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Everything posted by suhu
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I dont know how to solve this. We have 15 OR suites 2 floors away and send blood back/forth via the pneumatic tubes. The blood is either used on demand for some surgeries, or stored in the TempTraked coolers for other bigger surgeries. Biggest concern is If we start to use the Safe T Vues, I'm afraid they'll see red during transit. Other minor concerns are the logisitics of preparing a stock of tagged units and activating them carefully enough prior to sending... I'm interested in hearing what other large centers are doing. All ideas are appreciated, we are re-visiting our 30 minute floor rule also, but this topic concerns our OR units. Thanks everyone..
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We have permanent OR coolers with continuous temp monitoring (temptrak). Units are sent to and returned from the OR via pneumatic tubes. We are taking the temps of returned units (tempcheck) and discard units over 10 degrees. Way too many units are recording temps slightly over 10 and being wasted.I believe that the whole transporting process (taking units out of the coolers, placing in the tubes, traveling thru the tube system, removal of units from pneumatic tube and finally taking the temps) is causing otherwise fine units to go over 10 degrees during the transporting process. Is it necessary to check the temps of returned units that have been stored in continuously monitored coolers? It seems so silly, as we accept units back from the regular floors within 30 minutes of issue without any refrigeration or temperature checking.
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We use manual tube testing as our backup method . Never thought of daily reagent QC as a way of checking technologist technique. We do QC once daily, have 18 some technologists. Our Daily QC is to ensure the correct lot #'s are in use and they work as expected. We dont currently repeat the ABORH test/reagents by tube method, the instrument uses the very same reagents. I'm comfortable with this, just concerned if there are any regulations out there so we are in compliance. I appreciate everyones input
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We do daily QC on the reagents and methods not used on the instruments by our manual backup method daily (IAT, anti a,b, checkcells) which ensures the other equipment and reagents work properly. The ABORH test is done by direct agglutination on the Galileo. Does anyone know of any regulatory requirements that state daily QC must be performed by both methods?
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We use the Galileo instruments for routine testing, and manual methods for backup and problem resolution. I have a question regarding daily QC. Is it required to perform daily QC on the ABO reagents by manual methods if the same reagents (lot #'s) are QC'd daily on the instruments?
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May platelet pools be issued if taken directly out of a supplier's shipping box, or do they need to be rotated for a period of time? If so, how long? We receive platelet pools that may have been packed up the afternoon before we receive them. Should we require them to rotate for some amount of time before being acceptable for issue, or are they good as long as they swirl?
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we aliquot SDP for neonates into syringes. is there a minimum volume needed for the platelet to remain viable, or can the in-date SDP be completely used up?
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At our hospital we irradiate rbc's and plts. We cross out the blood supplier's FDA registration # , and add a sticker to the label identifying our hospital and registration #. Recently I've noticed that sometimes both the supplier's FDA registration # and US license # are crossed out. What is correct? Is it necessary to cross out the supplier's FDA number at all?
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We use a similiar looking one made by Hampshire controls for rbc, plts and plasma and calibrate it once a year per the manufacturer. Works great.
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Returning thawed plasma into inventory after issued
suhu replied to bkrobinson's topic in Transfusion Services
Brenda thank you for the info. I ordered some Safe T Vue to try out and had problems with them turning red also, but I didnt put the units on cold packs when activating them. I read where you can put the monitor on the units and store them that way, and just activate them directly before issuing. I want to prepare a bucket of units in advance (segs pulled, etc..) as much as possible for cooler use so it'd be helpful if the monitors were already attached and the techs just had to snap them closed. We are using 30 mins. for rbc and plasma due to not having a video cam on the cooler while it was out of the lab . Do you attach the monitors in advance? thanks, -
Returning thawed plasma into inventory after issued
suhu replied to bkrobinson's topic in Transfusion Services
Brenda~ we used the irreversible flower stickers a long time ago and stopped because (1) we found them hard to read, ie. color change was not clear (2) difficult to properly activate. We had to hold them on a heat block for a few mins. Do you have any problems with activating them in a rush, and do you have trouble reading the color change? we are looking at ways to monitor cooler blood, not comfortable assuming the blood remained inside the cooler for the entire time. thanks for your informative replies. -
We purchase pre-pooled platelets. Lately we've been noticing units with noticable particulate matter, usually resembling small fibrin strands. Most of the units have adequate swirl. Anyone know if these units are suitable for transfusion?
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rrvakin~ Platelet swirling can be obseved by holding the platelet product up to a light source and gently rocking the bag back and forth. Normal platelets have a discoid shape which refract light resulting in a shimmering, swirling pattern in the platelet plasma. If they loose the discoid shape, such as when activated, they will not reflect light and there is no shimmer or swirl observed. Hope this helps.
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Since lack of platelet swirl is associated with decreased platelet viability, I'm curious how many check for platelet swirl before issuing platelets? If so, how do you document this check and do you discard those which do not demonstrate swirling? We only purchase SDPL's and pre-pooled LR platelets, but some do not demonstrate swirling.
