sgoertzen

I supervise the Transfusion Service at a Children's Hospital so we give lots of platelets to lots of neonates and small kids. We use plasma compatible platelets for everyone up to 45 kilos. If we cannot get plasma compatible (our donor center supplies only leukoreduced-plateletpheresis), our policy is to volume reduce and remove the incompatible plasma. We also aliquot and irradiate almost everything, so we spend a lot of "quality time" with our products. :juggle:

We use the Cell Safe Igloos and we have validated all of them, and we revalidate all of them every couple of years. We always find one or two that don't pass that must have warped a bit or something from the last time they were validated and need to be replaced. As for QC'ing them at least twice a year, we use a thermometer inside each igloo and HemoTemp indicators on every product placed in an igloo, so every time a product comes back to us and the temperature and HemoTemp is OK or not OK, I would consider that "QC'ing" the storage ability of the igloo and the acceptability of the product. If an igloo comes back after the igloo expiration time, the HemoTemp and internal igloo temperature are used to determine whether the product should be placed back into inventory or be discarded. The big issue now is the AABB requirement for temperatures to be monitored and RECORDED every 4 hours for any storage device. Now that an igloo is considered a "storage device" instead of a "transport device", this means igloos need their temp taken at least every 4 hours. Our igloos are all validated to maintain temperatures between 1-6 C for 6 hours, but we have shortened their expiration period to 4 hours, since someone/something needs to record the temperature of the igloo every 4 hours. We either had the option to buy a temperature data logger for each igloo (and we have many) or change our policy and make them bring the igloo back to us at 4 hours (we can't trust them to take temps every 4 hours in SURG or in the ED or on the floors). We opted for the latter. If they need it longer, we take the internal temperature of the igloo, re-ice it, and give it back to them. We log all of this information on an Igloo Log.

Daily, we QC each opened saline cube being used and write the information on a log for each workstation. We check 1) saline appearance 2) printed expiration of the cube 3) 1 month expiration from date of opening 4) IDCT results and Check Cells (see procedure copied below) 5) We check the pH daily of the buffered saline for our Capture workstation ********************************************************************** Saline (To be done each day of use) 3. Observe Saline Appearance & Check Expiration of Cube • Inspect one of the tubes of saline. The saline should be clear, colorless and have no signs of microbial growth or particulate matter. • Check the expiration on the cube and the date it was opened to ensure it is not expired and is within 1 month of being opened. • Document acceptability of both of these with the symbol “” on the form. 4. Refill Saline Bottle • Pour the saline from the saline bottle at the workstation down the drain. • Using the “prime” mode of the cellwasher at that workstation, refill the bottle. • Document this was done with the symbol “” on the form. 5. Indirect Coombs Test (Cell #12 in Daily RQC may serve in place of this Negative Control) • Add one drop of the Pooled Screening Cells to a 10 x 75 test tube. • Add 2 drops of saline from the saline bottle at the work station and 2 drops N-Hance. Mix well. • Incubate at 37 C for 15 minutes. • Wash the tube (x 4 cycles) with the saline & cellwasher of the workstation being tested. • Add one drop Antihuman Globulin (polyspecific), spin, and read reaction (should be negative). • Document the reaction interpretation : Neg (Ø), Pos (+), Hemolysis (H) • Add one drop of AHG Check Cells, centrifuge, and read the tube for agglutination. If the saline and cellwasher are functioning properly, the tube should now show 1-2+ agglutination. • Document this check cell reaction interpretation : 1+, 2+ = Pos (), Neg (Ø) NOTE: Immediately discontinue use of the saline if the Indirect Antiglobulin results are positive, hemolysis occurs, or if visual inspection detects any signs of microbial growth or a change in color or clarity. ***************************************************************** I wrote a Cellwasher / Saline QC procedure and would be happy to share the whole thing along with a sample of our QC logsheet if you are interested. Just let me know! sgoertzen@childrenscentralcal.org

We are using HCPCS codes P9017 for the regular thawed plasma, and P9044 for cryopoor thawed plasma.

Franklyn, what exact kind of IR thermometer are you using? I bought one (not too expensive)and it consistently reads 2 degrees too warm. I hear there are good ones out there, but I haven't had any luck so far.

