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cswickard

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cswickard last won the day on May 17

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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. Try the Blood Type setting for Emergency Issue Units prompts. It says you can define products, etc. We don't have ours set up that way, but will need to consider it for MTP/ Trauma.
  2. cswickard

    0.8 Surgiscreen, vial # 2 reactions

    Very interesting post - especially given that we are having current problems with Cell 2 also (R2R) with our Solid Phase RS3 strips on our ECHO. We received a new lot# of strips last week and are doing better - just odd that it is cell 2 in both types of systems.
  3. cswickard

    Group O Whole Blood, Low Titer

    Yes to not wanting to worry about WB, but some of this is talking about actual transfusions in the field where fresh (<14 days) WB would be very useful and much easier to deal with for a field team. I have also heard that some Trauma centers have a procedure where FFP and pRBCs and all get mixed together as they are being transfused(?!!?) I have no clue how that works, but seems like it would almost be safer to give a WB unit than that procedure?!? Fresh FFP with more functioning Coag factors logically seems better, but maybe a fresh WB has enough to keep things going. I can't see us managing this though - the WB inventory, even with returning it for Packed RBC production, would kill us. Most of our "traumas" to date have used fewer than 4 units. It will be interesting to follow this trend. By the way - does anyone know if the WB is Leukocyte reduced? If not, still having white cells onboard the unit would cause problems too. Especially with WC degradation over time before packing and filtering. Would NOT want to go back to that!
  4. Grifols is still doing our rare ones - through send outs from the United Blood Services, Tempe AZ IRL, but the price is now over $500. Also -- they prefer a tube that has not been opened (risking cross contamination) for other testing, including automated. Theirs seems to be a molecular test that leads to a RH Type decision (prediction?). I have not been able to charge our pts, but appreciate the new CPT code. Might get that to work, but the results take too long to get back for most of our outpt encounters. (about 1 week.)
  5. cswickard

    Group O Whole Blood, Low Titer

    "and cold-stored WB contains PLTs that appear to have equivalent or better hemostatic effect in both in vitro tests and in clinical trials, compared to PLTs that have been stored under conventional room temperature conditions." (quote) How long do the platelets in a WB unit last? Even 7-10 days still leaves half of the unit's lifetime without platelets. The rest of the benefits sound interesting - especially pre-hospital. We are not even close to having blood products in the field, but it is an interesting idea to work on. I wonder how this would change the Massive Transfusion Protocol" 1st response (usually a unit of pheresised platelets in 1st load)- if at all?
  6. cswickard

    Return of Plasma to the Blood Bank

    Plasma is hard to keep track of just by temperature alone. If you are in a hurry - there is a good chance the plasma is going to be warmer that 1-6C when it leaves the Blood Bank to start with. Even in a separate cooler, that means the temperature monitoring tabs won't work and there is no way to know what happens to the plasma that way. Data loggers wouldn't work either. Difficult situation. We will only accept plasma back if it is cold and in it's own cooler and will only keep it for 24 hours. We do not extend FFP (any type) that was issued and returned into a Thawed Plasma product either.
  7. cswickard

    Blood Transportation to Floors

    Coolers (Credo line) for more than one unit or across the parking lot, and by hand for single units. Tried clear bags for awhile, and the nurses hated that because it was just one more plastic bag that had to be thrown out and added to our mountain of trash. We already use a ton of plastic bags (biohazard and plain) for our specimen transport. Our tube system is too small, fast and old to transport blood in.
  8. cswickard

    Benchmarking and Lean Expectation

    Dear God, you have my deepest sympathy. 1. Push the company to give details on their benchmark standards and where they come from. Chances are, you are not in the same boat. We had a similar problem here because our Micro and BB staffing for the weekends did not meet corporate standards (desires), but we were unable to cut staff because of the physical layout of our facility and the distance between the departments. 2. Your situation matches one hospital I know of, if you could contact them - University Medical Center, El Paso, TX. The Blood Bank is in the Main hospital and the main lab is way across the parking lot. They are a level 1 trauma center and a big surgical hospital, but the NICU is in a separate hospital next to them and did have it's own Blood Bank staff. 3. Do you have current FTE numbers that justify your current staffing? What is the difference in the "factors" in the staffing equations that are being used that lead to this new company coming up with their figures vs. your current FTE figures? Good luck. Patient safety arguments sometimes sway Administrations when nothing else will. If you can make a case for how dangerous it is for the staff of a Trauma center to be too little, too late - maybe it could help.
  9. cswickard

