kaz5485 Posted October 9, 2014 Share Posted October 9, 2014 Our institution has been fine-tuning protocols for suspected ebola patients and one of the hot topics has been point of care testing. I thought it might be interesting to hear how other institutions are handling this topic. Link to comment Share on other sites More sharing options...
Karrieb61 Posted October 9, 2014 Share Posted October 9, 2014 No clue, but for what its worth, I have asked our Medical Director to approve a Blood Bank protocol that will say that if a sample comes into the Blood Bank and the patient is documented as a suspected Ebola patient, that we release uncrossmatched, emergency release O neg blood only. I am trying to avoid the issue of what to do with contaminated tubes and avoid contaminated fluids (saline from manual cell washings) being dumped down our sinks. We are a small hospital in a poor community which has a large population of people from various African nations. So there is the off chance that such an infected patient could walk into our ER after returning from his/her native country. Link to comment Share on other sites More sharing options...
goodchild Posted October 9, 2014 Share Posted October 9, 2014 I believe that's the route we'll be going too Karrie but we're still in a planning phase that is continuously evolving. Link to comment Share on other sites More sharing options...
tbostock Posted October 10, 2014 Share Posted October 10, 2014 Guidance from our State Dept of Health has been (so far): no Blood Bank tests, and everyone gets O Neg uncrossed. bmarotto 1 Link to comment Share on other sites More sharing options...
Sko681 Posted October 10, 2014 Share Posted October 10, 2014 O neg uncrossed for the BB. As far as point of care there isn't much they can do besides glucose, blood gasses and protime and a UA . We don't have the proper centrifuges for chemistry tests. I guess they said our Hematology analyzer is a closed system so they could run a CBC. We have a level 2 hood in micro to do any of the set up for a malaria smear. They have the suit and goggles etc. with a log in Micro should a properly labeled sample come to the lab. We have an org policy and a specific lab policy in place. Link to comment Share on other sites More sharing options...
Auntie-D Posted October 10, 2014 Share Posted October 10, 2014 Sko - CBc may be a closed system but where does the waste go? thats a risk in itself. Link to comment Share on other sites More sharing options...
Auntie-D Posted October 13, 2014 Share Posted October 13, 2014 UK guidance - seems despite those on telly using containment suits, it's OK for us in the lab just to use gloves and eye masks https://www.gov.uk/government/collections/ebola-virus-disease-clinical-management-and-guidance Link to comment Share on other sites More sharing options...
L106 Posted October 14, 2014 Share Posted October 14, 2014 This morning we also adopted the policy of no Blood Bank testing. Suspected Ebola patients will receive uncrossmatched O Negative packed red cells. Donna Link to comment Share on other sites More sharing options...
goodchild Posted October 14, 2014 Share Posted October 14, 2014 What if a patient has a transfusion reaction?! Link to comment Share on other sites More sharing options...
tbostock Posted October 14, 2014 Share Posted October 14, 2014 It is interesting that they are only addressing red cell transfusion, when in reality, if they go into DIC, they will need all blood components. Link to comment Share on other sites More sharing options...
Eagle Eye Posted October 15, 2014 Share Posted October 15, 2014 haemorrhagic fever!!!They will need all components Link to comment Share on other sites More sharing options...
Auntie-D Posted October 15, 2014 Share Posted October 15, 2014 In the UK it seems gloved and a facemask is deemed enough protection for handling the samples and we are 'allowed' to run any as long as it is on a closed system. Looks like all the samples will be going on the analysers and EI will be done. Any open samples are supposed to be done 'with care' ie if a patient has no back group or a positive antibody screen and we can't EI. I'm not sure I'm actually comfortable with this though... Link to comment Share on other sites More sharing options...
L106 Posted October 15, 2014 Share Posted October 15, 2014 (edited) It is interesting that they are only addressing red cell transfusion, when in reality, if they go into DIC, they will need all blood components. We will give uncrossmatched O Negative Packed Red Cells, Group AB Frozen Plasma, and Plateletphereses of any ABO/Rh. Edited October 15, 2014 by L106 Link to comment Share on other sites More sharing options...
