John C. Staley

Wow, out of the business for a couple of years and I don't have a clue what most of the acronyms in this thread mean!!

For me this would come down to how either you or an inspector chooses to define prepare realizing the inspector will change with every inspection. It will be interesting to see how an current inspectors/assessors will respond to your question. Personally, for a small facility that does nothing more than the occasional thawing of FFP, I would not worry about it.

This started being a hot topic 10 - 15 years ago. It started in the AABB and they were fine with calling the coolers transport but then the FDA got involved and their stance was that it was storage and to my knowledge they have not varied from that stance. That was when I started looking into the "vending machine" blood band refrigerators for the OR. Sadly they were too expensive for our penny pinching administration so the OR had to be satisfied with blood delivery via pneumatic tube that was measured in seconds! They were devastated!

Had the nurse "spiked" the unit prior to laying it down? Was there any other possible source for the blood? I'm sure you asked these questions initially but I felt inclined to put them out there. One more question, how bloody was bloody? This is indeed and odd situation!

Fatal septicaemia? The injection is IM not IV. Malcolm don't you think that a septiceamia is a bit of a stretch. I would think that a nasty cellulitis is more likely and if left untreated could be very serious or even fatal depending on the bug involved. I appear to be feeling just a bit argumentative today, good thing my lovely wife is off visiting family for a few days.

Just out of curiosity, how has this been working out for you? Any significant problems or negative patient outcomes do to this practice? What caused you to pose this question? Also, how big and/or busy is your facility? Is your testing manual or automated? On the surface I would have to answer your question with a NO but a little more info would help. I've always been a "if it ain't broke..." kind of guy. If your system is simple and works well for you why seek to complicate it.

Just a side note, my wife's anti-K would show up at immediate spin, go away at 37oC and then come back strong at AHG. Her anti-D was detectable only at AHG. Her anti-S disappeared completely after about 1 year. She's a nurse, you can't expect her antibodies to be normal!!

I always considered antibody identification both art and science with a little magic thrown in for good measure.

People can be quite creative when it comes to finding an "easier" way to do their job. That is one of the reasons I have always been a firm believer that complicating a process never makes it better or safer. I know the rational behind the 2 types being required but I personally never bought into it being a practical solution the potential problems it is trying to solve because of the many more problems is has seemed to cause for the staff resulting in all the work arounds they manage to come up with. For it to really work you would have to have 2 separate draws performed by two different people at different times. (Both phlebotomists in the room drawing one immediately after the other defeats the purpose.) Then you need to have two different techs perform the testing, one for each sample. This would be impossible in many smaller facilities, especially on evening and night shifts. Of course the requirement came from people based in large, well staffed facilities. I'm starting to ramble so I'll stop here for now. I have one question, in the past the AABB rule was written that you had to have 2 sets of test results, the one you are currently performing and one on file to compare the current one to and if you did not have one on file then you needed the second test performed prior to issuing RBCs. It that still the case?

I always used the time the unit was issued to start the clock with the assumption that it had been removed from the refrigerator only moments prior to being issued and that was the documented time. No where did we specifically document the time it was removed from the refrigerator. Our process was, remove the unit, issue it on the computer, place it in the pneumatic tube, push the send button.

I think the more important question would be, how many facilities not doing this are seeing significant negative outcomes because they failed to detect those antibodies this technique would have potentially identified?

If I remember correctly AABB has a book on the validation of pneumatic tube systems for the transport of blood products. It was very thorough and in MY opinion overly and unnecessarily complex. We validated ours before it was available by simply timing the transport and checking the temp on arrival. If I remember correctly we may have even let the units used settle out to see if there was any excessive hemolysis visible but I'm not sure on that since is was 16 years and 3 jobs ago. Since we were transporting to every nursing unit in the facility we were most concerned with those farthest from the blood bank. We were fortunate to be able to do this prior to moving into the new facility which made life much simpler.

About 10 years ago I was having a deep philosophical discussion with the best blood bank medical director I ever worked with. During that discussion I told her that I thought the decline of the American Healthcare started when physicians stopped being hospital administrators and they started hiring MBAs to run the "business". She completely agreed with me.

I found it amazing that one of the corporations I worked for loved hiring consultants and on any given subject they would hire one after another until they found one that would tell them what they wanted to hear. It just never made sense to me to spend that kind of money only to search until they found someone who would confirm their chosen course of action was a good idea no matter how many others told them it was a bad idea. One place actually fired me because I told them the CEO's idea was a bad one when a consultant was blowing the expectations all out of proportion. Five years later they are still trying how to figure out how to make it work and it never will.

Pneumatic tube delivery solved all of our transport problems.