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Carrie Easley

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  1. Like
    Carrie Easley got a reaction from jayinsat in COOLER FOR THE OR   
    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
  2. Like
    Carrie Easley got a reaction from Sonya Martinez in Return of used blood   
    We pull two segments upon delivery.  One for retype, one in the event of a delayed reaction.  We keep them for two months.  The only units that we get back are actual suspected transfusion reactions.
  3. Like
    Carrie Easley got a reaction from Carol Salo in MTP with EPIC   
    Malcom is, of course, correct.  Epic is a hospital information system/electronic medical record.  They have a laboratory module called Beaker, but do not have a blood bank information system.  Epic users have to integrate a stand-alone B.B. system (Meditech, SoftBank, Sunquest, etc...) with it.  Epic has a blood product administration module (BPAM) that allows electronic scanning of patient and unit at the bedside (in lieu of paper records).  It’s not really fast enough for a massive transfusion situation at this point so we struggle to find an alternative in the most stressful times.  Rover is a handheld device that phlebotomists use for positive patient ID and real-time collection label printing.  
  4. Like
    Carrie Easley got a reaction from BldBnker in Blood Bank staff   
    Thanks, Brenda!  I feel the same way.  No matter how good a procedure, you have to understand the process enough to open it.
  5. Like
    Carrie Easley got a reaction from Ward_X in Cardiac surgery and what it means for our blood bank?   
    If at all possible, define a pre-admission process so that a T&S can be drawn prior to the day of surgery.  No one is happy when they find-out that the patient on the table has an antibody that will significantly delay packed cell availability.  I would also "make friends" with your Perfusion team.  Ours are the TEG experts in the OR, and help to guide the component utilization.  We still reserve two platelets for a CAGB, but rarely transfuse these patients.
  6. Like
    Carrie Easley got a reaction from Mabel Adams in What in your MTP?   
    The code is P9044.  It's about 25% more than frozen plasma from our supplier.
  7. Like
    Carrie Easley reacted to John C. Staley in negative Cord DAT, positive eluate   
    I have to ask, how many times when the DAT is negative and you can elute the antibody from the babies cells does the infant show symptoms of a significant case of HDN (old guy, old nomenclature) resulting in an exchange transfusion or even phototherapy?  Seems to me you are doing an awful lot of work for little, if any, benefit.  See Malcolm's technical discussion above.  
  8. Like
    Carrie Easley reacted to John C. Staley in Direct entry of manual testing results into LIS   
    I'm with David on this one.  Doing both paper and computer entry just adds one more opportunity for mistakes.  If you can't trust some one to put it in the computer correctly how can you trust them to write it down correctly!  The key is the ability to enter the results as they see them and not have to walk over to a computer station to do it.  Also, if you are entering from an instrument print out I highly suggest you get that instrument interfaced as quickly as possible.  Again, you are entering results from paper and that should be avoided.   
  9. Like
    Carrie Easley reacted to Mabel Adams in Blood on Helicopter   
    At the recent AABB meeting San Antonio reported on their program with whole blood out on ambulances and helicopters.  When the blood bags come in with the patient to their ED, they are sent to BB so they can be crossmatched after the fact.  Here, we keep segments from the units that we provide to our medical transport partner so we can crossmatch those brought to our facility if serological XM is needed or if a reaction occurs.  In TX they have two level 1 trauma centers and I think more than one supplier for the units so they have to try to solve it at the receiving site.
  10. Like
    Carrie Easley reacted to Mabel Adams in Blood on Helicopter   
    We supply blood to a helicopter service with a contract with our hospital system.  We put Safe-T-Vue indicators on all of their units.  They provide us a copy of their in-flight chart when they transfuse anyone not coming to our hospitals.  If the patient doesn't come to us but has an account in our HIS, we create a bogus registration in our BBIS using a defined format account number.  If they don't exist in our HIS, we create a complete registration manually in our BBIS using a defined format for MR# etc.  Then we emergency issue the product in our BBIS and handle it just as we would those patients who expire before a specimen is drawn etc.  We charge the helicopter service for the products which they include in their flat fee to the patient.  We maintain the final disposition records for any lookbacks etc.  If we got a market withdrawal or lookback, we would notify the helicopter company to follow up with the recipient.  That duty is at least vaguely covered in our agreement with them, I believe.  We tell the helicopter crew to return any unused products to us and not to leave them at the receiving hospital but this isn't perfect.  We sometimes transfer products on paper to the receiving site if we can document handling sufficiently. It doesn't work easily if the receiving hospital doesn't use the same blood supplier.
