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Posts posted by BBK710
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But Ag typing wouldn't use reagent red cells.
Wow, let's charge out our screens and panels for each reagent cell tested!!!
Could this be for additional cells beyond the first panel?
I know this is an old post but I was just reviewing reference lab charges from Red Cross. On the last two patients that we sent for testing we were charged this CPT code and not 86870 Antibody ID each panel/media as we were in the past. They appear to be charging for each panel cell tested as one patient had a charge for a quantity of 24 and the other a quantity of 39. Obviously the cost is significantly higher when charging per cell. Has anyone else noticed this? Is anyone charging their panels by individual cells?
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Daily we check the fill level, weekly we soak the heads in soapy water and clean them well. Monthly we perform bleach decontamination of tubing, tubing check, and performance testing (what is described above). Quarterly we check the RPMs.
A necessary evil indeed; we will now be taking back some of the checks that BioMed used to do for us, due to inspection issues....grrrr
We do the same except that we only do the perfomance testing annually. The Appendix 1-4 on page 37 of the Tech Manual (16th ediiton) suggests yearly function check for centrifuges and cell washers. We consider the procedure described (Method 8-6) as a function check and do it once a year.
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I just talked with Immucor about this today and told them that if I could find someone else that manufactured a Fetal Bleed Screening test, I would buy it in a second and leave them behind. We, too, are a small facility and would never use 20L before the expiration date. They told me that they had thought about putting the buffered saline in the kits but that it would not work because of the volume needed. They also told me that it was the small hospitals that were having the problem. We have not had a problem with false positives (Hematology does the KB). I think that it is a bunch of "horse hocky". There has to be a better way to fix the "problem". We use saline with a pH of 6.0 - 7.5 from Thermo. The person at Immucor told me that the pH would drop way below that once the cube was opened. He said that by the time it was 3 weeks old the pH would be 5.0. I am not so sure about that.
I believe that we will use what we have for as long as we can. Of course, when the new package insert comes out, we will have to figure something else out. I feel that it is a shame that we should have to use our financial resources for something that is not our fault or for something for which we do not have a problem.
phouck
Just tested a saline cube opened 2 weeks ago. pH is 7.0. So I think that our regular blood bank saline should be fine.
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I'd like to see their data supporting this change . . . not that they'd mislead me, but I haven't had any discrepant results (that I know of) . . . I use a pH adjusted buffered blood bank saline.
I have not heard from Immucor about this as yet. Are you saying that our regular pH adjusted buffered b lood bank saline can no longer be used for Immucor's fetal screen test?
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The MTS centrifuge manual lists it as a daily check. The last updated centrifuge manual (October 2008) lists the details. Ortho has a QC template for the daily checks required by the manufacturer.
I take this to mean that you must check the timer to see that the display begins at 10:00 minutes, counts down and blanks at 0:00 not that you must check it against a certified timer daily. We actually check all of our centrifuge timers against a certified timer monthly.
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No Aakupaku,
We do not see many alarms with these settings.
That is interesting. After reading these posts I decided that I would change my high alarm setting from 37.1 to 36.9. Our set temp was 36.5. We immediately saw that there would be a problem with this when everytime we thawed a unit the alarm went off and the baskets came out. I changed the set point to 36.0 and since then we have had no problems.
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We treat our gel centrifuges exactly like our other centrifuges for quality control.
AABB recommends that the timers be checked quarterly. Tech Manual 16th edition p.37
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See the 15th Edition of the Technical Manual; page 198 (Thermometers). "The temperature of the thermometer should be compared periodically with the temperature on the recording chart. If the two do not agree within 2C, both should be checked against a certified thermometer."
Brenda Hutson, CLS(ASCP)SBB
Interesting. I can't find that in the 16th Edition. There are major changes in that chapter and it is more vague than the 15th edition. It just says to do daily checks of temperatures and document diviatios on recording charts. There is no mention of comparison of thermometers to recording devices.
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Here is the abstract from an article in Transfusion (1997, Nov-Dec, 37, pgs1169-1172) that I have used in 3 different facilities to prove that it is extremely important that specimens be labelled totally correctly or they need to be recollected.
Adherence to a strict specimen-labeling policy decreases the incidence of erroneous blood grouping of blood bank specimens
JA Lumadue; JS Boyd; PM Ness Department of Pathology, Johns Hopkins Hospital, Baltimore, Maryland, USA.
