John C. Staley
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Posts posted by John C. Staley
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1 hour ago, Cliff said:
Yikes, I can't imagine. Our RBC inventory is about 1000. We run a short date list daily. We find units with X days remaining (I believe 3) and put them in a special place for immediate use. We also release units from patients nightly. One of those two processes finds units that may be a failure to issue in the computer.
With usage as high as we have, invariably units go missing. About once a year we lose a unit or two. We have an investigation process, and if that fails, we make them as lost.
I do enjoy simple and practical. We have a tendency to over complicate just about everything!
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I'm curious, often do the counts not match and you have to undertake an exhaustive search for figure out what happened?
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If I remember correctly, we required a new type with each new admission for plasma. Most of the time a type and screen was ordered just in case.....
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50 minutes ago, Baby Banker said:
There can be back pain in an HTR, although there are LOTS of other things that can cause back pain.
For some reason I was always under the impression that the back pain was associated with the kidneys trying to deal with all the rbc detritus resulting from an HTR. That being the case, I can not imagine that would be the only symptom but one of many.
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Just a thought but why must the acute pain be associated with the transfusion? Why was the patient being transfused, trauma, chronic anemia, etc.? It makes a difference. Where was the pain, at the site the blood was going in, along the same vein, some other part of the body? I know that it is a natural reaction for us to associate anything unexpected which occurs during or shortly after a transfusion to associate it with the transfusion but that is not always the case. It is worth the effort to also look elsewhere for the cause. As I've mentioned in other threads, I've seen a temp rise post transfusion that was caused by the window blinds being open and the sun shining directly on the patient. Bottom line is that it is not always the transfusion causing what you are seeing. Keep an open mind.
- David Saikin, Ensis01, Baby Banker and 1 other
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Personally, I never had a problem receiving in blood like you described as long as it met all the requirements that we required from out supplier. On the other hand I knew facilities that would discard any and all blood that was received from outside with out any thought. I considered this a dreadful waste of a precious resource! Just curious but did the blood have any of the temperature monitors attached to the units? If so, that could help you make the decision.
Having said all that, I have been out of the world for a while and many things have changed since I was intimately involved in the art of transfusion medicine so there may be some new regulations that can provide guidance for this well beyond my opinions. I look forward to read what others have to say on the subject.
- butlermom, Yanxia and David Saikin
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Personally, I think that is a judgement call to be made by the patient's physician. Is there some reason this one hour post transfusion temp documentation is being done? Any new studies I'm not aware of? There are uncounted reasons for a patient's temp will rise, my favorite was the time the curtains were open and the sun was beating down directly on the patient!
Just my thoughts.
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Having been out of the loop for awhile, what is BPAM?
As far as stop time, I'm with David, when the last of the blood is infused. I would assume that the nurse responsible for the transfusion would be the one to determine when that is since they will be the one making that decision. Also, there are occasions, for one reason or another, the transfusion will be stopped prior to the bag being emptied. Again, the nurse makes the decision and will be the one documenting the stop time.
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Just curious but has anyone thought to ask the timer manufacturer their thoughts replacing batteries? Personally I don't think I would be overly concerned with the need to calibrate a digital time simply because I changed the battery.
Also, "However, the batteries have all died prematurely." What makes you think that the batteries died prematurely? Did the manufacturer indicate that the batteries would last the calibrations period? If they didn't want you to replace the batteries they would probably make them inaccessible.
Just a couple of thoughts.
- Eagle Eye, exlimey, Malcolm Needs and 1 other
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19 hours ago, jalomahe said:
Patient first and last initials and reagent in the tube so for blood type it would be: JH-A, JH-B, JH-D, JH-DC for the front type and JH-AC, JH-BC for the reverse type.
My personal system was virtually identical to yours except for the the reverse type I used JH-RA and JH-RB.
In the facilities where I was the Transfusion Service or Blood Bank supervisor my tube labeling requirement for the staff was that anyone in the department could set down an take over the testing and know who and what was in each tube.
- Kris L., Ensis01, David Saikin and 1 other
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Is there any other possible cause of what the patient experienced such as antibiotics or food or anything else? I'm not saying it's not the transfusion but it does sound much more applicable to other things.
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Just curious but does your facility not stock a supply of group B blood? I'm only wondering why group O was used for the transfusion. Only idle curiosity.
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Congratulations Malcolm!
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On 8/20/2020 at 7:22 AM, Joanne P. Scannell said:
I hear there is some chatter/literature about immunizing Rh-Neg Females under 50 is, today, probably 'much ado about nothing'. Well, not nothing, but the argument is, with today's techniques (in utero transfusions, more sensitive monitoring, etc.), the risk of HDN is less likely than it was 'all those years ago'. Does anyone have any articles or insight about this 'new turn' to share?
So, just where are you hearing this?
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20 minutes ago, kimblain said:
Great! Thank you I will give it a read
and then give the rest of us a book report!
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Ok, I'll bite, what is "flying squad blood"?????
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20 hours ago, MDJones said:
I didn't work at my current lab when they brought BB software online. I am suspecting that the continuation of triple documentation is out of habit rather than need. I am trying to bring fresh eyes to the situation, I may very well bring up the fact that we could go completely digital. However, I'm taking baby steps right now, especially since our "mother" hospital also still employs the card catalog with the same software and they are 2x bigger than we are.
One thing I discovered in my many years as a Transfusion Service Supervisor is that inertia is the most powerful force in the Universe! Trying to initiate change, especially in blood banking can be extremely difficult, often impossible. Pick your battles carefully and make sure they are worth fighting. Good luck.
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Just curious, but why even have a card catalog at all? That was the first thing I got rid of when we computerized my last blood bank. It took about a year, if I remember correctly, to move all the old info from the paper records into the computer. One thing we did was research each patient that we had not seen in over a year to see if they were deceased or assumed they were if over 100 years old and not seen for a certain period of time. It made no sense to fill space in the computer with patients who were obviously no longer with us.
- albaugh and David Saikin
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My only thought is, "What is the motivation for such a change?" The retesting will still have to be done and you will pay for it one way or another so what, exactly are you hoping to accomplish?? A little convenience for the transfusion staff?
- MAGNUM and Baby Banker
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Just a side note that came to mind while reading this post. Do you still give Hgb-S negative blood for neonate transfusions? Back when I was still in the world we did so I was just wondering if it was still in vogue. If I remember correctly, the theory was to make sure we were not compromising the oxygen carrying ability for the neonate. Didn't mean to hijack David's post.
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Some one has to ask so I guess I will. How confident are you that the 2nd sample actually came from this patient? I know it is unlikely but unlikely is not impossible, hence my question. Just a thought to consider.
Bye the way, I agree with Malcolm's assessment.
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Have you attempted an antibody identification panel?
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What tipped me off that it wasn't you was the address. That and the some what cryptic message. I meant to let you know but then got sidetracked and forgot. Sorry about that. I don't know which is getting easier, being sidetracked or forgetting. They seem to go together.
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I'm with exlimey, please clarify what you mean by positive antibody screen. One cell positive or all cells positive or something in between.
No new members???
in Introductions
Posted
I find it surprising that there have been no new members in 2 months. I don't remember there being a week go by without someone new coming on board. Hope it wasn't something I said!