Carrie Easley

We use the Epic BPAM, and there is no 30-minute rule built in ours. Must be a facility setting. We removed every 30-minute reference years ago. In reference to the original question, we are not informed of transfers so the unit can travel w/ the patient. We just require that transfusion is complete within 4 hours of issue.

Our policy as well.

This is correct...two different products. The liquid plasma we use has a 26-day outdate, and was never frozen.

Went live with our Erytra in February (used to have a ProVue). The staff has been extremely happy with the switch...especially our 2nd and 3rd shifters who are covering more than one department. True random access, great traceability, & responsive company who are already implementing our suggestions.

We use HemoTemp II, and have great luck...even with long CV surgery cases.

Congratulations on your retirement!

We require direct observation of each step (specimen acceptability, historical check, pipetting, washing, reporting, etc...) in each method at completion of initial training, 6 months after initial competency, and annually thereafter.

Paperwork/double-check rule-outs.

Once a year for each method, but we require a second tech double-check of all ABID's prior to blood issue.

I would ask what "basic work-up" would let them know if they were transfusing a potentially bacterially contaminated unit (in the event of a febrile reaction). We require BB and MD notification of all suspected reactions. The Clinical Pathologist determines if a unit is continued (if hives/urticarial only), and must approve additional transfusions for other reactions.

A representative f/ Grifols saw my post and provided documentation that "lightens" the language a bit.

The Grifols panel cells use even stronger language "A known negative control and a known positive control with weak reacting antibodies should be run in parallel each day of use". We test a random heterozygous cell & known negative w/ dilute antisera daily. I don't really feel like it adds much value, but I didn't think I could argue it.

We use the Rad Source RS 3400 X-Ray irradiator. We really haven't had any issues with it, and have been extremely happy w/ the Atlanta-based service. It has a syringe adaptor for neonatal aliquots. We used to have a Raycell, but it took much longer for service as all parts had to clear Customs. Irradiating products does guarantee a visit f/ the FDA every two years. The devices are pretty expensive. We are ~2 hours f/ our blood supplier w/ large oncology & neonatal service, so we felt that it was necessary. Your LIS will need to be able to make new product labels.

We are 20, and only give full dose (no micro).

Scary stuff! Keep us updated. Wasn't your last post an ABO incompatible mistransfusion as well? Did they have a similar source of error?

That's what we use as well! Good luck in your new role 😀

Yes, we basically just honor the 4 hour limit from original packed cell issue (no different than if the nurse had kept it at the bedside). We edit expiration in our BB LIS, and print a new full-face label. If it's just a matter of getting a new IV site or getting a med, they can usually get it in.

We use Hemo-Temp II on our blood issued in coolers (Trauma, MTP, OR). Additionally, the cooler temp is recorded every 4 hours. Nurses are instructed to request a new cooler if the temp reaches 6°C. The coolers that we use, however, validated to hold 1-6°C for ~24 hours. For blood that comes back from a nursing unit (no Hemo-Temp), we wrap the unit around an NIST probe thermometer. If it exceeds 10°C, we adjust the expiration to 4 hours from issue stipulating that it has to go to the original patient.

Definitely! I have gotten differing answers on previous questions depending who was on the other end of the phone at CAP.

Retesting of the same sample will not catch a wrong-blood-in-tube. If performing a computer crossmatch, CAP states that you can only use same specimen if specimen was drawn using a mechanical barrier system or digital bedside ID system. I believe there was an other thread regarding Typenex/Hollister no longer meeting the requirements of a barrier system. We will use a hematology specimen for our verification if it was drawn on a separate phlebotomy event. The blood bank can order the verification per protocol if another specimen isn't available. If blood is needed in the interim, we issue type O. It's a hard stop in our BB system.

I believe critical access hospitals are required to have a massive transfusion protocol. I'm not sure of other regulatory requirements. Even if a smaller hospital doesn't accept Trauma patients, there is always the chance that they will experience a bad GI bleed, OB hemorrhage, or "routine " surgery gone awry. Working with the larger facility to develop a plan to stabilize and transfer could be included in the protocol. My hospital works with referring facilities to develop plans to improve outcomes. These will include pharmaceuticals like TXA, Kcentra, and vitamin K. With more blood suppliers providing liquid plasma, a small hospital still has the opportunity to hit a 1:1 prbc/plasma ratio prior to transfer.

We switched f/ an in-house created/validated Igloo system to MaxQ. We love them! They are plastic, so we can decontaminate after each use. When we did our validation, we maintained temp for > 24 hours in rooms @ 22, 65 (heart room), & 85 (trauma room) degrees. The lid is hinged, so it swings closed if someone forgets. We use a saline bag connected to a digital thermometer that sits in a pouch on the lid. This allows someone to constantly see the internal temp. We issue up to 6 PRBC/cooler, but it would probably hold more. I do think that they mentioned an upcoming upgrade w/ remote temp monitoring, so you might wait for that... I attached a Word doc that we used for PCS education. It shows pics of how the units are packed. New Blood Coolers.docx

Thanks, Brenda! I feel the same way. No matter how good a procedure, you have to understand the process enough to open it.

One of our issues is that our patients are not always in our blood bank system if nothing has been ordered during this stay. To issue to that person would require the blood bank to place an order in the HIS (Epic). We keep a "dummy" patient in the BB system so that we can issue to traumas that aren't registered yet, but that's not a great option when we know a name/MRN. All of your replies are helping me work through a plan, though. Thank you 😊

Rh neg moms and those with clinically significant antibodies. A physician may request one if they feel it's indicated for other reasons (a mom had a previously affected infant), but that's fairly uncommon. If a baby develops jaundice, we have a separate orderable for a venous or capillary ABO/Rh/DAT