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Posts posted by heathervaught
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3 hours ago, Ensis01 said:
I am confused because if/when a unit of blood goes to the nursery: how does blood get into the set? How does a presumably disposable uncalibrated infusion set calculate the amount of blood to be transfused? How is the change in product code and expiry date modified and documented or is the remaining blood just wasted? How and who determines that the correct amount of blood was given? Why would these, I assume, blood specific infusion sets be in the nursery?
Am I missing something?
I don't know. I've never seen such a thing, which is why I'm polling the larger community.
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Hi everyone,
I'm asking for a friend...this question was e-mailed to me and I couldn't find the answer. Any advice would be appreciated :-)!
"...we used to carry here an infusion filter set that you could dial in the amount you wanted to transfuse. The nursery used to keep them. Just found out that they no longer keep them and haven't ordered them in ages. Our central supply doesn't remember anything about them. The reason I asked, we had a newborn get transferred from here and the ambulance service took a unit of blood. ER wanted this specific filter to go with and we didn't have one. Normally for an infusion here, we'd just split the unit and go with it, but ER wanted the whole unit to go.
I'm striking out trying to find some. Do you know of any manufacturers of these types of filters?"
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Our nursing procedure states:
Acceptable catheter size ranges from 14 to 25 gauge (6.3-1.5 French); use the largest size possible for the patient.
- 18-20 gauge (3.8-2.7 French) catheter provides adequate flow rates without excessive discomfort for the adult or larger pediatric patient.
- Catheters smaller than 20 gauge (2.7 French) will require slower flow rates to prevent hemolysis of red cells.
- Larger bore catheters (14-16 gauge/6.3-5 French) should be used for patients requiring rapid infusions.
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This is in Draft status, but should be finalized this year. Once finalized, FDA will give 2 years for implementation. Transfusion services should not be mandated to make changes until some time in 2019 or later. There are some misstatements in some previous posts that should be clarified.
- PAS apheresis platelets can be stored up to 5 days and must have a "safety measure" test within 24 hours of transfusion if transfused on Day 4 or 5. The use of platelet additive solution does not confer any protection against bacterial proliferation.
- Plasma-stored apheresis platelets can be stored up to 7 days and must have a "safety measure" test within 24 hours of transfusion if transfused on Day 4, 5, 6, or 7.
- Pathogen reduced apheresis platelets can be stored up to 5 days and can be transfused up until expiration without additional testing.
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Most of our reconstituted whole blood is made using washed RBCs (to remove the residual anti-A/anti-B/anti-A,B), which necessitates the 24 hour outdate.
- MaryPDX, BldBnker and dragonlady97213
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We get a page also in the Blood Bank, but we don't have phlebotomy teams and our Med Techs (who are dedicated blood bankers) don't draw samples.
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Yes, we don't get a sample sometimes when the patient expires. Usually those cases don't go for too long...but there are some that have several doses with no sample. We have a big Level 1 Trauma service and activate our Massive Transfusion protocol every 2.5 days.
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The weather's getting warmer here in Indiana and that means that everyone's suddenly out shooting and stabbing each other again, which translates to an uptick in our Massive Transfusion activations. We seem to have a rash of these lately where "they" never send us a sample for a type and screen. For those of you who manage these often, can you please share the creative things that you do to help "them" remember to collect a specimen? I don't think that refusing to give out products will win me any fans, nor can I send Blood Bank staff out to collect the sample.
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We are validating DAT on the Ortho Vision platform, and they do not provide a positive control reagent for this purpose. What are other Vision users using for positive control for DAT on this platform?
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I need some guidance! I did a quick search of the forums for any discussion about this, and the most current posting was in 2010. I'm wondering if anyone has any new information, new experiences, or any advice about CAP TRM.40120. The note states "...all analysts participate in QC on a regular basis."
How frequently is "regular"? For example, when I was looking to complete our annual Competency assessment in September (don't ask...), I was looking for evidence that each individual who performs MTS testing had performed MTS QC. There were some employees who had not performed MTS QC yet in 2016. I'm inclined to say that someone who hasn't performed QC in at least 8+ months is not participating in QC on a regular basis. Being new to my role, I'm just not sure how the assessors interpret this standard, and how others provide evidence of compliance.
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Greetings Community! I would like to talk to anyone who has experience operating a blood bank in the pediatric setting.
The Blood Bank that serves my Pediatric hospital is located in the building next door, and therefore the staff at the Pediatric hospital feel that they "do not have a blood bank" (even though they are all connected by pneumatic tube and you can walk out of the door of one and into the other within several strides). Therefore, there are several refrigerators throughout the hospital containing a unit or two of O- Emergency RBCs that they can grab and transfuse as uncrossmatched (filling out the appropriate paperwork and sending with samples to the Blood Bank). They are located in the ER, OR, PICU, and NICU.
For anyone who stores RBCs like this for pediatric use, how old are the RBCs in the refrigerator? Do you irradiate them?
