AMcCord

We check temps when a unit is returned and document it. If it's over 10C , we give them a choice...can you get the unit started and infused within 4 hours of the original checkout? if so, then take it back upstairs and do so, preferably holding it in patient room, but don't put unit in the refrig or in an extra warm place while you are getting ready to actually hang it (works for situations like restarting IVs). If you can't get the unit started and realistically infused in 4 hours from checkout, then we'll take it back and the unit will be destroyed. Nursing service policy requires that a unit must be hung within 15 minutes of checkout so they are absolutely ready when a unit is checked out. Because of this, we get very few requests for return. Of those, there are only a couple of instances per year where the unit ends up being destroyed.

We manually bill for tests performed.

Oh NO! Cut off from the world! :eek: Isn't it amazing how we come to rely on technology. I used to think I didn't need a lap top, but now I feel like a part of me is missing when mine is misbehaving. Malcolm, I guess you'll just have to go for a walk .

We use electronic medical records, so no returns to blood bank. Everything is entered into the patient's EMR.

The fetomaternal bleed could have been occurring over time as a slow but steady blood loss, rather than one large bleed.

Moira - I should probably also give you the bad news. You will see enhanced reactions with warm autos and find more anti-Ms, as well, so be on the lookout for that little problem. Overall, the increased sensitivity is a good thing. Sometimes we have to pay a small price to get the good things in life! P.S. Welcome to Blood Bank Talk. It's a wealth of good information.

I LIKE your statement.

You can definitely catch anti-Fya with gel and miss it with tube. (Of course you can also catch anti-Fya with PeG and miss it with LISS.) Weak antibodies, in general, will be stronger with gel, though there will be exceptions. Don't look at this as a problem. What you are seeing is an advantage/patient care improvement with gel.

We handle RhoGAM only. Pharmacy does the rest, including NovoSeven.

Seems like most labs are already placed in cold dark cellars or at least by the back entrance by the garbage cans. Where will they move everybody to next?

A good reference person has the knowledge and something undefinable that I'll just call good instincts, for lack of a better description, plus enough experience to see the possibilities. They just 'know' where to go first - they 'see' it. Unfortunately, my bench techs are what Malcolm would call the Wrong hands - good enough at the basics but not good enough to 'know'. They have to stick to a plan or they are never going to make it out of the maze. Some techs on some days I don't think even realize that they are IN the maze .

Yes, that is an important addition. My procedure also includes a similar statement.

I also have a problem with people going straight to a prewarm procedure. The problem is that they are not THINKING first. They get reactions that scream warm auto and they prewarm. They get a weak reacting panel and instead of considering doseage, they prewarm. When the prewarm doesn't make all their problems go away, they stop dead, instead of addressing what they actually have. I am working on them to try a cold antibody screen first. IF that is positive, then prewarm. If it's not positive, then they need to try a different enhancement method (step down from solid phase), another panel, think doseage, all the good stuff we do to solve a problem. In other words, use a plan of action instead of the hit-and-miss method. I did have a tech prewarm away a developing anti-Fy(a) one evening. The reactivity was weak, but the pattern was there with doseage. The patient was discharged immediately after transfusion and sent home 100+ miles away, so all we could do was notify her surgeon (who probably didn't do anything about it). The next time we saw the patient was for a surgical referral months later. Her anti-Fy(a) was then reacting 3-4+. Did she have any kind of reaction? If she did, we never heard about it.

Oh yes.........surgery is the worst about this. We also have to explain the Type and Screen process over and over and over and over, to doctors (one in particular over and over and...) and nurses. We are 99.8% phlebotomist drawn. They collect extra blood bank tubes in the ER on traumas and on OB admits. They have pretty good radar, especially the more experienced phlebs, when it comes to picking up conversations about someone bleeding, going to surgery, broken hip suspected, etc. and will draw extra if they suspect there is a reasonable chance we might use it. We have a separate rack in Blood Bank for those specimens and we use enough of them, that it's well worth doing.

I would also suggest that you put a limit on the age of the cells used, maybe expired no more than 2 or 3 months. Check appearance for hemolysis, discoloration etc. when used.

We also do it this way.

We are considering the Typenex system. The reattachment system might work very well for us and surgery.

Thanks Bill! If I had remained blissfully ignorant of that, it still woulldn't have counted. Now you went and called my attention to it! I'm sure it'll happen in the middle of the night with an inexperienced tech and who knows what will happen then!!!

We repeat the type with add on crossmatches. Just a little insurance policy that may cover some basic screwups, like grabbing the wrong tube, for example.

I know of a facility that uses a small sticker with a Blood Bank ID# on it that is placed on the patient's hospital ID band. The sticker also says that it is not to be removed. We copied their idea and used it successfully until the 'powers that be' decided to change the armband format here. The barcode on the band become bigger and there was no room left for our stickers. We found about the change when a phleb came back from preop saying they couldn't figure out where to put the BB ID#. (You ever notice that folks in one area never imagine that something they change can affect other areas?? Usually in a bad way!) Anyway, we started putting the same sticker on another blank hospital band and have continued using the separate ID#. I know that the hospital we copied from is still using the same small sticker on the hospital ID band - I saw one 2 weeks ago. It's been working for them for > than 10 years.

Very good advice, Malcolm. I would add one additional point about using the rabbit erythrocyte stroma adsorbed plasma/serum. It's very helpful to use this product, but the resulting plasma should not be used for the reverse blood type, nor should it be used for the immediate spin crossmatch for determining ABO compatibility of donor and patient.

Our cell washer maintenance includes a weekly check of saline pH after it's run through the device post disinfection. Here's another little back door saline QC.

"I do occasionally get irritated with Tech Support because they think the first solution to EVERY problem is to remove and reseat the probe. And then invariably the probe crashes and needs replacing." Oh yes, been there done that! But I agree with the rest of your statement. The Echo has been great for us. Tech Support has been good.

This is a recommendation from Dr. W John Judd. The blood bank at U. Michigan, Ann Arbor (under Dr Judd) has done a lot of research/work with gel technology since it came out in the US. Based on the work they did, that's how they decided to name 'em when they saw 'em (weakly reacting Ds that is). If you read up on testing for the D antigen, you will see Dr Judd's name all over journal articles and AABB Technical Manual suggested reading.

Every methodology is going to have its own unique problems. You just have decide how far you are going to go with your workup to fit into your comfort zone for patient safety.