ED Clinical Pathway for Evaluation/Treatment of Children with Hemophilia and CHI

Bedside RN Procedure

Goals

  1. Expedite administration of brand specific 100% correction. Always use the patient’s home supply of factor if available.
  2. Factor correction should always be completed before imaging.
  3. Facilitate rapid cranial CT for diagnosis and patient disposition.
  4. Communication with team members and family.

Determine

For stable patients:

  1. Weigh and place patient in room as per ED procedure.
  2. Ascertain the following information:
    1. What product do you use?
    2. Does your child have any inhibitors?
    3. Did you give any factor at home? If so, how much? Was the dose correct?
    4. Did you bring your factor with you? Use the patient's factor for correction whenever available.
    5. Obtain immediate MD order for appropriate brand specific correction, and non-contrast head CT.
    6. Brief neuro evaluation:
      • Overall appearance/MS
      • VS
      • Bruising/hematoma on the head
      • Pupils/face/motor symmetry
  3. Calculate appropriate factor dose
  4. Reconstitute factor
  5. Discuss IV placement with parents and patient (butterfly if IV access is difficult)
  6. Check MD order and administer appropriate correction, document exact time
  7. Determine need for sedation for CT scan.
  8. Heplock I.V. and transport to CT scan asap
  9. Upon return, obtain a set of vital signs, keep NPO and monitor until after CT scan read.
  10. Refer to guidelines