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Hypocalcemia and Massive Blood Transfusions

A Pilot Study in a Level I Trauma Center

DiFrancesco, Nicole R. DNP, RN; Gaffney, Thomas P. DNP, RN; Lashley, Jenna L. DNP, RN; Hickerson, Kirsten A. DNP, RN, CEN

doi: 10.1097/JTN.0000000000000447

Trauma is a leading cause of death in the United States, and uncontrolled hemorrhage is often the primary cause of mortality. Massive transfusions provide lifesaving treatment for the bleeding trauma patient; yet, this is not a benign intervention. Calcium levels can be significantly decreased with rapidly transfused blood products due to the citrate preservative that is added. Citrate binds to the patient's endogenous calcium when blood products are administered, rendering calcium inactive. As a result, undesirable physiological effects can occur. Although there is a plethora of evidence reporting the negative effects of hypocalcemia during resuscitation, the research for standardization of calcium monitoring and replacement during a massive transfusion event is less robust. Consequently, monitoring and replacement of this vital electrolyte are often overlooked. Trauma department employees at an urban academic hospital were given a pretest to assess their knowledge of calcium monitoring and replacement during a massive transfusion. On the basis of test results and a need for staff education, a short, animated video was designed and distributed for viewing. Following the educational video, a posttest was administered and yielded higher scores when compared with the pretest (p = .001). Lack of knowledge and national standards may be root causes for hypocalcemia. Educational interventions such as innovative, brief videos can be effective for enhancing staff members' knowledge and improving patient care.

School of Nursing, University of Pennsylvania, Philadelphia.

Correspondence: Thomas P. Gaffney, DNP, RN, School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA 19104 (;;

Drs DiFrancesco, Gaffney, and Lashley participated equally to this work.

The authors declare no conflicts of interest.

Copyright © 2019 by the Society of Trauma Nurses.