UNCONTROLLED WHEN PRINTED
 Introduction
  • Human Fibrinogen (RiaSTAP) is a blood product derivative.
  • Haemorrhage in the setting of severe trauma is associated with significant morbidity and mortality. There is increasing awareness of the important role fibrinogen plays in traumatic haemorrhage. Fibrinogen levels fall precipitously in severe trauma and the resultant hypofibrinogenaemia is associated with poor outcomes1.
 Indications
  • Suspected or obvious traumatic haemorrhage necessitating pre-hospital blood product transfusion

AND

  • A point of care INR of ≥ 1.2
 Contraindications
  • RiaSTAP®, Fibrinogen Concentrate (Human), is contraindicated in patients with known anaphylactic or severe systemic reactions to human plasma-derived products
 Precautions / Notes
  • The most serious adverse reactions observed are thrombotic episodes (pulmonary embolism, myocardial infarction, deep vein thrombosis) and anaphylactic reactions.
  • The most common adverse reactions observed in clinical studies (frequency >1%) were fever and headache
  • RiaSTAP® is a blood product and therefore must not be administered to non-consenting conscious patients (i.e. Jehovahs Witness)
  • Medications administered intermittently rather than continuously may be administered via the same line providing the line is flushed with 0.9% saline both prior to and after administering the medication.
 Preparation
  1. Prepare RiaSTAP® by placing vials on flat, firm surface and removing caps from vials.
  2. Disinfect rubber stoppers with chlorhexidine/isopropyl alcohol swab and allow to dry
  3. Open supplied Transofix® transfer device and remove safety cap
  4. Penetrate rubber stopper of water vial with Transofix® spike, and remove remaining safety cap from the device
  5. Invert RiaSTAP® vial and penetrate rubber stopper withexposed Transofix® spike
  6. Gently angle the interconnected vials to encourage  the water to run slowly into the uppermost part of RiaSTAP® vial. Do NOT allow water to pour directly onto RiaSTAP® powder.
  7. When all water transferred, disconnect from RiaSTAP vial and GENTLY swirl the vial to fully reconstitute the contents (may take 5-10 minutes). Do NOT shake the vial.
  8. Following reconstitution, RiaSTAP® should be a colourless and clear to slightly opalescent liquid. Inspect for particulate matter prior to administration. Do NOT use if solution is cloudy or contains particulate matter.
  9. Gently withdraw reconstituted RiaSTAP® from vial using 50ml syringe to achieve final concentration of 1g/50ml.
 Management
 Weight-based Calculations
 
Clear
 kg 
Mode: 
Weight: 
Cefazolin for fractures/prophylaxis
Presentation: /mL
Calculated dose:  in

Critical Care

In critical bleeding situations, administer the below as a slow IV push over 2–4 minutes/g, i.e. 50mL over 2–4 minutes.

Adults

Weight Dose Volume
< 75kg2g100mL
> 75kg3g150mL

Paediatrics

  • ASMA Consult required
  • 70mg/kg to a maximum of 2g
 Special Considerations
  • The use of RiaSTAP® is only beneficial in trauma for patients with confirmed low fibrinogen levels
  • Approximately 75% of patients will have correction of coagulopathy and bleeding after a single dose of 50mg/kg
  • The lot numbers of all RiaSTAP® vials administered to the patient should be recorded in the patients ePCR
Presentation

Vials (powder and solvent):

  • 1g human fibrinogen (RiaSTAP®)
  • 50ml water for injection
Fibrinogen
Settings
Current mode:
Extended Care:
Colour assist:

References

Mengoli C, Franchini M, Marano G, et al. 2017. The use of fibrinogen concentrate for the management of trauma-related bleeding: a systematic review and meta-analysis. Blood Transfus;15(4):318-324. doi:10.2450/2017.0094-17


Document Control


Directorate
Clinical Services

Responsible Manager
Head of Clinical Services

Version

Issue Date

Expiry Date

Clinical Resources Website

St John Ambulance Western Australia Ltd (ABN 55 028 468 715) (St John WA) operates ambulance and other pre-hospital clinical services. St John WA’s Clinical Resources, including its Clinical Practice Guidelines (Clinical Resources), are intended for use by credentialed St John WA staff and volunteers when providing clinical care to patients for or on behalf of St John WA, within the St John WA Clinical Governance Framework, and only to the extent of the clinician’s authority to practice.

Other users – Terms of Use

The content of the St John WA Clinical Resources is provided for information purposes only and is not intended to serve as health, medical or treatment advice. Any user of this website agrees to be bound by these Terms of Use in their use of the Clinical Resources.

St John WA does not represent or warrant (whether express, implied, statutory, or otherwise) that the content of the Clinical Resources is accurate, reliable, up-to-date, complete or that the information contained is suitable for your needs or for any particular purpose. You are responsible for assessing whether the information is accurate, reliable, up-to-date, authentic, relevant, or complete and where appropriate, seek independent professional advice.

St John WA expressly prohibits use of these Clinical Resources to guide clinical care of patients by organisations external to St John WA, except where these organisations have been directly engaged by St John WA to provide services. Any use of the Clinical Resources, with St John WA approval, must attribute St John WA as the creator of the Clinical Resources and include the copyright notice and (where reasonably practicable) provide a URL/hyperlink to the St John WA Clinical Resources website. 

No permission or licence is granted to reproduce, make commercial use of, adapt, modify or create derivative works from these Clinical Resources. For permissions beyond the scope of these Terms of Use, including a commercial licence, please contact medservices@stjohnambulance.com.au

Where links are provided to resources on external websites, St John WA:

  • Gives no assurances about the quality, accuracy or relevance of material on any linked site;
  • Accepts no legal responsibility regarding the accuracy and reliability of external material; and
  • Does not endorse any material, associated organisation, product or service on other sites.

Your use of any external website is governed by the terms of that website, including any authorisation, requirement or licence for use of the material on that website.

To the maximum extent permitted by law, St John WA excludes liability (including liability in negligence) for any direct, special, indirect, incidental, consequential, punitive, exemplary or other loss, cost, damage or expense arising out of, or in connection with, use or reliance on the Clinical Resources (including without limitation any interference with or damage to a user’s computer, device, software or data occurring in connection with such use).

Cookies

Please read this cookie policy carefully before using Clinical Resources from St John WA.

The cookies used on this site are small and completely anonymous pieces of information and are stored on your computer or mobile device. The data that the cookies contain identify your user preferences (such as your preferred text size, scope / skill level preference and Colour Assist mode, among other user settings) so that they can be recalled the next time that you visit a page within Clinical Resources. These cookies are necessary to offer you the best and most efficient possible experience when accessing and navigating through our website and using its features. These cookies do not collect or send analytical information back to St John WA.

Clinical Resources does integrate with Google Analytics and any cookies associated with this service enable us (and third-party services) to collect aggregated data for statistical purposes on how our visitors use this website. These cookies do not contain personal information such as names and email addresses and are used to help us improve your user experience of the website.

If you want to restrict or block the cookies that are set by our website, you can do so through your browser setting. Alternatively, you can visit www.internetcookies.com, which contains comprehensive information on how to do this on a wide variety of browsers and devices. You will find general information about cookies and details on how to delete cookies from your device. If you have any questions about this policy or our use of cookies, please contact us.

St John Ambulance Western Australia Ltd © Copyright 2020, All Rights Reserved

Terms of Use | Privacy Policy | Copyright Statement & Disclaimer