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Ensis01

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  1. Like
    Ensis01 got a reaction from Mabel Adams in Preop Specimen   
    To my understanding the process of having to sign a document made the patient think and take the questions seriously. Obtaining and documenting accurate information is the objective.
  2. Like
    Ensis01 reacted to jayinsat in Temperature Alarm Testing   
    Correct. That is why we typically use 5.5 as the upper set point instead of 6.0. If it alarms at 5.6, you are still covered and have time to move product before it reaches the upper limit. I think that is why I am confused by the OP's citation. I wonder if they have it set to 6.0
  3. Like
    Ensis01 reacted to AMcCord in Temperature Alarm Testing   
    My interpretation has always been that the alarm should sound at or before the set point. The set point should be low enough to allow time to move products if necessary. But we are CAP inspected, not AABB.
  4. Like
    Ensis01 reacted to jayinsat in CLIA / CAP / Proficiency Testing   
    I agree with Neil above. I would challenge that deficiency and not change my process. 
  5. Like
    Ensis01 reacted to Neil Blumberg in CLIA / CAP / Proficiency Testing   
    I'd go up the food chain ladder and consult with this inspector's supervisor. 
    Clearly if the lab receives five samples, giving them all to one technologist does not in any way mirror clinical practice, and thus violates the regulations. Thus my initial take on this is that is another extremely bad idea from an inspector who has no idea what they are doing. Sort of the old joke about some physicians:  "Occasionally wrong, but never in doubt."
  6. Like
    Ensis01 reacted to applejw in Wrong ABO typing by Gel   
    Was the patient recently transfused?  We had a situation several years ago where the patient sample results were one type on the Vision and another type in tube.  I learned that the instrument samples red cells from the bottom of the patient specimen which, after centrifugation, is where the majority of the more dense transfused cells are vs. the top of the red cell layer where the less dense autologous red cells are.   This cause for a forward typing discrepancy was confirmed after communications with Ortho.
    The theory was confirmed with manual gel testing where red cells were sampled from the top, middle and bottom of the red cell layer of the patient's specimen. The top layer of red cells were Group O, the middle and bottom were primarily Group A.  This patient was discovered to be Group O after receiving several Group A RBC transfusions.  The reverse typing showed reactivity only with Group B red cells at that time.
  7. Like
    Ensis01 reacted to applejw in Omitting Crossmatch on Emergency Release RBCs   
    We have an active pre-hospital emergency service with both ground and air transport that carry blood products. If the patient doesn't come to a facility within our system, we don't have a specimen or even a system-generated ID, so the blood is issued in our LIS with a comment describing what happened in case of collection facility lookback.
    An alternate scenario is where the patient expires prior to specimen collection - if you don't have the specimen, you can't test it and we document that the units were issued emergency release and cancel the system generated crossmatch with a comment that no specimen was received.
  8. Like
    Ensis01 reacted to Malcolm Needs in Confirm anti-D (vs anti-G) via titers?   
    It is usual for the C+, D- red cells (e.g. r'r) to react with an anti-G more strongly than a C-, D+ red cell (e.g. R2R2), BUT, this is by no means "diagnostic".

    As Jsbneg says above, it would be far safer to perform the proper tests, to ensure you have ascertained the correct specificity/specificities.

