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cswickard

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Everything posted by cswickard

  1. Does the O.R ever tell you that the Pt's armband is "inaccessible" because it is "under the patient and contained within the sterile field"? We use an armband system for our BB patients and we get told that occasionally when we need to transfuse in O.R. and they didn't get the armband number before they covered up the pt. The RN usually winds up crawling under the pt's table. What does your O.R do in that case? Especially since they are having to do a barcode read of that band? We use coolers for our O.R. deliveries (one pt per room) and I never want to even discuss the introduction of an O.R. refrigerator. Anything giving in the O.R. is documented in the anesthesiologist"s records, which are also part of the electronic record.
  2. What is the rational for Whole blood vs. FFP and RBCs, especially with the blood mixers used at trauma bedside? Are there no problems with the decreased Coag factor levels with the older plasma in the WB units? I know some trauma centers are using liquid plasma so there is no delay in response - is WB even better than that? In what way? What about platelets? Do you still have to add them into the mix?
  3. We have two forms I could send you if you want to message me your email address. Most of ours is now in the computer also, but the forms have more instructions, both for Nursing and the techs. Good start.
  4. Since we use CP2D units for both our exchange transfusions (reconstituted with FFP) and small volume transfusions, we do not spin the unit down. We just measure the Hct and provide to the Drs.
  5. Malcolm - would you be able to share what happened to "improve" the titers? What changes were made in the procedure/ cell choices, etc that made them more reliable? Was it something specific or just more practice? CAP has introduced a "Universal titer procedure" - but peer results are still all over the place.
  6. Amen! Our nurses take vitals before, at 15 mins, at 1 hour, and at end (<4hrs). Don't know where it came from but that is our policy.
  7. We use the Helmer D4 and have had it for years - it doesn't have speck of rust anywhere. We only fill it with distilled water and use the Helmer CleanBath Would the dry heat thawers work well for Plasma exchange transfusions? The 4 well waterbath we have is not going to get through 16 units very fast.
  8. We have an irradiator on site, so irradiate 1 aliquot at a time. For the infants, we will not use an older irradiated unit. I can't give you any data on how fast the K+ builds up, but I wouldn't stretch it to 10 day for neonates. Since no one else answered - you might have to do an internal study to see how fast the K+ rises (and it DOES rise). Good luck. The other hospital in town does not have an on-site irradiator and I think they are now ordering at need - a tough job in this neighborhood.
  9. 1 per year or 1 every other year. Nightmare to maintain competency and training on! We get the little ones transferred here now - about a 200 bed hospital with maybe 10 neonate beds. (and to think we have a Children's hospital and a second huge pedi/neonate service 50 miles to the south of us - it is all a prestige thing, I swear).
  10. All the DTT treated cells were still positive so that should rule out Darazalex. I wonder about the new one anti-CD47? Has anyone run into it yet and do we have any way of coping with it yet? Does it have a name yet? I was thinking anti-Fy3 or anti-U because of the ficin testing results, but the phenotyping is wrong for that, isn't it?
  11. I wonder if the committee that came up with the recommendations for treating Rh weak Ds - Type 1, 2 and 3 as Rh pos had access to this data?? I wonder if this is going to change this recommendation any time soon?? I wonder if this is worse than the allo-anti-Ds we are going to see with the now widespread policy of starting all traumas (except children and females of child bearing potential) with RH pos blood before getting a blood type? That is not a benign policy either. We were just starting molecular testing and were just starting to call these patients Rh pos and not giving RhIg - now I don't know which way to go!
  12. . At what temp do you call it a Febrile reaction? we use temp increase - unless the pt is already hot and they had to transfuse anyway - then we would still look for temp rise beyond start point 2. Do you also use temp increase from the baseline? If so what is? start temp with 2F/ 1C temp rise 3. Do you use other criteria with Temp increase for culture? If so what are they? any symptoms that indicated bacterial contamination - shock, hypotension (significant drop from start point), high fever (from start point), chills, vomiting, diarrhea - are what we list for RN 4. If you do have one, what is your definition for tachycardia (eg =>100 bpm?) - no definition 5. Same with Hypotension, any numerical definition? - no - significant/noticeable drop from start point
  13. Just when we thought it might be safe to say we had a somewhat definitive answer..........
  14. There is also clotting to worry about. I have had to watch for and account for clotting in every ABORh slide test I have ever performed from a fingerstick (healthfairs and quick ones done for "can you tell me what my blood type is, pleeeease?"). How does the company recommend performing the test? If from a fingerstick - how much blood is needed, where does it go, how fast might it air dry and give erroneous results, what happens if it clots? All questions that would have to be answered before it could be put into service.