I work at a pediatric hospital and we still continue to do the following: Perform Cold Screen at 4 C first. If 2+ positive or greater, we then set up a thermal amplitude study starting at Room Temp (23 C), then taking it colder to 20 C, 18 C, 12 C, 10 C and we also run a cold titer. I am hoping to drop this to just a Room Temp, 15 C and 4 C along with a cold titer whenever any patient shows a 2+ or greater on the initial cold screen. I've asked the anesthesiologists whether this is really being used, and they said yes, and they are still hesitant to have us stop doing it. It would be nice if they just ordered it on the cases where they know it will be really important, rather than making it a part of the their pre-printed orders they use for all of the cardiac pump surgeries.

Hi jcoburn! When do you get a copy of this validation plan from Immucor? We are only a couple weeks out from getting our Echo delivered and installed, and I have a paper copy of the "Preparing for Better Blood Banking", and the CD of Recommended SOPs and Validation Guide. Is the validation plan you mention in your 3-19-09 note the validation guide on the CD? Thanks!

Has anyone seen or heard of a stand-alone software that will capture the information that we currently have to manually write down on a log each time we make an aliquot? Examples: Date, Time, Donor Number, Product Code, Lot Numbers of sterile welder wafer, tubing, bags, syringes, etc. and then the relabeling double-check? I stumbled upon something on a web-page back several months ago, gave the company a call, the rep said she would get back to me after the holidays and she never has. Now I can't remember the name of the company, and I am interested in submitting something like this for our budget next year (which we are already having to put together now!) Our hospital uses MediTech and they don't offer anything like this as part of their aliquot or components (modify) routines. Apparently, they have no plans to add this feature to MediTech either. Now that most of this information is barcoded and could be scanned, it seems like such a waste of time (and opportunity for error) to have to hand-write it all each time. Thank you! Sheri

Our facility doesn't issue blood in the pneumatic tube, but we do make them bring "something" with the patient's name and medical record number on it when they come to pick up blood. We do not have any one official "pick-up" slip that must be used. We are in the process of implementing a Pre-Printed MD Order Form for BBK tests and products (and orders to transfuse) and we have been batting around the idea of making them bring that when they come to pick up blood. That way the BBK tech could actually check the MD orders for themselves as part of the issue process (to ensure they were transcribed by the unit coordinator correctly into the computer). The courier would take the order form back with them to be used for more units (if more than one unit was ordered) and the form is eventually scanned into the patient's electronic record. They are hoping to move to physician order entry within a couple of years.

Franklyn, what data loggers do you use? How expensive are they? How often do you have them set to read a temperature? At the recent AABB meeting in Montreal, they specifically mentioned at the assessor training that temps had to be recorded every 4 hours, regardless of how long your cooler is validated for. I'm thinking I'll have to move to data loggers, or either have SURG/ICU/ED staff bring them back to us every 4 hours so we can read a thermometer inside and manually record a temperature.

We are in the process of purchasing an Echo, but have been using the Capture method for almost 2 years. Our blood bank techs love it. We also perform antibody ID testing for several very small local hospitals who prefer to send out any screens that come up positive using their ProVue. What we have seen is consistent weak positives being detected by the ProVue. When they send us their specimens, we repeat the antibody screens using first the Capture method, and if negative, we repeat with tube LISS/PEG methods. So often we find that there is nothing there. I can't imagine that all of these patients actually have weak "real" clinically significant antibodies that neither Capture or tube methods can pick up.

There is so much more involved than just getting your staff fingerprinted. Carefully read the NRC Order EA-05-090 from 2005 when this all began. Then add to it the NRC Order EA-07-305 dated December 5, 2007. There are pages and pages of instructions on the security program you must create. Someone at your institution (whoever "owns" your radioactive materials license) received both of these letters (or your State's version of these same orders if you live in an "Agreement State"). Too bad they didn't take the required actions when they got the letters, because now you will be scrambling. The fingerprints with the FBI is so that they can compare them with their list of possible terrorists. The FBI assured us that our fingerprints do not get "added" to this list. You must also do criminal background checks, and have a sophisticated program (written in policy) whereby your appointed Trustworthy & Reliability Official deems people either acceptable or not acceptable to have unescorted access to your irradiator. We formed a team to work on the whole thing that includes the blood bank supervisor, the lab manager, the hospital legal counsel, the HR director, the HR recruitment manager, our executive director, our security director, and our radiation safety officer (and you also must include your local law enforcement). Also, you must further secure physical access to your irradiator. Its been a rather large project. Apparently, non-compliance is not something you want to experience when they come to inspect you. Good luck!

