Owing to the FDA "bar code readable" requirement when signing out blood products from the lab, how is everyone coping with a neonatologist who requires a 40% Hematocrit unit (for example) in an Exchange Transfusion?
The usual course of events, for most I suspect, is an O Neg, Irradiated, CMV Neg, CPDA Packed Cell diluted to 40% Hct with a thawed AB FFP. If the lab transfers the FFP in to the red cell bag, I am assuming that is "making a product", and would require that the lab have an FDA facility code. It would also require a label printer able to output in both Codabar (for now) and ISBT (for now too?).
Are most of you with NICU's just issuing the units in their original configurations, and letting the NICU combine the products? If so, who in the NICU is performing that task, the MD or the RN? Do you give them a third satellite bag (say 600ml) to combine for the Exchange unit? How does the "combiner" in NICU know how much FFP to add to the Red Cells, and how do they measure that (e.g. scale, syringe, moist finger held to the wind)?
I was thinking that the 600ml Transfer Bag might be a messy proposition for the NICU folks, what with having to stab one unit, pull it out, and stab the second. So Baxter makes a plasma transfer set with a double spike that could cleanly go in to the FFP and the PRBC at the same time. Then, the FFP could be gravity fed to the PRBC unit to get the final Hematocrit. Is this viable, or is there some legal problem with doing this?
Finally, how do you handle the expiration date conundrum? Do you label the units with a 4 hour outdate, knowing they are going to have to enter the bags? And on what unit(s) do you put this expiration information?
There.........................I feel better just getting that off my mind. Thanks for any help (and by the length of this post, you can sure tell I need it!).