sgoertzen
Content Type
Store
Profiles
Forums
Blogs
Events
Frequently Asked Questions
Gallery
Downloads
Glossary
Links Directory
Questions
Jobs
Vendors
Posts posted by sgoertzen
-
-
We are also a pediatric hospital with an extensive oncology and surgery department. We coordinate our platelet orders and inventory by logging this info on a write-on/wipe-off white board any orders placed by physicians for platelets (even the ones scheduled for an outpatient txn a week from now). We've drawn a grid with colored tape on this board so there are 5 titled columns to log on each row the patient's name, product needed, order date, expected txn date, and current status (i.e. "to be ordered", "ordered", "on rocker"). When ordered platelets arrive, we do tag them with a piece of tape with the patient name as we place them on the rocker, BUT, we often juggle products around to ensure we use up the shortest date platelets first. We don't "assign" the platelet in the computer to the patient and tag it with the official computer generated tag until we receive the order to issue the platelets. The techs are diligent in referencing and updating this inventory board throughout all shifts of the day. We rarely expire platelets. We also keep track of our special ordered phenotypically matched units for our chronically transfused hematology kids on this board as well.
-
Dose mapping annually (done by Nordion) and a RadSure indicator on each product.
-
We have a table top MSE, Mistral 3000i. It is quite old (>15 years) but works well. It may no longer be available for purchase.
What surprises me is the number of volume reduced platelets you prepare. I supervise the transfusion service at a 300 bed pediatric hospital with a full NICU, PICU, heme/onc department and cardiovascular surgery department. We transfuse approx. 100-120 platelet transfusions per month, but we only volume reduce platelets maybe 10 times per year. We really try to discourage physicians from ordering spun platelets and most are happy with giving small volume aliquots made from the leukoreduced plateletpheresis units. I've copied (below) the "principle" section from our procedure for volume reducing platelets:
PRINCIPLE
Random platelets or plateletpheresis must sometimes be spun in order to reduce the total plasma volume of the product. There are only three conditions where spun platelets are warranted:
1. No ABO compatible platelet units are available for a patient weighing less than 45 kg. It is acceptable to give ABO incompatible platelets unspun if the patient weights over 45 kg. DO NOT CALL PATHOLOGIST if you must spin platelets due to ABO incompatibility.
2. Patient in fluid overload due to heart or renal failure. Even in these conditions, it is better to divide the product into smaller volumes using the sterile connecting device than to spin the product.
3. Patient has repeated severe allergic/anaphylactic reaction to plasma proteins in platelet products (even after pre-medication with Benadryl). Take these platelets down as “dry” as possible and add back 25 mL of Lactated Ringers prior to 60 minute rest incubation.
• QUESTION ALL ORDERS FOR SPUN PLATELETS
The use of spun (volume reduced) platelets is strongly discouraged and REQUIRES APPROVAL BY A PATHOLOGIST.
-
I went to Office Max and just bought plain white business cards on a sheet (perforated) that you can print up using your standard colored laser jet printer at work. I created a template for the sheet of business cards with our hospital logo (address and phone) and a place to hand-write the patient name, birthdate, medical record #, blood type and identified antibody and date. It was pretty easy and seems to work great! If you wanted to get more sophisticated, you could create each one in the computer and laminate it for your patient before you send it to them.
-
We use the Immucor "CorQC" kit. We QC each reagent vial used each morning and whenever opening a vial with a new lot number.
-
I am the Transfusion Service supervisor of a 250 bed pediatric hospital. We are AABB Accredited and CAP Accredited. Because we have an on-site blood irradiator and COBE washer (for washing rbc units), we are also FDA registered and have a state license for the manufacture of biologics, so we also get FDA and State inspected every other year. I am responsible for the clinical training and competency of 28 med techs who rotate through my department 24/7. I have 2 "lead" techs on the day shift who also rotate through hematology and chemistry, but whose primary department is transfusion. They do most of the training and they both help me quite a bit in maintaining my QA program, but I am responsible for all of the technical, personnel and QA oversight of my department. I don't have a QA/Compliance person.
-
Has anyone investigated the possibility of switching to the new Olympus reagents? What does their pricing look like and do their reagents and reagent red cells look like they could compete with either Ortho or Immucor?
My administration is NOT HAPPY about the major price increase with Immucor and as someone said above, Immucor's reason for price increases doesn't square up with their stock reports over the past few years that brag about the huge return profits they are making for their investors.