    The attached PowerPoint may or may not help (ignore if it is not helpful).
    The G Antigen and Anti G.pptx
  9. Like
    Ensis01 reacted to jayinsat in Omitting Crossmatch on Emergency Release RBCs   
    First, blood given pre-hospital is quite routine these days. Both ambulances and helicopters are carrying Low Titer O Positive whole blood that they transfuse on scene in response to traumas and hemorrhagic shock. In South Texas, the ambulances and helicopters receive their blood directly from our blood supplier. Who will be stocking your helicopter? Will it be your facility? If so, you have a lot of work to do. If your supplier, you have nothing to fear.
    Second, when a unit is given pre-hospital, our EMS techs give the empty blood bag and a record of transfusion to the receiving nurse in the Emergency room, who then sends them to the blood bank (theoretically, practically we seldom get them right away). Our emergency room physician orders a type and screen upon arrival. Only if an antibody is detected (or we have a history of a clinically significant antibody) will we perform any crossmatching with the unit. 
    I would suggest you google the topic Low Titer Whole Blood. It will help you answer your question.
  10. Like
    Ensis01 reacted to jayinsat in CellSaver quality indicators   
    I suggest reaching out to your director of the O.R. and to your Biomed Director. Start a conversation with them showing them the CAP standard and ask them how they are measuring the safety and efficacy of recovered products. Ask them to provide you a copy of their data to include in your records. Also, since your medical director has to actively participate in the program, they may need to officially report to them as well. Perhaps this could be covered in your transfusion committee, if you have one.
  11. Like
    Ensis01 reacted to jayinsat in stem cell transplant   
    I would add it to the title. For instance, I my blood bank collected donors, provided blood for transfusion, and participated in stem cell collection and infusion, my department would be called, "Transfusion Medicine, Donor Services, and Cell Therapy Laboratory."
  12. Like
    Ensis01 got a reaction from Ally in MTP cut-off policy, or Lethal Dose of Blood Products   
    My experience has always been that blood products given during an MTP were a stop gap while the cause(s)of the bleed were dealt with, continuing for as long as it takes. As described above this can involve a huge number of products.
    What situations during a MTP can cause more harm than good?
  13. Like
    Ensis01 got a reaction from Mabel Adams in Retirement planning advice   
    Part time / guest lecturer at your nearest Med Tech school?
  14. Like
    Ensis01 reacted to Mabel Adams in MTP cut-off policy, or Lethal Dose of Blood Products   
    We created a policy to ask at certain stages whether the MTP is likely to go on at the same rate so we can plan for blood ordering since we are several hours' drive from our supplier.  
    We have this on the back of our MTP log sheet:
    "Assess Futility?
    Round 10 cooler has left BB within the first 3 hours of MTP (or inadequate blood supply):
    • Evidence shows a much-reduced chance of survival if over 40-50 RBCs have been transfused in an MTP.
    • Pathologist can confer with providers regarding the chance of saving the patient with continued transfusion.
    • Be prepared to provide pathologist with available blood supply information and expected arrival of more units"
    Our rounds contain 4 RBC units plus varying yellow stuff. We are starting the conversation at about 40 RBCs, so we have an answer by 50, we hope.  We don't have other hospitals nearby that we can borrow more than a few units from.
     
  15. Like
    Ensis01 reacted to Mabel Adams in MTP cut-off policy, or Lethal Dose of Blood Products   
    Here are our "nudge" questions.  See my other post for our rounds etc. 

  16. Like
    Ensis01 reacted to jayinsat in Documentation of Visual Inspection at Issue with Remote Refrigerators   
    I do not have any remote refrigerators but, is there a way to have an automated comment added to the unit history when a unit is removed from the remote refrigerator that states it was visually inspected? That would give you documentation. Of course, you would need to have clearly stated in your policy that visual inspection is performed when units are retrieved, and nursing training would have to have that documented as well. That's how I would resolve that issue.
    That said, I think that the inspector may be improperly applying the checklist item to your situation. The checklist item states:
    TRM.40900 Blood/Tissue Sign-Out Phase II The process for signing blood and tissue out of the laboratory provides adequate protection for the potential recipient. NOTE: A person authorized by the transfusion medicine service must perform a clerical and visual inspection of each component immediately before it is issued. Transporters of blood components and tissue must be trained in prompt delivery. Training may consist of instruction at the time the product is dispensed.
    There is no blood bank staff that is "issuing" the blood so, technically, there is no "person" signing out the unit. I would argue that the inspection would have to take place when the unit is placed in the remote remote refrigerator. I would challenge the deficiency on those grounds.
  17. Like
    Ensis01 reacted to Baby Banker in Mismatch Kidney Transplants and Titers   
    That's still a significant number of A subgroup kidneys to give B patients.  
    Patients who are type B and need a kidney transplant usually have to wait years, and sometimes die because no type B kidney is available.
  18. Like
    Ensis01 got a reaction from exlimey in Repeat of donor Antigen typing   
    The policy at all places I have worked; to find antigen negative units in our inventory requires testing two different segments sequentially (not parallel). First segment is a screen and second is confirmation. 
  19. Like
    Ensis01 got a reaction from Toph in Repeat of donor Antigen typing   
    The policy at all places I have worked; to find antigen negative units in our inventory requires testing two different segments sequentially (not parallel). First segment is a screen and second is confirmation. 
  20. Like
    Ensis01 got a reaction from Toph in Repeat of donor Antigen typing   
    To quote my first BB manager “first rule of BB; get the ABO right, last rule of BB; get the ABO right. “
  21. Like
    Ensis01 got a reaction from Toph in Repeat of donor Antigen typing   
    If you are screening unknown units in your inventory then a second confirmatory test on that unit is strongly advised.
    If you receive labeled antigen negative units from your reference lab then believe their process and the label.
    Retesting because a tech does not trust someone else’s work due to “comfort” seems to be a waste of time and money.
     