We used to monitor 100% of the returned transfusion forms but after several years and after we were satisfied that we were getting compliance consistently up to our targets, we have dropped it to 100% review for only one month per quarter. The nursing managers all get this Quality Monitor report for their areas each quarter, so they know we are still watching. I'm sure if we dropped it altogether, the noncompliance would sky-rocket back up. I'm looking forward to moving to the bedside electronic transfusion record, so that we can just run reports for our data and not hassle with inspecting each form and trying to figure out illegible handwriting.

At the AABB meeting in Montreal last week, it was explained at the Assessor Day training session that coolers used for temporary storage (like we use them at my facility in the ED, OR, ICU) must have a temperature "recorded" at least once every 4 hours as per standard 5.1.8.1.2 "For storage of blood products, the temperature shall be continuously monitored and the temperature shall be recorded at least every 4 hours." We have our igloos all validated for 6 hours, use a temp bag inside (take temp at issue and return) and also use HemoTemp indicators on the blood bags, but this apparently still doesn't fulfill the standard. We've decided that we are going to have to buy some loggers that we will program to take the temp every 30 minutes or so, and place one in each igloo at the time it is issued. Does anyone have some good suggestions on temp loggers that are fairly inexpensive but that perform really well? We have seven Cell-Safe Igloos and on some busy days they are all being used, so we don't want to spend a fortune on loggers. Thanks! Sheri sgoertzen@childrenscentralcal.org

We have also assigned a 4 hour rule for platelets and when issuing them to a surgery patient that also has RBCs issued in a cold igloo, we place them in their own room temp platelet igloo (i.e. an igloo with room temp gel packs with the word "Platelets" on the outside) and we also attach a bright blue sticker on the bag that says "STORE AT ROOM TEMP". We haven't had any problems with platelets getting dumped into the cold igloo along with the plasma and RBCs since we've starting using the stickers.

We bought a ThermoTrace IR w/Laser from DeltaTRAK and have returned it for a replacement, which also doesn't seem to work correctly. I can point it at a unit of blood sitting in our refrigerator at what I know is 3 C, and it will show the unit is 7 C. Whatsup with that? The manufacture "certified" it was working properly, but it sure doesn't seem like it to me. I would like to use it, but I don't trust it.

I heard Pat Distler (fron ICCBBA) give a talk on this and she described it that if you are making one aliquot at a time, you should give the first aliquot made the division A0, and then also relabel the remainder of the volume in the original bag as division B0. All subsequent aliquots made from the original bag would then be labeled as divisions Ba, Bb, Bc, etc. We are a pediatric facility so this is how we are doing it... lots and lots of times every day! If you are splitting a bag into 3 or 4 pieces all at one time, then you would make them A0, B0, C0, D0, etc. We have MediTech and it has no problem doing this... it actually gives each split the correct division code for you when you use the "Make Aliquots" routine.

You need for your IT department to use KBA 27704 to get your entered split units to display correctly (Part A, Part B, Part C) rather than have it add the A, B, C to the end of your unit number on your cards & Issue form. It will still display that way on your screen, but not when you print cards, labels and forms. I work at a children's hospital so we deal with tons of parts and containers and then modify those parts and containers, and then further split some of those parts and containers. It can get pretty complicated, but believe it or not, my techs are actually finding the ISBT system easier to use than the Codabar.

I am the supervisor of a transfusion service at a pediatric hospital and on Oct. 1, 2007 we adopted the 2nd required specimen (drawn at a different time) prior to issuing them red cells for transfusion for all non-O patients who are over 4 months of age and have no historical ABO/Rh on file. We do our best to find another lab specimen from a previous or subsequent lab draw to prevent the kids from being re-poked. For patients that will be getting group O red cells anyways (neonates and group O patients), we simply repeat the ABO/Rh on the same specimen if they have no history. If the 2nd collection is a "hardship", we give the MD the option to request we set the patient up on group O red cells. We are finding that we only need 2 or 3 patients redrawn per week (mainly pre-ops) with no history. Our SURG staff is great in getting us a fingerstick microtainer while they are checking in the patient for their surgery, or they wait until the patient is sedated. Since we do a recheck with a quick forward type, it doesn't take but a minute. If we can adopt the 2nd specimen policy at a pediatric hospital... anyone can do it!