L106 Posted October 15, 2014 Share Posted October 15, 2014 What if a patient has a transfusion reaction?! Oh, goodness!! Good question, but with Ebola (hemorrhagic fever), how in the world would you tell he/she is having a transfusion reaction? (It seems like the disease itself pretty much looks like a hemolytic transfusion reaction!) Eagle Eye and Auntie-D 2 Link to comment Share on other sites More sharing options...
kaz5485 Posted October 15, 2014 Author Share Posted October 15, 2014 Emory limited testing to point of care instruments in the patient's suite of rooms with testing done by laboratory personnel. We do not have an instrument to run POC CBC so that is not an option. We have limited testing to CBC with diff, BMP, hepatic panel, PT/INR, Fibrinogen, blood and urine cultures, and malaria in the main laboratory. Link to comment Share on other sites More sharing options...
Auntie-D Posted October 15, 2014 Share Posted October 15, 2014 Emory limited testing to point of care instruments in the patient's suite of rooms with testing done by laboratory personnel. We do not have an instrument to run POC CBC so that is not an option. We have limited testing to CBC with diff, BMP, hepatic panel, PT/INR, Fibrinogen, blood and urine cultures, and malaria in the main laboratory. Quick! Get one... Link to comment Share on other sites More sharing options...
Sko681 Posted October 15, 2014 Share Posted October 15, 2014 Sko - CBc may be a closed system but where does the waste go? thats a risk in itself. Management and the company say that the reagents used for the CBC etc will kill anything so I guess waste isnt a worry. Personally...I'm not so sure about any of this. Apparently the manufacturer of the PT/PTT analyzer says the same thing- however after every use you have to call the company to come and decontaminate the analyzer before using it again. Link to comment Share on other sites More sharing options...
galvania Posted October 16, 2014 Share Posted October 16, 2014 Well I would just like to say hats off to all those people who are actually involved in caring for patients with Ebola - we're worrying about testing, but someone has to bleed the patients and set up drips - more dangerous.Pity the industrial world only got interested after thousands of Africans had already died........... Malcolm Needs 1 Link to comment Share on other sites More sharing options...
Auntie-D Posted October 16, 2014 Share Posted October 16, 2014 Well I would just like to say hats off to all those people who are actually involved in caring for patients with Ebola - we're worrying about testing, but someone has to bleed the patients and set up drips - more dangerous.Pity the industrial world only got interested after thousands of Africans had already died........... Malcolm - they're doing it in full protective gear though. In the lab we are expected just to get on with it... Link to comment Share on other sites More sharing options...
goodchild Posted October 16, 2014 Share Posted October 16, 2014 The transfusion reaction comment was tongue in cheek, but it should be something addressed in your blood bank's protocol. Link to comment Share on other sites More sharing options...
Eagle Eye Posted October 16, 2014 Share Posted October 16, 2014 UHC had nice webinar today... Link to comment Share on other sites More sharing options...
Auntie-D Posted October 17, 2014 Share Posted October 17, 2014 (edited) Eagle eye - did they release notes from it? Edited October 17, 2014 by Auntie-D Link to comment Share on other sites More sharing options...
L106 Posted October 17, 2014 Share Posted October 17, 2014 Our current protocol states that if there are clinical symptoms or laboratory testing results that indicate that a hemolytic transfusion reaction may have occurred a pathologist must be notified immediately. He or she will consult with the patient's physician and decide on treatment and any further action that is warranted. In the situation involving a suspected Ebola patient, I am sure the decision would also involve the infection specialist physician. I would also expect that "where do we go from here?" would depend a lot on the patient's medical condition, etc. Donna Link to comment Share on other sites More sharing options...
Eagle Eye Posted October 18, 2014 Share Posted October 18, 2014 Eagle eye - did they release notes from it?it was by Emory hospital physician who accepted first two patients , back on July 30,2014.they explained how thy treated the patient etc. I do not know about the slides or webinar itself, BUTby end of this week they promised to post their protocols and video about PPE. It was excellent how they took care of those two patients and they did it so well!!! Auntie-D and L106 2 Link to comment Share on other sites More sharing options...
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