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John C. Staley

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Everything posted by John C. Staley

  1. We have a "hold clot" drawn on all OB patients when they are admitted and then perform any testing as ordered by the physician. We feel that testing evey sample would be way over the top but having a sample in hand during a crisis adds a great deal of comfort as well as speeding the process. The vast majority of these hold clots have no testing done, no charges generated and are simply discarded.
  2. Thanks for the replys. The "current" concern is pediatric patients. Neonates we would not give anything that had been thawed more than 24 hours, no supporting data just wouldn't do it. Now the concern has moved to peds patients and whether or not to avoid giving anything to them that has been thawed for more than 24 hours. It will be interesting seeing how the corporation currently defines a pediatric patient.
  3. Hey Mary Jo, I wondered when you would show up. Glad to have you here. John
  4. I keep running into road blocks. The most current being, who can received thawed plasma with the extended out date and who can not. For those of you who extend the out date of thawed plasma upto 5 days, are there any patients you have identified that you would not transfuse with plasma that was thawed more than 24 hours prior to the transfusion? If so who and why? Thanks John
  5. We have Rh only as an orderable test. ER seems to use it the most but OB docs will as well sometimes.
  6. We have no such policy. On the other hand we provide nothing but leukoreduced blood products to everyone.
  7. I think you are reading much more into this CAP requirement than is there. My answer to this question is YES. We do have a program and we do monitor it, constantly in fact. Everything in the note is open to interpretation and suggestion. No where do I read that anything more than we are currently doing is required. No system will work if you can't convince nurses to leave the armband attached to the patient. The most dangerous creature in the world is a nurse with a pair of scissors. I do hope some one comes up with a better system but more complicated is not better.
  8. Hey Bob I wondered how long it would take you to find this place. Welcome aboard.
  9. Just out of curiosity. Who do you bill for this when multiple patients get part of a unit? Every body gets hit with the full price, first one in foots the bill and everyone else gets a freeby? These were some of the issues we didn't want to deal with when we were considering sharing units.
  10. We are struggling to implement a policy for converting FFP to Thawed Plasma with a 5 day out dates. One of the corporate transfusion medical directors is strongly against this idea (not sure why) but her latest stated concerns were "disulfide bond reductase, levels of prothrombin fragment 1 + 2 which are slightly elevated in PHF". Have any of you heard or read any thing pertaining to either of these and thawed plasma? Any help will be greatly appreciated. Thanks John
  11. Depends on the age of the tech and the sample. Cord Blood DATs are almost always read microscopically. Adult DATs will be read microscopically by "more experienced" techs. New tech and my self seldom use the microscope. Actually I'd like to get rid of it altogether. Causes too many unicorn hunts.
  12. When we get a request for blood for a neonate and an aliquot is taken from the unit it belongs to that baby and will not be given to anyone else until it is either gone or outdates. The only exception is our neonatologits have requests we put twins on the same unit if blood types allow.
  13. I think this is one of those situations where "one size fits nobody". I personally am very much against a second, blood bank specific arm band. I feel it causes more problems than it's worth. I think that each facility needs to evaluate what is out there, how each system is used and then try to come up with something that fits their specific circumstances. A lot of this is driven by the comfort level of the medical director and their experiences. When it comes to patient identification, the simpler the better. The more compicated we make things the less likely they are to work effectively every time. If the system becomes too complicated the folks using it (nurses) will find a better way to get around it or simply ignore it and we never know until something terrible happens.
  14. Currently just 24 hrs but we are in the process of changing that to 5 days. Hope to be there by Sept. 1.
  15. We were not given the choice. Our blood supplier told us they would be providing nothing but 24 hour plasma. Luckily there have been no concerns. As far as we are concerned it is interchangable with FFP. We were worried about liver transplants and neonates but the neonatologists have accepted it and the liver transplants have gone well.
  16. Thank you bmarotto. You gave me exactly what I was hoping to find. I looked through a Shamrock catelogue and their website and could not find that but with the numbers it shouldn't be hard. Thanks again John
  17. Hopefully this is the last time I bring this topic up. I feel like I'm stuck in the movie Groundhog Day. For those of you who "convert" your thawed FFP to Thawed Plasma with an extended outdate upto 5 days: 1. Do you change the component label on the bag from an FFP label to a Thaw Plasma Label? 2. If so, where did you get the label and what is the nuemeric barcode number for the product code? I've looked in both UAL and Shamrock and neither have the component label I'm looking for. 3. Also, if you use a computer do you component process the unit from FFP to Thawed Plasma in the computer? Thanks for your help and patience. I think we might actually be doing this soon. John
  18. My experience with neonates is that there are very few standards. Most practice appears to be driven by the experience of the neonatologists at the facility and most of that is anecdotal. Also a lot depends on where their fears are the greatest. Here we will put twins on the same unit becasue the docs want to expose the family to the fewest donors possible. Other facilities I have talked with are absolutely appalled that anyone would take the chance of exposing both twins to the same donor. Yet there is no standard to follow. I haven't read the technical manual for a while but I don't recall anything so specific as to it saying "you should not exceed 24 hours after irradiation. Consequences includes infant death secondary to cardiac arrest." Our neonatologists are fairly conservative yet progressive in a lot of ways. I'm certain that if they were concerned, our use of irradiated units until expiration would not be allowed. Our limitation is that we do not have an irradiator and never will have one. In the perfect world we would be able to irradiate each aliquot immediately prior to issue but I'm afraid that is not the world I live in at the moment.
  19. We have an active 36 bed NICU. We do not have an irradiator and are located between 2 and 4 hours (depends on traffic) from the blood center. We keep 1 O neg, 1 O pos, 1 A neg & 1 A pos irradiated units available for NICU at all times. After about 1 week on the shelf they are moved into the general population. Once a baby is assigned to a unit during that first week we will give the baby aliquots from that unit until the unit is depleted, outdated or the baby leaves the hospital. We seldom are tranfusing from a unit that is approaching it's outdate. Most of the time the baby has stopped receiving blood long before that but we will use it up to the outdate and have not been informed of any problems from the physicians. Our neonatologists are very conservative with their transfusions and with the use of erythropoeitin(sp) our transfusions of have dropped dramatically. Cliff, where's the spell checker?
  20. Some of the small rural facilities in our corporation have one refrigerator and one freezer. They are acceptable for blood products and everything else goes in them as well. So far no inspection agency has had any problems with it.
  21. The only value I can think of is if your result is >16 you can be fairly certain that it is not the result of a RhIG injection.
  22. Now that's interesting. Back in the olden days when I was involved with donors I seem to remember that the sets for the apheresis machines didn't vary only the settings on the machine changed based on what you wanted to collect. Of course my memory is failing daily so I could be really off base here. I hope some one does come up with the difinitive answer some day. Maybe it's just that nobody thought of it. Sounds like another good SBB student project.
  23. Actually it dosen't make sense. Why would a platelet pheresis stored at room temp have a 5/7 day out date and the same technology producing the plasma stored at 1-6oC have a 24 hour outdate? Now the story I heard is that the anticoagulant used was different and had not been validated for use as 5 day plasma. I'm sure there are probably other stories out there as well.
  24. We try to limit incompatible plasma in adults to 600 ml in a 24 hour period not to exceed 1000 ml in 7 days. Not sure where this came from. Think it was the corporate transfusion medical director.
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