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Everything posted by Likewine99
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Saline use when pooling cryoprecipitate
Likewine99 replied to Franklyn's topic in Transfusion Services
We use 50 mL sterile saline that we get from Central Supply. Cost is 35 cents a bag, our computer system has a place in the pooling procedure to record lot numbers. -
Welcome, this is a great site. I too am the BB sup in a 350+ bed hospital. Let me know if you have questions or if I can help in anyway.
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We also make it part of the yearly nursing education "blitz". For those not attending they are given a copy the Power Point presentation. I had a CAP inspector ask one time to see the person who was picking up blood in the BB's training checklist for this reg!
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Ortho Mts Gel System
Likewine99 replied to JerryB's topic in Immunohematology Reference Laboratories
I have been a gel user since 1994 and would not want to go back to tube testing. As mentioned above it is very sensitive to anti-natal RHIG and it does decrease colds somewhat. It is very easy to use, new techs in the field and cross trained techs find it very easy to read. It facilitates crosstraining those "non-blood bankers" and frees up time for techs to do other things, like go to lunch! We use it for screens, panels and ABO/Rh typing, we have found that the anti-D in the ABD card is "more sensitive" than the tube reagent. We have found patients that typed Rh neg with tube reagent (over 5 years ago) now type 2+ positive in the D well. We don't even own a cell washer anymore that's how comfortable we are with it and we moved to the ProVue 2 years ago and are very happy with the automated system. -
We do a second type but on the same specimen. We do not charge for it, we consider it part of QA and regulatory. Our patients are Hollister banded, tube hand labeled at the bedside, Hollister card signed by 2 "nursing" staff members at time of collection. Or so they say!
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I'm with mda, go with a ProVue if you are on gel, we have had one for 3 years and are very happy with it. We eliminated a lot of bench gel card QC, whatever cards are used on the ProVue get QC'd by the machine, less work at the bench!
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We had an adult sample and a donor unit that was AB, weak D-pos (two separate occasions), that both tested neg w/tube anti-D and was weak D pos in tube testing. We tested this same pt and donor unit in an ABD gel card and got 3+ pos in the anti-D well, verifying that the pt and the donor are truly D pos. We use an IgG gel card, make a cell suspension like we were doing at DAT in gel, add 50 uL cell suspension to the card, add 25 uL tube anti-D reagent, incubate for 15 min then spin. This pt tested weak D pos (3+) with this methodology and the donor unit also. We have also validated Fya typing in gel cards, same scenario as above and using 25 uL anti-Fya. We tested 10 patients and 25 donor units in this validation, comparing it to tube testing. None of our cord bloods have ever tested weak-D pos in gle but we don't even own a cell washer so on the rare occasion that we have an Rh neg cord blood we do this procedure.
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We do not repeat antigen tests on units received as antigen neg from our blood supplier. They are AABB and CAP accredited and we have their CLIA license on file. We do an AHG XM on these units when received in the BB prior to issuing to the pt for tx. We only keep a few of the "common" ones and often times when the pt has 2 antibodies we order ag neg units to save time ($$$$).
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We are going live with HCLL Transfusion 2.9.3 on 8/12, an 8 site multi-facility group on the same database. We are former Hemocare users and also looked at one other vendor. This system is like Hemocare on steroids but our current system is 15 years old! Like any system it doesn't function exactly like the old one but we've managed to come up with workarounds. We have had AT LEAST 1.5 FTE working on this, a BB sup, LIS coordinator and current staff tech who is a whiz with HC. It will take all 3 of us to get everything done that needs to be done before go-live. The training takes a while but the staff has caught on just fine.
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I have my "day of use" defined in my SOP's as "every 24 hours", this was suggested when we went to the ProVue by our installation consultant. All of the gel cards are QC'd on the Provue, by the night shift every night. The eveing shift QC's the tube reagent rack (only one rack) every evening, this covers my "every 24 hour" rule. I would explain to an inspector that any new lot of tube reaget that was opened, even if it was opened at the beginning of the evening shift gets QC'd the next evening which covers the every 24 hour rule. I've had 3 successful CAP inspections and hope this flies next spring when they are due again.
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We have been using the ProVue for 3 years and have been very happy with it. It facilitates crosstraining technologists and techs that have worked with analyzers in Chemistry and Hematology caught right on to it. We use it for everything except donor confirmations and cord bloods. We put panels on it 3 months after go live and the evening and night shifts like it because it frees them up to sign out blood, work another dept, etc. Our backup is manual gel at the bench. We only use tube testing procedures for prewarm XM and LISS is our backup antibody ID method.
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We perform an ABO/Rh and DAT using Otho's gel system on all babies born to group O moms and Rh negative moms. Our OB dept handles about 1500 deliveries/year. We wash the cells one time with saline prior to loading the gel cards. We have been using gel since it's beginnings back in the 90's and the staff feels that the IgG in the gel card is "more sensitive" than the tube reagents. We do perform weak-D testing on these babies if Rh negative, also done in gel (we validated this procedure on-site) prior to use. We have not had any physician concerns re: DAT results performed with this method.
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Testing Standards (Pt. Retypes and DATs)
Likewine99 replied to n.peters's topic in Transfusion Services
We do a retype with a second cell suspension (same sample) done by a second tech if possible. No charge to pt, does not appear on chart. Autocontrol done with a panel, DAT (poly, then IgG, then complement) if AC is pos and pt has been tx in last 21 days. 350 bed, level II trauma center in suburban St. Louis, MO -
We have had a ProVue for 3 years and don't have a problem adding stats onto it. We do everything on it except cord bloods, it rocks for panels. Adding stats is a matter of reading the screen and knowing when the pipetting sequence is done. It has increased our efficiency by roughly 50%, everyone loves it, esp evenings and nights, it is truly walk away. Techs are freed up to do more complex tasks and no one is missing lunch/dinner anymore!
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At our institution we do not repeat the antigen types on the donor units. Our Reference Lab is AABB, CLIA, CAP accredited and our SOP states that the antigen test is the test of record. The Ref Lab is NOT accredited to do transfusion testing so we do the XM on the units prior to transfusion. Another reason for not repeating the ag type on the donor unit is cost of reagent and tech time. Most, if not all of our patients receiving antigen neg blood are inpatients and there would not be any additional reimbusement to the hospital if we charged to repeat the antigen test since we are paid at the inpatient DRG rate. Hope this helps and doesn't confuse.