-
For syringe aliquots, we also use the 24 hour exp. for RBCs and FFP, a 6 hour exp. for cryo, and a 4 hour exp. for platelets (aliquoted using a sterile connecting device). I couldn't find any published data on how long these products maintain acceptable viability after being moved into a sterile hard plastic syringe, but it sounds like we are pretty much in line with others. We do a lot of syringe aliquoting since we are a pediatric hospital and everything ordered with a volume of 50 mL or less for patients in NICU or PICU automatically gets aliquoted into a syringe.
-
We are a pediatric hospital.
If we have a historical blood type, we only do one ABO/Rh.
If it is a new patient to us, we repeat the ABO/Rh a second time on the same specimen. It would be nice to have a second separate specimen drawn, but with our baby and kid population, each draw is a major ordeal and we try to minimize blood draws as much as possible.
-
We are a pediatric hospital so volume is of great importance to our transfusing nurses. We weigh and write the volume on every product issued.
-
We are a pediatric hospital and we have a 2 tier matching protocol for all chronically transfused patients: (e.g. sickle cell, thal, hgbopathies, etc.) We initially match for Cc,D,Ee,K. If the patient makes an antibody in spite of this basic matching, we then move them into the 2nd tier where we also match for Kidd, Duffy, and S.
-
We use the regular hospital ID band (which is bar coded), but currently only medications are being given using the hand-held bar code readers at the bedside. We will be converting to this bar code system for printing specimen labels and administering blood products over the next couple of years.
-
We are also a 300 bed hospital and our chart reviewers perform the routine 30 chart retro-transfusion reviews each month (rotating month from month through the various components to audit). We do, however, perform an additional ongoing prospective audit at the time of issue for every transfusion by linking the most recent Hgb/Hct result with all red cell products, PLT count with all platelet products, and PT/PTT results to plasma and cryo products. We have the Meditech system which allows those most recent lab results to pop up and display to the BBK Tech at the time of issue. Anything that looks suspicious for appropriateness is brought to my attention and I request my pathologist and QA to audit that specific transfusion for appropriateness. We also have boxes and fill-in the blank fields on the issue form for the nurse to complete as she/he is doing the pre-transfusion ID check as to the reason for transfusion. We have very good compliance and rarely do audits fall out becuase there is no indication for transfusion documented.
-
We are a pediatric hospital, so we send the family a simple letter and an antibody card for their wallet explaining that it is important that if their child is ever treated at a different hospital than ours, they need to show this card to the physician and nurse taking care of their child and ask them to make sure they relay this information to the laboratory blood bank at the new hospital.
-
Our informed consent form does not list the reasons for or the current risk statistics of blood transfusion. It just states that the physician has had a discussion with the patient/family and has explained both of those things to them, that the patient/family understands the risks and benefits of receiving the possible transfusion, that they have had all of their questions answered to their satisfaction, and that they agree to this course of treatment. Coming from California, we also need to cover the Paul Gann requirement and so there are boxes to check on the form about having had the discussion about donor options (Directed Donor or Autologous) and that they are either deciding to utilize those options or they are not. Our hospital transfusion committee has developed a Transfusion Brochure that the physician is encouraged to use during the informed consent discussion which details the risks, benefits, and the various transfusion options (directed, autologous, associated additional costs for special donated products, the phone # to call at the local donor center should they be interested, use of alternative methods such as cell saver, hemodilution, and possible enrollment into our "Bloodless Program" should they decide they want to try to avoid transfusion altogether.) This seems to work well. I update the Transfusion Brochure annually as part of my document review to make sure information remains current.
-
We have the Meditech system which is not yet approved by FDA to perform electronic crossmatch. We do, however, already use the system to perform a variation of the electronic crossmatch (ABO/Rh compatibility check with subsequent assignment) for those products which technically do not require crossmatching (i.e. RBC aliquots for infants < 4 mo. and autologous units.) 07/14/04
-
Our donor center has purchased the BacTAlert system. :|
We are a pediatric hospital, so we send the family a simple letter and an antibody card for their wallet explaining that it is important that if their child is ever treated at a different hospital than ours, they need to show this card to the physician and nurse taking care of their child and ask them to make sure they relay this information to the laboratory blood bank at the new hospital.
RHo Control for AB Rho Pos Patients
in Education / Quality
Posted
Rather than saline, we use 2 drops LISS reagent (N-Hance) for the Rh neg control on all AB Pos patients. The N-Hance idea was suggested to us by our Gamma rep (who had her SBB) many years ago since it is very handy to use directly from your regular reagent rack.