ED Clinical Pathway for Evaluation/Treatment of Children with Hemophilia and CHI
Bedside RN Procedure
- Expedite administration of brand specific 100% correction. Always use the patient’s home supply of factor if available.
- Factor correction should always be completed before imaging.
- Facilitate rapid cranial CT for diagnosis and patient disposition.
- Communication with team members and family.
- Severity of hemophilia?
- Product brand used by patient?
- Home correction since trauma?
For stable patients:
- Weigh and place patient in room as per ED procedure.
- Ascertain the following information:
- What product do you use?
- Does your child have any inhibitors?
- Did you give any factor at home? If so, how much? Was the dose correct?
- Did you bring your factor with you? Use the patient's factor for correction whenever available.
- Obtain immediate MD order for appropriate brand specific correction, and non-contrast head CT.
- Brief neuro evaluation:
- Overall appearance/MS
- Bruising/hematoma on the head
- Pupils/face/motor symmetry
- Calculate appropriate factor dose
- Reconstitute factor
- Discuss IV placement with parents and patient (butterfly if IV access is difficult)
- Check MD order and administer appropriate correction, document exact time
- Determine need for sedation for CT scan.
- Heplock I.V. and transport to CT scan asap
- Upon return, obtain a set of vital signs, keep NPO and monitor until after CT scan read.
- Refer to guidelines