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massive transfusion units, do you tag each one?
suhu replied to suhu's topic in Transfusion Services
rravkin, yes, this is helpful. We are considiering doing something similar. I have a few more questions... Regarding the tags, to clarify, you just write the MRN on the tag, not a name? Do you put any type of Patient ID sticker on the blood bag itself? Do you pre-tag only Group O units? Or do you pre-tag other blood types as well, for example patient already has sample processed, but massive bleeding situation is encountered and they want a cooler of products all at once? -
massive transfusion units, do you tag each one?
suhu replied to suhu's topic in Transfusion Services
thank you for all your replies, interesting to see what others are doing. DAR, yes that's it exacltly. The expectation is we have the cooler all ready to just hand-out, when in fact its pretty high-maintainance. MTPs usuallly happen on shifts when we only have 2 techs working, and it takes full attention of both techs to get all the units properly tagged and packed up. Funny, our emphasis has been on "send us a speciman ASAP, and you can have all the crossmatched blood you want"....and now they're pretty good at sending samples. sigh, with the advent of the MTP , we are better off without samples, much faster if we could have everything waiting for just the patients ID to be put on.. -
The hang up with our current Massive Transfusion Protocol is the computer. We order an Emergency Release Test and then allocate each unit to the patient, put in the required comments and print out individual tags. We then remove a peelable sticker containing the Transfusion Record info and affix it to each unit. We then place the units and corresponding tags in a cooler for pickup. It's a cumbersome process. Since the MTP pack is 6 red cells and 6 FFP, the time consuming part is waiting for the printer and "tagging" each unit. There doesnt seem to be much advantage to making them up in advance, because each unit needs to go through this process to be tagged with the patient's name/ID. I read through most of the MTP threads but it's not clear to me. If you make up the coolers in advance, are you still tagging each unit with patient name/ID at issue? Another related question, do you issue the units in the computer at time of issue, or after the fact?
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We ship blood to our affliates daily, sometimes multiple times daily. Does blood "have" to be shipped on ice? Can cold packs be used? We have a small ice machine that we use to fill bags, but it is cumbersome and we need to purchase better bags. Just wondering what others do...Thanks
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David- I'd like to use the Immucor corQC reagent but manufacturers directions state it is designed for use with solid phase antibody detection. We need a reagent to test our antibody screen by manual tube testing (our back-up). I dont know if its okay to use this reagent to test by manual methods, for QC purposes.
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Thank you everyone. All your replies were put to good use....we have switched from the pricey Infecon bags to regualr ole ziplocks, at 1/2 the cost. Now if I was only allowed to buy them at Target, I could get them for 1/2 the cost again!!
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what do you use for your QC antibody reagent for daily QC of screen cells? we are automated, but use a 2 cell screen as back-up by manual tube testing.. CAP requires "each cell used for antibody detection must be checked each day of use for reactivity of at least one antigen using antisera of 1+ or greater validity" (TRM. 31400) We have been diluting commercial antisera as appropriate for each new lot of screen cells, but this is getting rather expensive. Would inspectors frown on using a diluted anti D for the antibody? Thanks.
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30 minutes to return issued product to BB?
suhu replied to Lecia Guill's topic in Transfusion Services
what do you do with plasma? if thawed and then directly issued it is warm at issue. do you discard it if returned after 30 mins. of issue? -
We put our blood products into an Infecon biohazard specimen bag for issue (mostly through a pneumatic tube). We recently have been told it will now take up to a month to get these type bags as the supplier no longer stocks them. I'm curious what others do. The Infecon are more $$ because they have are leak-proof. A regular biohazard specimen does not claim to be leak-proof. What type of specimen bag do you put your blood products in? If not using the Infecon bags, do you double-bag, or this not a concern?
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We have several full-service blood banks at hospitals within our system. We share the same computer and patient identification systems. Here is a scenario: Specimen drawn at a system clinic and sent to hospital A. Specimen is processed at hospital A and patient qualifies for electronic crossmatch. Patient is admitted to hospital B and blood transfusion is ordered (within the 3 day time-frame) Is it acceptable for hospital B's blood bank to access the patient record, perform an electronic crossmatch and issue blood to the patient? In other words, can a specimen be processed at one facility but the units electronically crossmatched and issued at a different hospital (within the hospital system)?
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emergency issue blood and electronic crossmatching
suhu replied to suhu's topic in Transfusion Services
thank you everyone for your input. I do have one more question. If the emergency patient subsequently qualifies for electronic crossmatch, how exactly do you the electronic crossmatches on the already issued units? Do you bring each of them back into inventory, re-allocate them to the patient, "electronically" crossmatch them, and then re-issue them as clerical reissues or something to that effect? Seems very cumbersome. We are a busy level one trauma center in a depressed city, sometimes issue 10 or more emergency units before we get a specimen. Can I just add a comment to each unit, like ABO confirmed, if I later perform a computer record check to confirm they are group O?