    COOLER FOR THE OR

    Oh - we have a Credo set of coolers for our OR and floor use - they have worked very well for us. But darn-- it never even crossed my mind about taking the temps every 4 hours - now we are going to have to look at that. We seldom get units back, except from OR, and that is usually within 4 hours, but still....... Thanks for the heads up.
  10. cswickard

    COOLER FOR THE OR

    I I thought the only reason we were driving ourselves crazy (in the US) trying to get everything down to 1-6C was because the FDA (at least) has determined that coolers moving blood around in the hospital are considered "storage" - not transport (1-10C). Have they changed their minds again - officially??
  11. cswickard

    Antibody Titration

    "Tube testing is notoriously variable, while gel testing is believed to reduce some of those nuances. " Yes, but it is also - according to years of CAP survey results - routinely 1-2 endpoints higher on every titration run. So, make sure you are telling your physicians that your facility is doing titers with gel and that the actionable titers for their patients might be at higher endpoints than those historically with tube testing. "It does need to be reliable/robust and give the same end point each time, even with the acknowledged variations in serological tests (reagents, test cells, techs, etc.)" I wonder if the inspector would have been OK with procedures with this kind of control if it was used when there was no retained sample (no control avail) and not used when the new specimen was run in parallel with it's retained pair (internal control avail)?? I guess we will have to see, because that is what we are going to try doing.
  12. Further follow up. We did purchase the HemoBioScience premade DTT - very nice and really not too expensive for a small hospital - saves all the worry over the manufacture of an in-house DTT reagent. Works well to use 8-10 drops of your 3-4% RBC reagent cells to make one drop of "Packed" RBCs to treat with 4 drops of DTT. Once they are treated and washed, you remake to a 3% solution and get 8-10 drops of treated cells to work with. As hard as the DTT treatment is on the reagent cells - I don't think they are going to last very long for a small hospital - maybe a day or two for a reference lab?? (didn't see the results of that validation study.) We treat the reagent cells (I, II, III) and the first RBCs requested for crossmatch every 72 + hours (new specimen), but if the antibody screen was negative - we just continue with K neg , immed spin, type specific RBCs for the 72 hours (same specimen) for any add-on units. If the antibody screen is positive - a reference lab is going to get the workup. We only have one liquid panel, so I can't see us being able to work up an underlying allo antibody in-house. Dr still is not happy that it takes someone 3-4 hours to work one of these pts up - go figure. It is amazing that even an Oncology specialist thinks that just because we did an antibody screen 3 months ago - we should be fine with giving them "some of that least incompatible stuff"! oh well - will attach my SOP for DTT for anyone it might help. We can survive the simple pts with this procedure here - don't look forward to the 1st pt that forms an allo-antibody on top of the DARA. DTT SOP.pdf
  13. cswickard

    Can leuko-reduce prevent GVHD

    Is this true for all of the pathogen reduction methods or only some of them? The new Circular of Information keeps qualifying the statements to say " if approved for GVHD prevention".
  14. cswickard

    Can leuko-reduce prevent GVHD

    This also makes you wonder - still - if all of these studies on Patient Blood Management today were really done on patients with 100% leukoreduced blood products - especially the studies done in the US. It is not always listed in the controlled study parameters. Also - if my memory has not faded completely(!) - I seem to remember leukocyte reduction being touted to decrease the same problems they are now after us to just "not give blood" for - the reasons so well detailed above. We have been on 100% leukocyte reduced RBCs here (from our blood supplier - Blood Systems, Inc) for a couple of decades now - and we see VERY few transfusion reactions. While that is not the only reason not to give blood - why are the posited post transfusion complications still the same? Did leukoreduction not work? Or are we still fighting the same complications because some of the US still has not adopted universal leukocyte reduction? Leukocyte reduction seems to have helped our patients a lot. Just curious -
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