Copyright
ABSTRACT
BACKGROUND: To assess the effectiveness of a system of preventing incompatible blood transfusions resulting from the misidentification of patient specimens, a prospective analysis of all blood samples submitted to a laboratory was performed. STUDY DESIGN AND METHODS: Incorrectly labeled specimens (rejected samples) were tested for ABO and Rh type, and routine antibody screens were performed. Test results were compared to historic patient data or patient data obtained from subsequently submitted (correctly) labeled specimens. For comparison, all discrepant serologic results from appropriately labeled samples were also recorded. RESULTS: Specimens that failed to meet the criteria for specimen acceptance were 40 times more likely to have a blood grouping discrepancy. CONCLUSION: Strict adherence to the labeling requirements results in a significant decrease in erroneous blood grouping. This would accordingly diminish the likelihood of transfusing out-of-group blood components.
Hope it helps.
This is also referenced in an article "Two-Specimen Requirement for Verification of ABO/Rh" in the new Transfusion(July 2009 Vol.49,No7 pgs.1321-1328). Interesting reading.
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There has been a lot of discussion on this topic in the CAP Antibody Titer Survey. They have presented and recommended tha "standardized" method and we too had a reaction one tube lower when we incubated for 30 mins instead of our SOP of 60 mins. The standardized method also called for unbuffered saline, but since we don't have that anymore, all of our testing was in pHix buffered saline (we use Capture solid phase for routine testing). I don't know if that would make a difference too.
The results of the titer surveys have consistently shown a higher titer achieved in gel studies - I assume this is because gel acually has LISS enhancement(?) involved in the method. There are 2 distinct curves for tube testing vs gel testing over and above the curves involved when enhancement medias are used in tubes.
CAP has been trying to get some standardization in this test for some time. The CAP AB Titer survey final critiques have several references in them - might be useful. The best article I ever found was a Transfusion article - Transfusion Vol 41, Nov 2001 - titled "Practice Guidelines for Prenatal and Perinatal Immunohematology - revisited". We designed our SOP around that article and have been on the CAP survey mean for tubes since. I really hope they have another conference and put out another set of guidelines in the next decade too (seems to be about how often they do that).
Still one controversy even in that article - What kind of cell to use? heterozygous or homozygous for the antigen the mother has an antibody against. We still have trouble with picking a consistent cell depending on the antibody and the cells available to us. The CAP survey just gives you the cell now because they have tried to eliminate that part of the variability in the test results too.
Does anyone out there know why unbuffered saline and what difference it would make? Seems like alot to get unbuffered saline for a procedure that is done infrequently.
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Is anyone considering switching from Immucor at this time based on the FDA letter? I am getting pressured to switch to Ortho since we already use gel.
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Is anyone using the "standardized uniform procedure"? That incubation is only 30 minutes, no potentiator and w+ read macroscopically as the endpoint.
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Anyone hear about this? FDA might pull manufacturing license.
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Someone mentioned having recent problems with the Safe-T-Vue Monitors lately. We too have experienced that.
We Issue them, then take one last look (also showing the Transporter) to ensure it is white as it leaves our dept. We have had numerous come back red, with the OR swearing they never removed the blood (granted I have seen some horrendous things from ORs at various Hospitals in my years; like falsification of temperature charts on OR refrigerators, and falsification of Patient Transfusion Records; documenting what time the transfusion was started and what the vital signs were, only to have the entire unit returned to the Blood Bank intact). However, because this is being said by multiple people in various OR rooms, and because we are having situations where one unit in the cooler comes back with a white temp. monitor while another in the same cooler comes back red, it has caused me to look at other issues.
Our Blood Bank Dept. is extremely warm; we are finally going to get a portable air conditioner this week. My concern is that while the units are out being Issued in the computer (which will multiple units and a read-back, can take some time), that they become too warm to meet the 4.5 start point that the insert states you need when placing the temp monitor on the unit. Perhaps then it is some kind of "delayed" changing of color?? Anyway, I am now having staff Issue only 1 unit at a time (for blood going into coolers) and to place it on a cool pack when they do that. Then put them back in the refrig. as they are Issued, and put all monitors on at the same time, while the units are in the refrig.
We are swtiching to the Safe-T-Vue 6 Monitors so I really need to get this solved.
Any other methods/thoughts would be welcomed!
Brenda Hutson, CLS(ASCP)SBB
I wish I had the answer because we have been having the same problem. Our department is usually very cool so I don't think that the blood is getting too warm while being issued. I find that the safe-t-vues will turn red if you are not extrememly careful how you apply them. We are switching to the Safe-T-Vue 6 as well and I am worried that we will have even more blood wasted.
