November 26, 2017

TXA ADMINISTRATION WITHOUT 100CC PIGGYBACK BAGS?

This question was asked by a student who is now a contractor teaching TCCC in the Middle East.

I have been asking around but nobody seems to know so far. So, in TCCC the guidelines for TXA is 1g in 100cc NS or LR over 10 min. Check. However. in remote areas (like the one I am working in) do not always have 100cc bags available. Most of the time they are 500cc bags or bottles. Due to supplies being very limited at times, I hate to waste 400cc of fluid every time I need TXA. Do you have any idea about the supporting evidence for 1g in 100cc? Am I able to mix a higher dose and give partial? I am just trying to think outside the box. Any thoughts?

Doc's Reply via Pharmacist consultation: 
​​So really the bottom line is the concentration doesn’t matter. It can be given undiluted it can be given in a 100ml bag it can be given in a 1000ml bag. What matters is the total dose and the time. So whatever way you can get 1g in over ~10min in whatever way works the best for the particular crew, that’s what you should do.

Things to consider:
Why do we usually give TXA? We want to stop the body's process to breakdown the clots in the black box area in order to evacuate them to the most appropriate trauma center. We strive for permissive hypotension with these injury patterns. Would administering 1000ml of NS which has your TXA in it benefit the patient? Probably not. We are trying limit the amount of fluid we are giving the patient. I bring this up because we want you to think outside the box when you do not have 100cc piggyback bags for the TXA infusion. The point being made is that it does not matter what the concentration is, just that 1 gram is infused over 10 minutes but don't run with utilizing the 1,000ml bag for convenience of not carrying the 100cc bags. Be a thinking medic!