  11. Like
    Carrie Easley reacted to OregonBB in Level 1 trauma center Massive Transfusion protocol   
    Question. If the patient is registered, why can't you use the SoftBank emergency issue function prior to the Type and Screen being completed?
  12. Like
    Carrie Easley reacted to David Saikin in Positive Cord DAT, RH= mom, Allo-D and Rhogam   
    How do you know it was alloanti-D if it was not ruled out?  If she had a history of alloanti-D why did she receive RhIg?   Anti-D tends to stay around for quite a while, in my experience.  Are you sure you weren't detecting  residual RhIg initially?  To do or not do elution - you should follow your policy. 
  13. Like
    Carrie Easley reacted to AMcCord in Confirmatory test for ABO groups in first attend patients   
    My advise for safe patient care is confirmation of the patient blood type by a laboratory professional. 
  14. Like
    Carrie Easley got a reaction from JessieBeeley in Pregnancy Termination and Rhogam   
    https://www.uptodate.com/contents/prevention-of-rhesus-d-alloimmunization-in-pregnancy?search=RhIg pregnancy termination&source=search_result&selectedTitle=1~150&usage_type=default&display_rank=1
    We do a K-B after 20 weeks if we don't get cord blood.  A single, full dose if < 20 weeks.  Here's one of the sources I found.
  15. Like
    Carrie Easley got a reaction from Malcolm Needs in Group A plasma for traumas   
    Chhibber V et al. Is group A plasma suitable as the first option for emergency release transfusion? Transfusion 2014;54:1751-5. Cooling L. Going from A to B: The safety of incompatible group A plasma for emergency release in trauma and massive transfusion patients. Transfusion 2014;54:1695-1697. Isaak EJ, et al. Challenging dogma-Group A donors as universal plasma in massive transfusion protocols. Immunohematology 2011;27:61-65 (NOTE: Free pdf download of full issue). Mehr CR, Gupta R, von Recklinghausen FM, et al. Balancing risk and benefit: maintenance of a thawed group A plasma inventory for trauma patients requiring massive transfusion. J Trauma Acute Care Surg 2013;74:1425-31. Zielinski MD et al. Emergency use of prethawed group A plasma in trauma patients. J Trauma Acute Care Surg 2013;74:69-75  
    Some of these are several years old.  A quick search will literally provide dozens of articles.  It was well publicized @ AABB 2018 and the Blood Bank Guy has a podcast from August 2017 that provides more info.
  16. Like
    Carrie Easley reacted to Malcolm Needs in XM for a newborn with mom's specimen   
    I am a little worried about the fact that there is no serological cross-match if the mother has made an atypical antibody.  The reason I say this is because it is well-known that when a person makes one antibody, they often make more than one.  If a mother makes, for example, an anti-K, which is easily detected, she may well also make another antibody specificity, such as an anti-Dia.  As the Dia antigen is a low prevalence antigen in most populations, it could well be that the Dia antigen is not expressed on either the screening cells or the antibody identification panel cells - in other words, it may not be detected.  Even if the baby does not express the Dia antigen on its red cells, the maternal anti-Dia will still go through the placenta, and so this anti-Dia will still be in the baby's circulation.  If, the unit to be transfused is K-, but Di(a+), the baby could well have an unexpected haemolytic transfusion reaction, which could be avoided by a serological cross-match against the mother's sample.  Once the unit has been cross-matched, and found to be compatible, then aliquots from the same unit of blood can be safely transfused without a further cross-match, but I feel that, for the first transfusion from any unit of blood, a serological cross-match should be performed.
