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sgoertzen

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Posts posted by sgoertzen

  1. 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.

  2. 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.

  3. 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.

  4. 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!

  5. 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!

  6. 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.

  7. 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.

  8. 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.

  9. 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!

  10. We do the exact same thing as "adiescast" at our children's hospital. Every split (aliquot) costs the same, regardless of the volume, based on the average number of splits we make from an original unit. We do "split studies" a couple of times a year, looking back at data for 3 months, and adjust our prices of aliquots accordingly. The only difference is... if we make one split for a baby and end up giving the rest (majority of the volume of the unit) to an older child, the older child also gets the split pricing.

  11. I ditto Karen. We do the same; we still require hand-labeling from the ID band and 2 sets of initials on the blood bank specimens. The other adult hospitals in my city have all gone to 2 separate draws and computer labels, but one of the supervisors told me she strongly suspects that their E.R. is drawing both specimens at the same time and holding one at the desk, re-ordering, then labeling the 2nd one with a later draw time. We are a pediatric hospital, so getting separate specimens drawn on our little ones at 2 different times is like asking for the impossible. I'm debating on whether to go to issuing only O units until we see a 2nd separate blood specimen on the patient and retype it for ABO/Rh (either a transported cord blood, CBC, or another BBK specimen). The hassle factor of tracking down specimens from different departments is the major reason why I have not done this, and I agree that teaching the people drawing the specimens to properly ID the patient and specimen is a better way to go. Once we go to bedside scanning, I imagine the hand-labeling will stop... but even then, I worry that some creative nursing staff will come up with ways to work-around the safe-guards.

  12. We do baseline vitals, 15 minutes, 1 hour and completion. We used to do every 30 minutes too, until new nurses complained that they had been giving blood at other hospitals and only had to take vitals a few times. I called around to other area hospitals and other children's hospitals (we are a children's hospital) and we came up with what we are currently using. As an AABB assessor, I can tell you that most hospitals I have assessed are doing baseline, 15 minutes, 1 hour, and each hour until completion.

  13. At this pediatric hospital, we routinely give partial units to patients. In fact, that is how they order blood here ... either in mLs or units. We have our aliquot system set up to bill per aliquot - not per mL. We do aliquot studies every 6 months for the previous 6 months and adjust our billing accordingly. Currently, we are routinely making 2.8 aliquots from each split leukoreduced PRBC unit ($202), so each aliquot is currently being billed at $72.50 - regardless of whether the aliquot is 15 mL or 150 mL. In the example you gave above, at my hospital, each patient would be billed the $72.50 for a partial unit (plus the split fees). We rarely waste much of any blood or platelets, even from the units that have had small aliquots removed from them. I understand how it gets more complicated at an adult facility where you have an NICU population and an adult population and nothing in between. When I used to work at a facility such as this, we would try to make those rarely ordered aliquots for babies from the heavier PRBC units, leaving them with about the same volume as many of the smaller full units. Since PRBC and PLTPH units often vary quite a bit in volume and Hct or Plt count, we felt justified billing the patient for a full unit even though a small part of it had been split off and given to another patient.

    Since we are a pediatric hospital, we do have an on-site irradiator and we always try to irradiate each aliquot as close to the time of issue as possible. When freshly irradiated units get issued and come back to us from surgery, we try to use them for > 4 mo. non-cardiac, non-NICU/PICU, patients where potassium is not a concern.

  14. Just wondering... from all of your experiences... what percentage of group O plateletpheresis have an Anti-A titer of less than 1:200? How about the anticipated titer values of Anti-B in a group A or O plateletpheresis?

    I'm at a pediatric hospital and we spend a lot of time volume reducing platelets when we do not have plasma compatible available - which is often for group B and AB patients. We are using >45 kilos as the limit for which we no longer have to volume reduce incompatible platelets, but I am wondering whether maybe titering the product would be a better (maybe even safer) way to go. Even though we use the methods suggested by AABB, I always wonder about the final quality of the platelets after we take them through the volume reduction process.

    Please e-mail me if you have some experience with this.

    Thanks! Sheri Goertzen

    sgoertzen@childrenscentralcal.org

  15. Is anyone out there using the hand-held bedside ID system that has apparently been built into the latest versions of MediTech? My hospital wants to use some sort of hand-held bedside ID system for specimen collection/ID/labeling and also for administration of blood products. I have been told MediTech has developed such a system, but can't seem to find much information on its capabilities (not even from our MediTech consultant). Do any of you have some information on this system you could share?

    Thanks, Sheri

  16. I am the transfusion service supervisor of a children's hospital and our policy for irradiation is:

    Irradiated packed cell units are no longer returnable to the donor center so it is important to utilize these units on appropriate patients prior to their 28 day expiration

    • RBC products and aliquots should be irradiated as close to the time of issue for transfusion as possible to avoid red cell storage lesion.

    • Do not issue RBC products more than 7 days post-irradiation to any patient in the NICUs or PICU due to possible problems with high potassium values.

