AMcCord

We require a hand labeled tube, though this may change soon. (We are looking at barcode print at bedside.) I require that the patient's name and both of the unique numeric identifiers we use are on the top 2 lines of the tube label. The rest of the information -time of drawn, location and phleb - is on the rest of the label and is also captured in the LIS when the specimen is collected and received. Once the specimen reaches Blood Bank, one of us verifies the label information. If the specimen is acceptable, we then place the bar code label for Echo on the tube so that the name and 2 identifiers are still visible.

We document RPM readout and clock countdown daily. Tach and timer check is done only quarterly.

Even though our supplier confirms historical types, we reconfirm everything for which we have antisera.

I've been told by my rep that he has a client with one in a small volume hospital in Wyoming.

To quote a fine movie I once watched..."Run, Forest, Run!". We got hit with the same issue and "you order and store tendons for us and eat the cost if we don't use it and nothing in it for you" and "store our corneas for us and deliver them to us for no compensation" and more, much more. Our administration won't play. Direct competitors... What is wrong with these people!!! The physician who put together the center 2 miles from us (we're talking a rural area here) has privileges at our facility. When he announced the plans - big news conference - he called it a win-win situation for the center and us at the hospital Phew! I feel better now.

Phix is available from Immucor. It is a bottle of buffer to pour into a cube of non-buffered blood bank saline - one bottle per 20L cube. It is recommended by them for their automated systems. If you look for it to order on line, it is with the reagents/supplies for automation.

We also dilute Immucor Panoscreen with good results.

It's on my shopping list :D:D! This is a terrific reference for methodologies. I had several questions on my SBB exam that I answered correctly thanks to this book.

Good point John! Immucor Anti-A Series1, Anti-B Series 3, Anti-D Series 4 and Anti-D Series 5 plus Referencells run on Echo and will work for tube.

Using only 1 rule out/rule in is begging for trouble. Coincidence can bite you if you are not careful. (Such as: By coincidence, that panel cell has a slightly weaker expression of the antigen and your patient failed to react with it for that reason or By coincidence, that K pos cell your patient reacts with is also Co( positive and they have anti-Co( and not anti-K after all.) Do I speak from experience, you ask??? Yes, I do...learned that lesson a long time ago and don't aim to repeat it.

I vote with John. We dropped routine auto controls when we switched to gel years ago. DATs only with antibody IDs or reaction workups.

I would not give a male patient RhoGAM either. If it was a female of childbearing age, I would go for IV Rh immune globulin, rather than IM. Pharmacy would be your friend in that project.

All transfusions, except Surg and ER, are documented directly into the electronic medical record here. We use McKesson's Paragon system. Nursing service designed an electronic 'page' for the transfusion flow sheet, with input from me. If they use it correctly, it allows for very good documentation. The major problem they seem to have using it is that they do not close the 'page' after each entry. This results in everything... and I do mean everything, pre-vitals, 15' vitals, post vitals, etc...appearing under the same time stamp. This is an education issue. Those who have been properly trained (and who paid attention and who follow the protocol) have no difficulty in correctly documenting transfusions. The compliance level is about the same as it was for paper flow sheets, which is actually pretty good. (I have done a LOT of nagging!) The folks who failed to complete paper flow sheets are the same ones who fail to complete electronic flow sheets. It is a pain for me to monitor the flow sheets, but that's more a matter of how nursing service designed the sheets (works for them, looks backwards to me) and how I have to access them. My access method is restricted by security requirements from IT - I'm not worthy to access the information through the same format that nursing uses . Oh well! Surg and ER (and NSY, for 2 or 3 transfusions a year) are required to use the old paper flow sheets. Once completed, I get a copy and the original is scanned into the electronic record by Health Information.

The 'new' Ortho slide things have been updated so that they are not culturally offensive, if you get what I mean. That part bothered me when I pulled one of the old ones out for a student to use.

Yes, you can use the same reagents for ABO/Rh typing on Echo and by tube. Echo is a bit smaller and weights much less. Provue requires 20" space behind it for access for service. Echo requires 10-12". Provue also has a hatch that opens upward, so you would need to make sure an overhead cabinet wouldn't be in the way.

We use 1 week for not transfused, not pregnant in 90 days. We strictly enforce it. However.......if we have a patient that we will not see within that one week period, we draw a specimen anyway and do a type and screen, no charge, to make sure there will be no surprises the day of surgery. Any patient that is drawn greater than 72 hours prior to surgery gets redraw so we have a fresh specimen for crossmatching. If we need to crossmatch, we repeat type and screen (as it is a different specimen), but this rarely happens. We do not use electronic crossmatch, so this puts us in compliance with Joint Commission.

My institution is 180 beds and we've not been doing anything routinely for the almost 30 years I've been here. I did have to meet the demands of an extremely nervous mother once and draw an autologous unit on her 10 year old - mom was sure that the kid would need blood and then get AIDS . The doc 'educated' her until he was blue in the face but couldn't budge her. Thank heavens the kid was big AND mature for his age so the auto draw didn't traumatize us all!

I've been using a format similar to what Marilyn outlined. For Rh enhancement, I use a dilute anti-D that normally doesn't give me a positive reaction until AHG phase...after treatment of the cell with WARM, I get 1-2+ after 37C incubation. I figure that shows enhancement.

I've enjoyed your input and I appreciated your advise on ECHO. Wyoming is gorgeous. Enjoy your retirement.

Hi Kelly....I knew I hadn't talked to you lately in Reference and wondered what you were doing. Basic antibody ID is always a good one. Warm autos on a basic to intermediate level might be good, too - how to ID, how to work around them with limited resources, implications for transfusion, etc.

Agree! Agree! Agree!

I've twisted and twisted on the arms of some of the RNs on the Patient Education committee here about revising the sheet they hand out. They were using one that talked about taking iron supplements and eating well and 'Oh, by the way, if you feel funny....call your Dr.'. I've finally gotten a couple of them to see the light and provided them with several examples I got off the internet from large hospitals (many outpatient transfusions) - carefully selected to meet my approval, of course . It is working it's way through committee (save me from committees!!!) as we speak. I will poke them with a stick every couple of months and hope we have something within the next 6 months. If and when it comes through, I will share. Meanwhile, do some surfing. I looked for 'blood transfusion patient education' and variations and got a number of examples.

We check the Biohit pipettes quarterly in house. We have found that it pays to check them frequently - we've had to replace two of them 3 months after they checked out OK.

We are finishing up validation on Echo and we just found and ID'd an anti-E on Echo that gel missed. On the ID panel, it was weak with Capture - one question mark result, with other wells that were fuzzy when the camera shots of the ID panel were visually examined. When the specimen was repeated with tube/PeG, the anti-E was also ID'd. My lesson from this one (and a couple of other samples we've run) is that we need to actually look at the camera shots even if Echo calls it negative.

We have a Sorval. Unfortunately, I think they don't make those anymore.