In 5.6.2 SR5 (we currently have it loaded in our TEST system for validating), Enhancement 10471 is included which is "BBK: Electronic Crossmatch". I've asked my IT person to find out what this means as far as FDA clearance is concerned. At the end of the Enhancement it states: NOTE: For testing and validating the Electronic Crossmatch feature, please contact your LAB Applications Specialist to obtain a copy of the Magic Blood Bank Validation Guide's Electronic Crossmatch Section. In the text of the enhancement it also states: NOTE: The Electronic Crossmatch feature is not available in the LIVE environment until customer validation testing has been completed and MEDITECH has received a signed copy of the Electronic Crossmatch Guide. I'm hoping this all means it is ready, FDA cleared, and just waiting for us to validate it for our individual sites so we can begin using it!

We also print a crossmatch card (for crossmatched units) or an assignment card (for assigned units like PLT, FFP, CRYO) on a printer that has a roll of 1.5 by 4 inch sticker labels. This then gets attached to a card stock tag which is attached to the product using a labeling "gun". Actually, this is how we "tag" the units prior to issue. We generate the IT card (form) at the time of issue. We have no problem with the nurses detaching the tag from the products. They have no reason to. We have created our own custom crossmatch cards and assignment cards as well as a custom IT card.

We require that the trauma ID band remain on the patient (along with the secondary patient name ID band) until the blood bank calls and gives them the go-ahead to cut it off. We have our computer system programmed that any time a patient's name is changed in the computer, a report auto-prints to the blood bank printer notifying us. When the patient is given their real name in the computer, their "trauma name" is moved to their "Maiden/Other Name" data field so you can reference back to that. Once everything is reconciled, we then call them and allow them to cut the trauma band off.

I was forwarded this link this morning by one of our hematology specialty technologists asking me what I thought about all this. I'm not sure what to tell him. http://www.medpagetoday.com/HematologyOncology/Hematology/tb2/6918

I am beginning to test my system with some sample labels from our donor center and I am finding that the splits are not translating into the correct product code. Example: a regular FFP unit will have the product code E0701. The FFPPED (i.e. split) units all use the same ISBT product code E0701 too, but they have an A, B, or C at the end to differentiate the various product code split such as E0701A. When I scan the sample labels, everything is scanning as the regular FFP and it is apparently not seeing the A, B or C divisions to differentiate the FFP from the FFPPED units (there are volume differences and price differences so this is important). I have entered the new ISBT codes to the same products we are already using with codabar, so I'm very confused about why the computer cannot interpret the split product codes. Also, I am noticing that the sample labels of divided products are automatically adding an A or B or C to the unit number when I scan in the product code. This would actually be good if it worked like this... since each division would still have its own unique unit number. The problem is the computer also needs to read the differences in the product codes (example E0701V00, as compared with E0701VA0, E0701VB0, and E0701VC0). It appears it just reads the E0701 to decipher the product code and then it adds the A or B or C to the unit number rather than to the product code. Can anyone shed some light on what might be the problem? My IT department has been of no help whatsoever and don't seem to understand any of this.

I supervise the Transfusion Service at a pediatric hospital in California, so we will have to relabel (print new labels) for all of our aliquots and products we irradiate, wash, or pool. Currently, we buy all pre-printed labels except for just the unit number for which we print a small Codabar and eye-readable number label. We have MediTech version 5.6.1. I am still very confused about all the product dictionaries that will be required and whether we will need to always print full face labels or just the bottom 2 quadrants. We have already purchased the scanners and printer recommended by Digitrax and I am waiting on my donor center to supply me with the sample ISBT labels they will be using for the products they will be supplying. My donor center has targeted April 1, 2008 for Go-Live with ISBT. Currently, we use the "make components" routine rather than the "make aliquots" routine for both splitting and modifying products. Is this how the rest of you do it? I've often wondered if using the aliquot routine would be a better way to go, but I inherited the system set up this way, so I've never done the work to change it. But now.... for ISBT and having to print new labels, I'm wondering if maybe it's time to re-create my system to use "aliquots" for splitting and "components" for modifying (irradiating, washing). For you experts out there... is there any benefit to doing it that way? For those of you who both split and irradiate.... are you planning on splitting, then relabeling, and then irradiating and relabeling again (with two separate modification steps in the computer)? If so, this is going to be much more labor intensive and slow for my staff... not to mention confusing since there will end up being SO MANY products in the computer with all the same unit number by the time we are all done with making 4 or 5 irradiated splits from each original unit. It seems like such a greater chance for error to me when only the product code changes, and not the unit number as well (i.e. A, B C or -1, -2, -3, etc.) Any advice from anyone would be greatly appreciated!