bag be filled to the target volume (450mL±10%) because the donor blood bag contains a citrate-based anti coagulant. An overfilled bag can result in line clotting or thrombosis in the recipient, while an underfilled bag can result in hypocalcemia in the recipient. However, presently employed WBB methods (e.g., 6.5” beaded cable, 10” paracord, operator gestalt) result in high rates of mis-filled donor blood bags. What was needed was an investigation specifically designed to determine whether a Ruler/Marker System of measuring the distance from the base and from the corner of the blood bag at 450mL target fill volume, then marking the blood bag prior to donation, could result in high rates of donor blood bags fills to the target volume. Methods: Chinook blood bags (N=20) were suspended with the port side up. Using a 50cc syringe, each bag was filled with water and marked with a felt pen in 100mL increments (with one final 50mL increment) until the bag reached the target 450mL volume. Bags were then drained and the final 450mL line was measured (in cm) from the lower corner (Corner) and from the base (Base) on a flat, rulered, measuring mat. Primary statistics included the mean, standard deviation (SD), and standard error of the mean (SEM). Results: The mean distance from the Corner was 2.09cm (SD=0.39cm; SEM=0.09cm). The mean distance from the Base was 4.38cm (SD=0.39cm; SEM=0.08cm). Conclusion: The Ruler/Marker System is promising as a precise and reliable method to collect the target 450mL of blood towards reducing hypocalcemia and thromboembolic risk when the WBB strategy is employed in high stress environments. Follow-on studies include testing the Ruler/Marker System versus the presently employed WBB methods in rates of overfills, rates of underfills, and rates of hitting the target 450mL(±10%) volume in both novices and experts. This line of investigation holds potential towards safely preserving the lives of traumatically wounded warfighters in need of WBB donation in austere settings.