AMcCord

Exactly what we do.

Agree! Save the life first. Our medical director would likely order at least one DAT the next day, possibly for additional days, to monitor. Anti-E is generally relative benign (though I have seen one patient who had an acute hemolytic reaction), We might also monitor plasma Hgb or haptoglobin, depending on the antibody involved.

We also recollect the day of surgery, but don't test unless we need to set up units that day.

Small rural critical access hospitals operate under very tough conditions. If they close their doors the next closest facility, which may also be a critical access hospital, might be an hour or more away. It's a world I am thankful I am not working in, though my facility is one that receives transfers from critical access hospitals after they stabilize and ship.

They probably barely have enough staff to cover what they cover now if they are a small enough facility to not have a night shift.

We are using CH5214-18 from Cardinal - plastic, 2 mL, consistent drop size for Blood Bank. Had some trouble getting them for a while about a year or so ago, but not recently (knock on wood and rub my lucky rabbit foot!).

Yes there are.

Our nursing policies state that infusion should begin within 15 minutes of checkout. This ensures that the transfusionist and patient are 'ready' for infusion before the nurse comes to Blood Bank to check out the unit: pre-transfusion vitals have been taken and evaluated; IV looks good; infusion set is at bedside; consent has been signed; etc. etc. We implemented this policy in cooperation with nursing service to reduce blood product waste due to inadequate preparation and unexpected patient issues. Fifteen minutes gives them just enough time to come down and check out the product, take it to the bedside, have a buddy ready for the 2 nurse ID process, and to start the infusion. If something unexpected pops up and they have to return the unit, we check the temp. If its over 6.0 C we ask them to take it back to the floor if they think they will be able to start infusion soon and remind them they have 4 hours from the time of original checkout to complete the transfusion. If transfusion is a 'no go' or will be delayed too long, the unit is discarded. This is working well for us - very few wasted units since implementing this policy. Quality includes the 15 minute start time in their transfusion reviews.

It is possible to designate a cold reactive antibody as not clinically significant in our BB LIS system. We report them as we would any other antibody. We can add a 'special needs' requirement for an AGT crossmatch to the patient profile, if appropriate/necessary for the antibody in question, when a 'clinically insignificant' antibody is reported. Our system is also set up to flag all red cell units issued for patients with antibodies, including clinically insignificant, if antigen screening was not performed. That flag is included in the daily system review report. We don't remove a cold antibody ID from the LIS, but can inactivate the AGT crossmatch requirement if the antibody is no longer detectable. I have no references for that.

Can you use the nursing service charge nurse on duty - less turnover in that position possibly so better training opportunities?

We used to have a weight based formula but recently switched to sending the same cooler of products regardless of patient age/size. For kids the red cells would be O neg and AB liquid plasma. It is up to the surgeon/pediatrician to determine what and how much is transfused. We just make sure they have plenty of what they need. Any unused product comes back in the cooler and is returned to inventory. We receive very few pediatric trauma cases that need blood products over the course of a year so we (Blood Bank and our Medical Director plus Trauma Coordinator, with pediatric consult) decided to keep things simple on our end and let the medical folks do what they need to do. It's hard for us to get timely basic info in a trauma situation - male/female, kid/adult - much less weight. Using the one size fits all response instead of pulling a chart to check for specific requirements minimizes confusion for our generalists who may only have to respond to MTP orders a couple times a year. It keeps our TAT for cooler delivery fast and doctors happier. We aim for <10 minutes and our median time is 6 minutes over the last 2 years, regardless of where the cooler needs to go.

We hold that document in Blood Bank. We haven't discarded any of them to date, but we don't have a huge volume to hold. I've been thinking that it's something we could/should scan into the BB LIS patient profile so we can dump the paper copy.

I strongly suspect that you've got your answer. Echo/Lumena probes are calibrated to go to a specific depth after level sensing at the top of the plasma of the specimen and I would think that is true for other analyzers as well. Another (opposite) problem that can happen is failure to pick up a red cell sample if the Hct is extremely low. With the 'extra' plasma in the tube because of the low Hct, the probe doesn't go deep enough after level sensing the specimen to reach the red cells.

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.

I have seen issues with tube testing on one patient that I suspected was due to contrast media. I don't remember was was used but do remember that it was administered about 30 minutes prior to our specimen collection. When we recollected the specimen about 4 hours later, no problems.

Yes, definitely need to plan for the possibility of workarounds in your risk analysis and SOP. And its important to monitor for that to demonstrate quality improvement. We are using a Blood Bank specific armband and require lab collection for Blood Bank specimens, with the exception of some OR collections. (OR is expected to place a BB armband or use an existing one and label with appropriate patient ID.) If we can't use electronic patient ID we require that the specimen be hand-labeled directly from the patient armband. We don't need to do this very often, but it is a part of the required competencies for phlebotomy. We collect only one specimen.

Yes, that is an electronic ID system. Just make sure that you write your specimen collection procedure very carefully. The phleb should still be verbally IDing the patient and comparing that with the patient armband (full name, birthdate) and matching the Rover info with the patient armband. The procedure should also state that the label will be printed at bedside and the tube labeled at bedside. You will also need policy for what to do if the phleb is unable to scan the armband (Rover not working, emergency specimen collection and no armband present, OP collection if Rover not used for patient ID, etc.). There may be some specimens that can't be collected under the electronic ID process, which would require another process (2nd specimen collected or Blood Bank armband or ???).

We used the Sure Tech kit when we were doing Kleihauer Betkes. They offered a 'training book' of KB stain photos, good and bad stains, that included info about troubleshooting the staining process. It wasn't terribly expensive. I found the photos very helpful in getting my eye 'calibrated'. After that I had zero problems hitting the CAP survey results. I tried to use it to educate staff, but I couldn't get them zeroed in - they always overcalled (better than undercalled). I think our major problem was that we did so few patient KBs that it just wasn't possible for anyone else to become proficient. That's when I approached our medical director about switching the test to a send out. We are able to get specimens to our reference lab within 24 hours, usually much less, so it hasn't hindered patient care. I still use the book for student education.

We report the fetal bleed volume.

Are any facilities using an infusion set for platelets with 80" tubing? If yes, which one? Thanks!

Our LIS is set up to allow an EXM for PAT specimen outdates of 14 days if the patient qualifies for EXM.

We extend for 14 days.

Thanks!

Somewhat related question..... I need to replace the liners in my Credo coolers and order a couple of RT TICs. However I haven't been able to make contact with their sales people over the past year. No response to phone calls or emails. Can anyone give me a contact with someone that can help us? Thanks!

This is what my facility uses.