  17. Like
    Carrie Easley reacted to Cliff in More Antibody I.D. Questions   
    Here's the file:
     
  18. Like
    Carrie Easley reacted to AMcCord in More Antibody I.D. Questions   
    Thanks for sharing Malcolm ( and Cliff for facilitating).
  19. Like
    Carrie Easley reacted to ANORRIS in Antigen typing   
    manufacturer's individual instructions ...always
  20. Like
    Carrie Easley reacted to Maura in FFP and RBC's Administered through same line simultaneously   
    I am a certified emergency nurse and combat veteran and in my experience, it has been standard protocol to administer PRBCs and FFP in the same tubing during massive transfusions.  We hang PRBCs on one side and FFP on the other and alternate in a 1:1 ratio using the same tubing.  I have done this with both the Belmont Rapid Infuser and Level 1 Infuser.  Platelets, however, are administered in separate, regular y-type blood tubing and free-flowed (hung "wide open), and not given via rapid infuser/warmer because it is contraindicated per manufacturer's guidelines.  I stumbled across this thread because I have also been looking for specific clinical practice guidelines describing this practice and I can't find any.  Yes, tubing is changed between units during routine blood transfusions to ensure there isn't cross contamination and so you may test products and tubing individually if there is a transfusion reaction, but when someone is hemorrhaging and we have implemented the massive transfusion protocol (MTP), we only hope that they live to have a reaction.  The only adverse reaction I have ever seen to blood products is TRALI, which is a delayed reaction, so we don't know which unit would have caused it anyway.  In reality it was probably a combination of all of the units and the inflammatory response the patient's body was going through s/p bilateral above the knee amputations, shock, acute kidney injury, and massive transfusion, resuscitation, and damage control surgery.  If anyone has found any references regarding giving PRBCs and FFP in the same tubing, please share! My email is mauraleo@gmail.com
    Thanks,
    Maura Leo BSN, RN, CEN
     
  21. Like
    Carrie Easley reacted to Mabel Adams in Physician Signature for Emergency Released Blood   
    There is some value in the need for a provider to stop and ask himself if the need is urgent enough to give uncrossmatched blood.  Placing an order, verbal or otherwise, serves that purpose.  Getting a form signed after the fact is just bureaucratic blame-shifting, I agree.  Someone should propose that all of the regulatory standards be changed to reflect that. 
    Has anyone ever seen someone request uncrossmatched blood whose mind would be changed by knowing they needed to sign a form?  I have definitely seen some of them change their minds about transfusing when faced with signing our "increased risk" form for transfusing patients with, say, a warm auto, high retic count and Hgb of 6, but maybe that is because we provide more information about the risk when we complete the form.
  22. Like
    Carrie Easley got a reaction from AuntiS in Retirement   
    Congrats!!!  I think many of us have our own version of Malcom in our mind 🤓
  23. Thanks
    Carrie Easley got a reaction from Malcolm Needs in Gold Medal.   
    An amazing honor and well-deserved.  The knowledge you share spans continents and grows exponentially!!!
  24. Like
    Carrie Easley reacted to tcoyle in ABO Retype   
    Agreed!  From the 31st Edition of the BBTS Standards:
    Standard 5.14.5 Pretransfusion Testing requires two ABO group determinations and cites Standard 5.14.1 as the precursor.  5.14.1 states the ABO group shall be determined by testing the red cells with Anti-A and Anti-B reagents and by testing the serum or plasma for expected antibodies with A1 and B reagent red cells....
    TRM.40550 Forward/Reverse Typing Phase II
    For each patient, red blood cells are tested with anti-A, anti-B, anti-D, and serum/plasma is tested using A1 and B reagent red cells.
    NOTE: The ABO/Rh type of the patient's red blood cells must be determined by an appropriate test procedure. Tests on each sample must include forward and reverse grouping.
    CAP and AABB are in agreement.
     
     
  25. Like
    Carrie Easley reacted to ANORRIS in ABO Retype   
    AABB ---BOTH
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