  15. We are starting to phase in the molecular testing for discrepant RHD testing. (Rh neg/Weak D pos and/or weak reactions with standard FDA approved Anti-D reagents (- which may be what Sunshine is doing - only we put them in the computer as Weak D pos)). We are going to be taking the recommendations of the 2015 workgroup ("time to phase in RHD genotyping....)" and getting a more definitive answer for ourselves and our OB doctors that is safe for our patients and less of a strain on our Rh neg blood supply. Can anyone share a procedure with some of the correct technical terms to help us get through this morass? AuntiS? or JoyG? - seems like you already have it working. We may go a head and build it in the computer reflex testing too, but that will be for another day since Meditech may take some convincing!?
  16. We are not yet charging the patients, so are sending out under our pathologist's name to the Immucor DX Reference Lab. We place the results in the history comments of the patient's computer record. If we start charging, we will also have to scan the lab report into the pt's chart for the electronic record.
  17. We tried clear plastic bags for awhile and the RNs complained about one more piece of plastic to have to throw away (amid an already huge plastic waste burden of trash from the hospital). Materials Management didn't want to buy the paper bags - too expensive they said - and we could not find a contracted source of colored plastic bags (to hide the unit). I hate to waste even more single use plastic trash, but even the packed cells occasionally break if they happen to hit wrong and they are a huge mess to clean up. With Whole Blood coming back in some of the Trauma protocols, look out - they always break!
  18. How long will they be in transit between the various hospitals? PelicanBioThermal has the Credo coolers and they have a series for 22C transit protection. We have one of the soft side ones that we use to move Platelets between our facilities. It works fine. Their website is extremely difficult to work with - just get the phone number and call them, if interested.
  19. 1. The AABB Tech Manual, the AABB Standards, Harmening's book is good, Issit's "Applied Group Serology" is excellent; Mollison's "Blood Transfusion is Clinical Medicine" is excellent; Blood Bank Guy - a very useful site; this forum - always useful. The AABB website. National websites (AUS, New Zealand Canada) for their blood services. ARC and UBS (now Vitalent) - our big national blood suppliers. 2. Get a set pattern of working set up that you can follow (within the ways your Blood Bank likes to do things: tubes, automated, computerized, etc.); ALWAYS do the work the same way - keep things in the same order always - your tubes, your results, your units as you work with them and label them. I have trained people who I watch do things in a completely random order, especially as they load the centrifuge - then they had to straighten out every thing to read it and enter it in the computer. Waste of time and very confusing - it will get you in BIG trouble someday when you are in a hurry. At the same time - things will change overtime - new computer, new instrument, etc. - be adaptive to change. If you need to set up a new pattern because it is more efficient or works better with a new instrument (especially computers) - be willing to change and adapt. 3. Always keep an eye on processes - make sure they follow the Standards and are being done correctly. Watch for inappropriate procedural drift - don't just change the procedure to "your" way just because you think it works better - it may be the other way for a good reason. If not - talk it out and see if you can initiate change. Blood bankers can be slow to change, but they follow rules for VERY good reasons. 4. You just always wish you knew more. Patients don't always follow the "rules" and situations can be very fluid in trying to get the right products to the right patient at the right time - and YOU will be the one holding the line on staying within safety rules (and yes, they do scream at you sometimes.) Most Drs and many RNs do not know a lot about Blood Bank - you will answer many questions. Always try to keep learning. Remember always - there is a patient at the other end of that conversation and they need your help. You may be the only one with the right and safe answer, but you have to find a way to help the patient 1st. Best of luck - enjoy the adventure.
  20. I have found that the anti-sera that requires coombs phase testing works well to make elutes, but the monoclonal anti-seras that only require RT incubation, don't work as well. Since that is most of the commercial anti-seras now - it is getting tougher to manufacture this stuff yourself now. AMCord's recipe would work well, but always leaves you with a anti-D eluate. Cliff - do you use a whole syringe of RhIg? How do you mix it?
  21. Quote: "Do you just have it as a check off item on the Maintenance Log and document review there knowing that 1) the Echo won't let you run the test if QC is not performed and passes 2) the actual QC runs are on the archive disks? " This is the process we use. We also "Review and Approve" the QC daily using the "check" button. That shows we at least looked at it each day. Everything is archived too.
  22. I can give you my current one, but it is specific to dataloggers and Credo coolers. Hope it helps Remember also - for the primary validation - the FDA likes to see the testing done under minimum loads (1 or 2 units) and maximum loads (as many as the container will hold). Validation coolers 4.doc
  23. I think one of the threads once mentioned Trypsin - maybe check with a reference lab???
  24. I haven't even heard of this one - what is it used for? What disease or what target that is cross-reacting with RBC antigens? If this is anti-CD47, see the thread on anti-CD47 therapy interference. Might help, unless this clone is one of the ones mentioned in the last post detailing clones that are not IgG 4.
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