    • If a DD unit or antigen specific unit must be used for a NICU/PICU transfusion after 7 days post-irradiation, consult a pathologist to either obtain a Deviation from SOP to use the unit “as is”, or to wash the unit to remove the anticipated higher levels of potassium in the plasma.

    • Attempt to use older irradiated PRBC products on larger pediatric patients without hyperkalemia concerns.

    • If PRBCs need to be washed and irradiated, perform the irradiation after the washing whenever possible to prevent excess potassium leakage which can occur in pre-irradiated cells that are subsequently washed.

  17. I'm at a pediatric hospital and the "latest" is that DHS considers breast milk to be a "tissue" and is now requiring hospitals that store mother's breast milk to be fed to their own baby to have a Tissue Bank License. Our surgery department already has one of these licenses for the transplantable tissues they control in surgery, but the other pediatric hospitals we've contacted recommend getting a second license just for the breast milk program (so that problems during an inspection with one program doesn't jeopardize the other program). They have enlisted me, as transfusion service supervisor, to help them try to come up with a method to "control" all of the bottles of breast milk in a way similar to the way we control/inventory/issue blood units. In a pediatric hospital that encourages breast-feeding for all newborn patients (extending out to all of the floors - not just NICU), you can imagine how wide-spread this program is and how many people it involves. I have heard that many hospitals are really struggling with this since most institutions don't have a breast milk repository bank that accepts/labels/stores/issues all the breast milk for feeding these infants.

    I would be interested to hear what other hospitals are doing to "control" their bottles of mother's breast milk in their refrigerators and freezers as a "tissue".

    sgoertzen@childrenscentralcal.org

  18. We use the Cell-Safe igloos (ISC) packed as per manufacturer's instructions:

    3 plastic Freezer Bottles stored in a freezer between -10 and -20 C for a minimum of 24 hours - one at both ends of the igloo and one along the wall. We place up to 6 units of blood inside of the plastic tray/tub along with a thermometer. Then we put a large Polar Gel Pack (from the 1-6 C refrigerator) over the top of the blood units in the tub. We have validated each igloo to maintain a temp of 1-6 C packed like this for up to 6 hours (they actually are OK longer than that, but we set the 6 hour limit so that surgery, the ED or PICU have to return the igloo for re-packing with new freezer bottles if they want to keep the igloo out longer.)

    The Cell-Safe igloo system comes with the freezer bottles and the plastic tray/tub. They also come with the manufacturer's validation report, but then of course, you need to do your own validations as well. For the packing method we use, you cannot keep the freezer bottles in your plasma freezer... it freezes them too cold and takes the temp too low in the igloos, so we purchased just a regular inexpensive upright home-type GE freezer for the bottles. We've numbered each igloo and it's 3 corresponding feezer bottles, so that we know to check the igloo issue log and not to re-use that same igloo with the same freezer bottles for at least 24 hours from the last time it was returned. We keep several sets of frozen "back-up" freezer bottles in case we cannot wait the full 24 hours before re-issue of that igloo.

    Note: we also attach HemoTemp II indicators to the units so that we can verify that the units were not removed from the igloo and warmed to 10 C.

  19. We use a SCD to attach multiple pedi-bags to the original container with one weld. When an aliquot is needed, that volume is then pushed off into one of the pedi-bags and the pedi-bag is irradiated. (The blood irradiator cannister can accommodate the 30 ml syringes, but the techs prefer to irradiate the pedi-bag). Then if the aliquot is less than 50 ml, we enter the bag with the syringe and pull it into the syringe just prior to issue. We label the barrel of the syringe with the crossmatch or assignment card (which we print on a label instead of paper) and we attach a tag to the end of the plunger of the syringe which holds all the remaining labels (facility, product type, irradiation, etc.) The syringe pumps do not have a problem with this attached tag and it does not get in the way. I would be happy to share my procedure if you would like to see it. sgoertzen@childrenscentralcal.org

  20. I agree with everyone else. We can't have a PT for every kind of antibody ID technique we use in blood banking. How about things like prewarming, adsorptions, neutralizations, or enzymes??? I work at a pediatric hospital, so getting enough specimen to do all of the investigational testing just once is a challenge. There is no way they are going to let me get another set of tubes from those little anemic patients to send to another facility just to reverify the established techniques that we use are working.

  21. From Children's Hospital Central California:

    We use both the 30 ml (REF 309651) and 60 ml (REF 309654) BD Syringes for making our aliquots. We don't prefilter, but rather, we issue a 33 cm 80 Micron Filter Blood Component Infusion Set (Y type for saline flush) Baxter (4C2223) along with the syringe aliquot. Our hospital uses the Medex Medfusion pumps 3010a, and the Trilogy multichannel pumps. Any small aliquot (less than 50 ml) is automatically placed into a syringe prior to issue.

    Anything larger than 50 ml is issued in a pedi-bag or the original container.

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