  22. Like
    Ensis01 reacted to Malcolm Needs in Panagglutinin in eluate   
    I did allo-adsorptions on eluates for quite a while and never once detected anything in the adsorbed eluate.  My own experience suggests that it is a waste of time and resources, but others may disagree.
  23. Like
    Ensis01 reacted to SbbPerson in Fetal Screen   
    Does your sister hospital uses the same Lot numbers of Immucor FBS kit? If yes, then you guys must be doing something wrong.  When was the last time your cell washer/centrifuge was calibrated? RPMs? Amount of saline dispensed? 
    If they are not using the same Lot #'s, perhaps give them one of your kits and see if they get the same result. If the kit's QC passes for them, then there is something wrong with either your procedure or maybe equipment.  This is really strange. Good luck. 
     
     
  24. Like
    Ensis01 reacted to jayinsat in Grifols analyzer users: Roll call!   
    I would consider switching to Immuco ECHO Lumena before going to Grifols. You could also look at Bio-Rad's IH system for gel alternatives. That said, I prefer Ortho for gel and Immucor for solid phase. 
  25. Like
    Ensis01 reacted to Andrea Pointer in Transfusion vital signs   
    Hi all, this is a late response to the post, but I have some valuable info to add. I searched "vital signs" in the forum so it's still a relevant topic to me.
    We just transitioned from CAP to TJC (JCAHO) for lab accred (before you ask why or judge, it was a legit reason; I also was hesitant, but it's been good so far!) and learned that CAP doesn't really care. It's all TJC.
    TJC follows AABB guidelines for their standards. AABB published in the 19th Ed Technical Manual (the only one I have; not sure if a more recent version would change the info) indicates a pre-transfusion check, within 15 min of starting, during transfusion "at regular intervals", and after transfusion is done is advised, but there is a lack of published study evidence to actually assign the intervals. TJC will hold you accountable to whatever is in your policy and their transfusion tracers will review charted vitals. 
    I'm keenly interested in the topic because we are needing to address our policy, which is a pre, 15 min in, 30 min in, hourly from there, and one hour post. Our initial surveyor is an SBB and said that the majority of facilities she had personally inspected were doing pre, 15 in, hourly, then one hour post, and her suggestion was to adopt that model. Anytime there is a lack of distinct guidance, TJC will direct you to check out the industry best practice. My suggestion is to take all this advice and check with your friends in other hospitals. 
    I came here to ask about traumas/emergencies/MTPs and how often THOSE vitals should be taken. Like I said, we have to make a change and it was just suggested by an exec MD that we basically publish our policy to say whatever the hemorrhagic emergency, the patient's vitals will be trash until stabilized so we aren't going to check the vitals until the patient's bleeding event is stabilized. Unstable vitals in an unstable situation will not provide direction for care, per the exec's thinking. TJC will only hold you accountable to your own policy on this until further evidence-based best practice is established. Likely never. 
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