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I have used various coolers to send blood to the OR, in the different Institutions I have worked in. However, in trying to look for the website on 2 different types, I cannot find anything. Do these coolers still exist?
One is ThermoSafe and the other is Cell-Safe. This new Hospital opens July 12th so time if of the essence for me to place orders.
If any of you have contact information for either/both of these (or any other company that uses the "freeze" bottles), please let me know.Also, I have always used the Safe-T-Vue 10 temp. monitors. After reading a recent discussion, am wondering if the coolers for OR are supposed to store blood only at 1-6C instead of the 1-10C that probably many of us have, or still do, use. Does anyone use the Safe-T-Vue 6 Monitors? If yes, do you have any trouble with them turning red frequently?
Thanks very much!
Brenda Hutson, CLS(ASCP)SBB
Brenda, Were you able to get these coolers? I tried to order the Cell Safe through Fisher Healthcare and was told that they were discontinued. They suggested the ThermoSafe but it is larger (holds up to 8 units) and 3 times as expensive.
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Suggested Infusion Rates from the 16th addition are:
Adult Pediatric
Red Blood Cells 150-300mL/hr 2-5mL/kg/hr
Fresh Frozen Plasma 200-300mL/hr 60-12ml/hr
Platelets 200-300mL/hr 60-120mL/hr
Cryoprecipitated AHF As rapidly as tolerated As rapidly as tolerated
Granulocytes 75-100mL/hr 65-100mL/hr
They are pretty broad guidelines. We actually tell the nurses 5ml per minute for platelets which usually means that they are running a unit or pool over about an hour. We tell them 10ml per minute for FFP which means it runs about 30 minutes. To be honest I don't remember where we got those guidelines but they are pretty close to the rates from the tech manual.
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The aabb technical manual has recommended infusion rates. In the sixteenth edition it is on p.620 Table21-1.
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How do you charge when you order antigen negative units from ARC? They bill per antigen but they also charge a Screen 1-10 or Screen 11-20 etc. Can we only charge for one antigen for each unit that we order? This question was raised at a reimbursement seminar that I attended but the "experts" couldn't answer it.
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We do the same as cindym. We only keep A neg and Oneg irrad. units in inventory so we often need to order B or AB units or units that are CMV neg but they are almost always transfused.
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Who performs this test? Hematology or Blood Bank?
Is it done on all shifts as a STAT test? If so how do you maintain tech competency if your 2nd & 3rd shift techs are generalists?
What is your turnaround time?
The majority of the KBs that we do are ordered by physicians on antepartum patients who have fallen or have been in a car accident. Our current policy is that this test is done on day shift only since that is the only shift that does evaluations on Rh neg moms post partum. We have a physician who wants us to change our policy to to the test stat on all shifts. Obviously our generalists are having a fit.
Any information that you can offer would be appreciated.
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We keep cord blood specimens for 14 days. They are collected into K2 EDTA Blood Bank tubes and archived with the other Blood Bank specimens. Those not tested for RhIgG are maintained for evaluation testing when requested.
We keep the samples for 10 days for the same reason. Do you test the cord bloods when requested after the baby has been discharged? Have you had any identification problems. We currently have the same policy and on the few occassions that the doctor orders testing after discharge the baby's last name has changed since they were born so our specimen no longer matches the order. I would like to change our policy and only test the cord blood prior to discharge.
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We stopped testing ALL cord bloods 7 years ago and now routinely test only those of Rh neg. mothers. We do "hold" the cord bloods until discharge in case they suspect an ABO incompatibility in which case they can request that the cord blood be tested.
It was hard to get the docs to go along with this change and we still have one older doc that requests that all of his patients be tested because he likes to be able to tell the parents the baby's blood type.
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We pull segs when units are processed then keep for three months, or until someone cleans out the bottom shelf of the fridge!
Love your reply. We pull segs when they are processed and keep in bags labeled with the exp. date of the unit. We keep each bag 7 days past the exp. date to assure that we meet the 7 day post transfusion requirement although most units are transfused well before the exp. date. We also keep them in the bottom of the frige and many times they are kept much longer than 7 days because no one remembers to check and throw them away. Some things are the same everywhere.
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Our pool size is 5 units. Our policy for interchanging aphersis and whole blood platelets is the same as Linda's. We do for some but not all - based on availability from our blood supplier.
Specimen Collection by Paramedics
in Transfusion Services
Posted
We would NEVER use a specimen drawn in the ambulance by paramedics.