Page 61 - JSOM Fall 2025

a pre-marked heavyweight zip tie that is secured around the ruptured lines), particularly among novices. Because the purpose
middle of the blood bag prior to donation to actively restrict of this study was to contrast BC, PC, and OG techniques in a
the total volume. For the PC method, the user uses the 10" within-subjects design, only novices with complete data (for BC,
length as a flexible ruler by periodically wrapping the PC PC, and OG) were included in the analysis (65 of 104, 63%).
around the belly of the donor bag until the ends of the PC
meet. The OG method involves periodic bag inspection; the Expert group participants (n=10) were certified Valkyrie
bag is considered filled when the corners dimple with the bag course instructors. All were Fleet Marine Force Corpsmen and
flat, and when held up, the air-fluid line is above the corners Combat Trauma Management Instructors who were screened
of the bag. Currently, no technique is preferred over another in and hand-selected by the Navy Education and Training Office.
Valkyrie training, and the choice of which technique to employ Each then completed the extensive Valkyrie training progres-
in operational environments is operator-dependent, largely be- sion to become a certified instructor. All 10 experts completed
cause it is unclear which technique is superior in filling blood BC, PC, and OG techniques without failure and were therefore
bags to the target volume. included in the analysis.

Therefore, to fill this important knowledge gap and towards Materials
preserving the life of the traumatically wounded warfighter in
need of safe WBB donation, the objective of this study was to Blood Draw Kit
contrast BC, PC, and OG techniques in volume (mass), correct Components of the single-use Valkyrie LTOWB Whole Blood
fills (to 585g ±10%), underfills, and overfills, as well as user Administration Set are displayed in Figure 1. The compo-
ratings and assessments in both novice and expert groups. nents were provided by Combat Medical (Harrisburg, NC).
This kit was created at the request of Dr. Wier and the 1st
Marine Division in 2019 as a cost-saving measure, providing a
Methods
comprehensive one-stop kit for handling FWB in the field. As
Setting and Sample shown, it includes record cards and labels, hemostat, isopropyl
Study data were collected in an outdoor setting at Marine alcohol prep pads, a 450mL bag containing 63mL of Citrate
Corps Base Camp Pendleton, California. This study was Phosphate Dextrose anticoagulant, an integrated draw needle,
granted exempt status as a process-improvement project by and blood tubing with an in-line filter. Note that the 10" PC
the Clinical Investigation Department and Institutional Review and beaded cable are labeled near the top-center of Figure 1.
Board of Naval Medical Center San Diego, San Diego, Cal-
ifornia (Reference CIP# NMCSD-PI-2022-04-28). Approval Beaded Cable
for public release was granted by the Public Affairs Office at BC is designed to actively restrict the total volume collected
Naval Medical Center San Diego and the 1st Marine Division. from the donor to one unit. Prior to initiating the fill, the BC
tie is wrapped around the midline (middle) of the donor bag
Novice group participants (n=65) were individuals who were and secured like a common zip tie. The pre-marking (indicated
not previously qualified in conducting prehospital whole blood by the arrow, top-center of Figure 1) ensures that the BC is se-
transfusions and were enrolled as students in one of three iter- cured at 6.5.” In this context, the midline is determined by op-
ations of Valkyrie between March and November 2022. Each erator estimation. As the bag fills, it forms an hourglass shape
novice was required to attempt blood draws using BC, PC, and (Figure 2). Once the bag is no longer filling it is considered
OG techniques. Blood draws sometimes fail for reasons unre- complete. BC is the collection method recommended by the
lated to bag volume measurement (e.g., intravenous access or 2017 Ranger Study. 14

FIGURE 1 Equipment included in the Valkyrie Low-Titer O Whole Blood administration set.

Note: LEFT IMAGE: LEFT TO RIGHT: Restriction band, 450cc donor bag with CDP anticoagulant (TOP ROW); clamp, gauze, blood Y-tubing with
filter (MIDDLE ROW); test tubes, Eldon card, two alcohol swabs, elastic venous tourniquets, Tegaderm, two 18G catheters, chlorhexidine swab,
gloves (BOTTOM ROW). RIGHT IMAGE: As packaged.

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