Date of Award

Spring 4-28-2024

Document Type


Degree Name

Doctor of Nursing Practice (DNP)




Dr. Brian Garrett, DNP, CRNA

First Committee Member

Dr. Chai Sribanditmongkol, PhD, RN, IBCLC, CNS

Second Committee Member

Dr. Amy Bishop, DNP, AGCNS


Viscoelastic Monitoring, Major Hepatic Surgery, Coagulation Guidelines, Transfusion

Subject Categories

Medicine and Health Sciences


Patients undergoing major hepatic surgery are at high risk for intraoperative transfusion of allogenic blood products. These patients are at increased risk due to pre-existing hepatic pathology, surgical stress, and the complexity of surgical procedures. While blood product transfusion may be necessary to support hemostasis and hemodynamics, it is not without risk. Current literature states that viscoelastic monitoring is superior to traditional laboratory values when guiding transfusion during major hepatic surgery. Viscoelastic monitoring is a term used to describe the measurement of change in viscoelastic properties of whole blood during clot formation. There are two readily available point-of-care types – thromboelastography (TEG) and rotational thromboelastometry (ROTEM). For the purpose of this project, ROTEM will be referred to as viscoelastic monitoring. Although the literature supports the use of viscoelastic monitoring during major hepatic surgery, some facilities’ guidelines and policies may not be up-to-date with the most current evidence. The lack of an evidence-based approach to standardize transfusion utilization may lead to misinterpretation of viscoelastic monitoring, which may result in over- or under-resuscitation. This Doctor of Nursing Practice (DNP) project aims to develop an evidence-based practice guideline, utilizing the Rosswurm and Larrabee conceptual model, to assess a need for change, identify gaps in practice, implement the guideline, and evaluate the outcome. Successful implementation and dissemination of this DNP project could lead to changes in the standard of practice, hospital policy, or a revision of current guidelines. The work of this DNP project will be limited to the perioperative setting. Further scholarly work can explore the utility of viscoelastic monitoring in the pre-and postoperative settings.

Acknowledgement 1


Acknowledgement 2


Licensing Permission

Copyright, all rights reserved. Fair Use



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.