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cswickard last won the day on August 15

cswickard had the most liked content!

About cswickard

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    Seasoned poster
  • Birthday 04/17/1953

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  • Location
    Las Cruces,NM
  • Occupation
    Transfusion Service Supervisor

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  1. I forgot - you also have to have a documented training program for all users and establish competency with the irradiator functions and any computer work (relabeling, etc. ) that will need doing on all irradiated units. You have to at least REGISTER with the FDA (if in the USA) because irradiation is considered a manufacturing step and that makes you a producer.... (YEAH!! - such fun)
  2. We have a Best Theratronics Raycell X-Ray Irradiator. We have the paperwork from the technician that installed or repaired the unit - they do extensive testing and verification of the dose delivered. We send a test shot phantom (contract with MD Anderson's Radiation Dosimetry Services (RDS@MDAnderson.org) (713-745-8999) twice a year to document the dose delivered. We would have to have a test shot after any repair too. You would have to have a documented test shot with documentation of the dose delivered to start operating. Every time we get a new lot # of indicator tags, I run new tags from each box against tags from the current lot number, to check for duplicate functionality. We are FDA inspected - they have never asked for anything else. Ask your manufacturer - they should have some suggestions too.
  3. Yeah - sorry - I was just assuming it wasn't an obvious problem like that. When nothing else makes sense and the baby is still in trouble - that is when you are thinking about that rare antibody.
  4. You should also just check with your blood distribution center. They should be able to supply you with some empty bags. If you do not need an ongoing supply, they should be able to help with what you would need for validations - primary and ongoing. We store our "phantoms" in the frig and I have had them for years now.
  5. We do an eluate only if the Dr orders one, and we haven't had that in years. We only do the cord bloods of O and all Rh neg moms anyway. An O mom with a B baby can frequently be seen to have a more aggressive HDN - but usually treated just with Bili lights and hydration, occasionally they also don't let the mom breastfeed. Any ABO HDN eluate workup really doesn't yield anymore useful information than you already know - Mom's are usually O and the babys are A or B - DAT mystery solved. On the rare clinically significant antibody - try to find whatever it is mom has and phenotype the baby (if possible) if the DAT is positive - might be worth sending out if you can't do any of that. Do you have to send out AB Titers if they are monitoring the pregnancies? Do you usually know in advance, the moms with positive antibody screens or do you get little prenatal work? That might effect what you need to do. On the very rare(!): Dad has a rare antigen and mom has the corresponding antibody - good luck even remembering that if shows up. The only real way to work one of those up is to have specimens for Mom and Dad and crossmatch Mom with Dad's cells. If Mom had a negative antibody screen (frequently) but is incompatible with Dad and the baby - send that out for information to use on the next pregnancy - if there will be one. Otherwise - the current infant will have to be dealt with as well as possible - Bili lights, hydration, maybe exchange transfusion with units compatible with Mom's specimen. That is what we would do.
  6. mostly 72 hours, but if we can get some history - will extend until midnight of 3rd day.
  7. A - to find out the specifics of the problem - personnel may not talk in front of supervisor, so this needs to be done 1st. B - to get the other side of the story - if there is one. Don't spring a meeting on the supervisor with other personnel present without discussing problem 1st. 3 - to work things out - if possible.
  8. There has been the occasional OR RN who has had to crawl under the table and access the wristband under the drapes! The Cardiac OR team has learned to get their BB pick-up cards ready in advance.
  9. It might be that today's philosophy could be stated as: "I have to give one unit - but I don't need to give two." We are seeing some REALLY low hemoglobins around here, but the Docs have adjust nicely to giving fewer units.
  10. That's usually true Malcolm. But in the world we live in with these pesky patients doing their "own" thing you just never can say never. We had a anti-Lea the other day that we didn't even see with solid phase (almost never do/ detects IgG dependent Abs)) and didn't see it with immediate spin XMs either (should have picked up IgM), and then the pt HATED a unit - nasty transfusion reaction. Went looking for a low frequency antibody, but found the anti-Lea and it was reacting 4+ only with AHG tubes - so was it IgM (no I.S,. reaction) or IgG (no solid phase reaction)???. Go figure. That one sent us back to the textbooks. Immucor had just put out a Self-Check with an anti-Lea. The discussion paperwork gave us a good idea of what the patient had been doing - but it makes absolutes seem like a distant memory in this field sometimes. Happy 4th to all of you that are in the states! Everyone else - have a nice day.
  11. Are you computerized? If so - build a Cord Blood panel that includes what you want - ABORh and DAT, say. Then the Dr only has to order that for whichever mother/baby pairs you ordinarily do that work for. If your orders are on paper - see if you can get a Cord Panel added to the order form - same result. We just do the Cord panel (ABORh /DAT) on the OPos and all Rh neg mom's babies. We don't have to evaluate "DAT yes/no" based on prior work or digging up the Mom's types. It is DR/Nursing responsibility to get the Cord workup ordered. All Cords are kept in the Blood Bank (part of our "Abducted Baby security SOP) so we do get all of them sent to us so we can see if they missed a CORD order on one. Labeling for babies is as AMcCord above (Mom's and Baby's labels on tube) - except the mothers are using so many 1st and last names now - we had to flip the baby name convention to Last name, Male/female Mom's 1st name (Smith, Female Sissie) - otherwise we ran out of label space before we got to the baby's sex.
  12. Does your system allow you to "GROUP" all of the individual products(codes) under single headings (RBC, FFP, CRYO, PLTPH, etc)? If so - then that is probably how you then build the Ordering screens to limit the Drs to the seeing the Groups only. Anything special they have to put in comments - or your system may allow some questions and answers in the Order screens. That is how Meditech does it and I think that is how Safe-Trace did it too. You see all the product codes in Blood Bank - but the Order screens don't - that would be complete chaos!! The system on your side also has to recognize the Groups so you don't have to line up each special product to a special order - also chaos!
  13. This is such a complex question - I don't even know where to start. Meditech is a basic system (DOS based) that ties the unit to the patient after ordering and resulting. The system then "issues" the unit that has been crossmatched in an ISSUE screen that lists the patient, the unit, the date/time (and who crossmatched the unit) of the crossmatch, the date/time and people involved in the issue process and then transfers the unit to transfused status in the system - all tied to the patient. So I guess the basics of what you need would be: Patient - full ID (name, DOB, system IDs (medical record #, etc.); Pt's group and type - ideally, the system should also list any pt. antibodies on the tag also. Blood Bank ID band numbers (if you use one of those systems) and/or any other required identifier for your hospital Unit number and Group and type - the system should be built to help you restrict units to type specific/compatible units only Ideally the system should be able to list any antigen testing on the units. Who did the crossmatch and when (so you can keep track of expiring crossmatches) When the unit is issued- by who and to who Our Meditech Issue/Transfusion tag is also built to print out a blank form (this is the bottom half of the tag) for Nursing to list; Transfusionists (transfusing RN and secondary ID check RN), the times and vitals for pre, 15 min, 1 hour and End for the transfusion - but if you do this some other way - say in the computer itself - you may not need that. Does that help? In any computer system, this data has to be linked to so many different areas in a Blood Bank system that getting that data to a new form is where the challenge comes it. Best of luck.
  14. Been there - done that - still can't make any headway with the neonatologists! Not even when we brought our Blood Distributor"s Medical Director with all the facts and figures. They still want CMV neg. On the plus side - everyone else is OK with leukoreduced cells as CMV safe now.. I think leukoreduction is the best production step that has ever been added to blood - especially the pre-storage leukoreduction we get now. Now - if we could just get some more donors....
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