For anyone who does NOT store RBCs like this, how did you convince everyone that you could deliver uncrossmatched RBCs quickly enough that they should just order them from the Blood Bank? I have suggested that they can just call and we can get them what they need, but was met with the argument that "when we need them, we need them now."
Thanks in advance!
Heather
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According to the AABB Association Bulletin 16-02, if you detect an actual antibody and need to do an AHG crossmatch, you can treat the K-/antigen- donor RBCs with DTT before doing the crossmatch. If you have identified and honored all of the underlying allos, your AHG crossmatch would be compatible :-).
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On April 6, 2016 at 7:09 PM, Mabel Adams said:
Does anyone have problems with clots or other white stuff that shows up in thawed plasma units after a day or so in the fridge? We're trying to figure out if it is a problem at our supplier or something that happens more with thawed plasma.
Stick it back in the thaw bath. If it resuspends it is fibrinogen. If it doesn't, then it's activated fibrin.
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Yes, just like thawed plasma, you can hand write the expiration date and time.
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On March 11, 2016 at 8:34 AM, Dr. Pepper said:
That's what I was getting at.....but then, I got curious, and looked it up to see if it was actually true about water draining one way or the other. It turns out that in a perfect, static state of affairs, Coriolus forces can indeed cause the hemispheric effect, BUT in the real world those forces are vastly weaker than other influences at play and are overcome by variations in the shape and structure of drains and tubs, motion of the water in a basin caused by use or a slightly off center (which they all are) faucet filling it up, and so on. Hence it joins a long list of charming but untrue urban legends. There's an equatorial nation where, for a modest fee, you can see a toilet on the north side of the line flush in one direction and one on the south side flush the other. They're rigged.
Dr. Pepper, it's no wonder you're a blood banker! Search for the answer and never give up until you've found it. Bravo!
- Ensis01, AMcCord, Malcolm Needs and 1 other
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I will occasionally get requests from a hospital to provide a divided red blood cell for a patient with congestive heart disease. They transfuse one half over the allowed 4 hour window, then have an additional 4 hours to complete the second half.
- amym1586, mawyant, David Saikin and 1 other
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You all are officilally scaring me. I am starting a new job next month as the director of the transfusion services at THREE large academic medical centers (two adult hospitals and one pediatric). I am almost positive that one of these patients will show up in my first weeks.
I wanted to share that because I feel compelled to compliment you all on your willingness to share your own knowledge in these forums. I have been studying them for weeks trying to glean tidbits of valuable information that I might be able to use in the upcoming weeks, months, and even years. BloodBank Talk has some of the best and brightest minds in the industry openly sharing a wealth of information, and I appreciate each and every one of you who contribute to the conversations!
- Malcolm Needs, Teristella, Auntie-D and 3 others
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I am by no means an expert on the topic, but I think that since Rhogam is human-derived and therefore polyspecific, it seems as though there is a possibility that the product contains antibodies to multiple D epitopes and would therefore be able to bind to whatever antigen is present on the fetal RBCs that Mom lacks.
Im not familiar with all of the brands of RhIg though, I don't know if that is true for the others.
- Malcolm Needs and Yanxia
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Hi all,
I admittedly have been absent from these forums for an extended period of time. It's good to see some familiar names on here! It's equally good to see some new names on here as well.
I was was just reading through a forum and saw some posts that involved name calling and general disrespectful behavior. While I appreciate a good debate and a witty discussion of relevant topics, I find neither of those actions as fueling intelligent conversation. I considered calling out this individual in the forum, but then discovered that there was a way to report the post to the administrator. If you also feel that these comments are detrimental to furthering productive discourse, I would encourage you to use the Report feature. We, as a community, do not need to tolerate such behavior.
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I'm a fan of Serum Hemagglutinin of Indeterminate Type...
But I really like this one, too.
On October 1, 2015 at 8:07 AM, AMcCord said:Our reference lab uses "Antibody of undetermined specificity. All common clinically significant antibodies ruled out."
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2 hours ago, pinktoptube said:
Is it necessary to culture all suspected transfusion reactions? The supplier cultures the components already and unless the reaction has sepsis like symptoms why bother?
The only components that are routinely cultured are platelets. Red cells and plasma are not. And there is always a possibility that contamination occurs that is not related to the product, for example infusion set or solutions.
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https://www.cms.gov/regulations-and-guidance/legislation/clia/downloads/clia_compbrochure_508.pdf
This document outlines the who/where/when/what of Competency Assessment.
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9 hours ago, Cliff said: Thank you
We have two cesium and they get a lot of use. We transfuse about 10k platelets and35k red cells, all irradiated. Heather, you said you have two x-ray devices, what type of volume do you do?
We do about 5000-6000 components per year between red cells and platelets.
Thank you
RBC Inventory Practices
in Transfusion Services
Posted
I'm looking at my RBC inventory levels...something that I haven't done since I started here a year and a half ago (and goodness only knows when it was last reviewed before then). Can you all please tell me what you currently do?