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Posts posted by tbostock
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The procedure for centrifuge calibration, Method 7.5 in the Technical Manual:
We do this annually, and I have a question. There are the saline instructions, as well as high-protein, and Coombs/cellwashing phases. My question: we don't use albumin here, we have gel. So we do our blood typing in tube, and we use gel for antibody screens and panels. Do we still need to calibrate the centrifuge using the albumin? Or is it OK to just do the saline and Coombs/cellwashing phases?
Thanks.
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We have a Bloodless Program here for patients such as yours. We usually identify them as Bloodless by putting a bloodless wristband on them, putting a bloodless sticker on their chart, and a sign over their bed to make everyone aware. We also make sure they have a signed Health Care Proxy and we get their wishes documented on a Blood Refusal form so that we are covered legally. We put a bloodless "code" in our Lab computer system so that nobody in the Lab inadvertently releases any blood products. Then we get a Hematologist consult ordered STAT; they usually do an anemia workup to look at iron levels, B12, etc. The hematologist will then usually get the patient on IV iron and Procrit to boost their red cell production. We also use bloodless techniques, such as cell saver (there is a special Jehovah's Witness protocol where their blood stays in a continuous circuit which is acceptable to most of them), interventional radiology techniques (such as embolization to stop active bleeding). We try to limit blood draws as much as possible so that we don't deplete what they have left.
Hope some of this is helpful to you.
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Oh, sorry...I forgot to add that part...
When we see their name updated in the computer, we send someone up to ID them. Preferably, we try to get the same phlebotomist who collected the original specimen. They go to the patient's bedside and check that their ABC1234 Typenex band is still on, and then we look at their "new" band with their real name. If they are alert, we ask them to verify their name and DOB to make sure the right band was placed on them. We have a logbook in the Lab where the phleb then initials that she performed the ID. So in that case, we can still use the original specimen because we have a cross-reference.
If the phleb goes up and someone has removed the Typenex band, we start from scratch and recollect the specimen.
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We use the Typenex bands at our hospital; we are a busy level II trauma center. All trauma patients get a band, whether or not they are conscious or have ID on them (we've had kids with fake IDs...what a nightmare when you call the wrong parents!). If the band is "ABC1234", patient registration registers the patient with a new MR#, puts their name in as ABC1234,Trauma. This way we are complying with the two identifier reg. As soon as their real name is verified (we wait until they are out of OR, and there is family here to confirm the identity), the name is changed to their real name. If they have been to our hospital previously and have an old medical record number, it is merged after discharged.
In the case of a crime victim, where we want to keep their identity private, we leave their name as ABC1234,Trauma until they are discharged.
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There is no regulatory requirement to QC panel cells that I know of. We just do a visual inspection upon receipt.
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We go with the regulation, which is quarterly. We do not have this in our user's manual, but we started gel about 10 years ago. We have no intention of changing to daily checks.
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We don't identify cold agglutinins here since most of them are clinically insignificant. I've never seen the value, if someone can enlighten me on why so much time is spent on identifying these...
We are also not fans of prewarming here; we use it as a very last resort, and are very careful about it.
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We've had Sunquest here for about 9 years or so. We just converted to 6.3, which for Blood Bank was quite a change.
The Pros:
The system is hardly ever down
The reports are really good
6.3 system is much easier to use and train new staff
The Cons:
It does not allow for much flexibility; you can't adapt it to what you do at your Blood Bank...it is what it is
Serious glitches that they seem unwilling to change: see above posts, and also that there is no place for visual inspection at product entry.
QA warnings/failures appear excessively, leading to techs tending to "ignore" them.
Overall, it's a good system, but you do have to come up with some workarounds.
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Yes, many frustrations with that here too. We have tried keeping them in the refrig, as well as trying their "protecting from light exposure" theory, and we have seen no improvement.
To save panels, if we have a positive antibody screen that looks like a false positive (weak reactions, usually only in one cell), we repeat them on freshly diluted Surgiscreen cells. If they are negative, we do not proceed to a panel.
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Another "ER" episode where the doc played by Noah Wyle bravely stepped forward to donate blood to a victim because the hospital was out of the extremely rare blood type O neg. So he pulled up a chair, and they took the blood directly from his arm and gave it to the patient...took his word for it that he was O neg apparently, not to mention wasting time by testing it for infectious disease markers.
I crack up too, that whenever they show a lab, there are always beakers and flasks filled with pretty colored liquids...that kills me.
And "CSI"...how can they work in the dark...can't they turn on a light?!!
OK, I'm done ranting....
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We probably wouldn't give the RhoGam here either. If we did, we would probably give the IV version, WinRho...that many IM needles is just not nice.
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Check your state regs; an off site surgical center here in NY State also wanted to do this, but the State regs concerning limited transfusion services scared them off.
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I was able to open both with Office 2003.
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You're right, John, that was a hit, not a miss. I agree that a miss is something you catch before it reaches the patient.
Our latest near miss here: When we were doing a blood type verification on a new patient inhouse, it didn't match his original specimen drawn that day by the nurse on that floor. Found out upon questioning that she really collected the blood from his roommate, put the blank tube in her pocket and went to the desk. Then she was asked "a million questions" by doctors, unit secretaries, etc, until she got distracted. When she finally remembered to label the tube, she grabbed the wrong addressograph card (the roommates). Our policy is to handlabel the tube at bedside directly from the wristband....she was an experienced nurse who knew the policy but chose to do it her way.
This was a near miss because we had a process to catch that error before blood reached the patient's bedside. Thank God we had just implemented the blood type verification process a few months prior...or it would have been a direct hit.
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Same thing here, 60 minutes, but we average 45-50.
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Our pneumatic tube request form (it's a two part form) is sent to us through the tube. We sign out the blood, two Blood Bank techs check the product against the request and both initial the form. The whole form is sent up with the blood. The person taking it out of the pneumatic tube carrier takes the request form out, initials the receipt part, keeps the front copy for the chart, and sends us the back copy. If we do not receive the back copy back within 15 minutes of sending it up, we call the floor to make sure they received the blood, and ask them to send back our copy. This works pretty well for us, and fulfills all the regs.
We do not use secure send. If when we call the floor they say there is no carrier in the station, we can look on the pneumatic tube control PC and see where it ended up if someone accidentally sent it to the wrong station. I think this has only happened once.
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We are a very busy level II trauma center. We have a predetermined "recipe" that was approved by the trauma surgeons...based on the criteria used by the major trauma centers. We use a 1:1 ratio of red cells to plasma, with an apheresis platelet every 6 red cells/6 plasma units, and a batch of cryo after 12/12. Works great, and of course, if the trauma surgeon wants to alter that due to a patient's condition, etc, we would comply.
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I'm for clear bags; I kind of like it that the visitors can see the blood as it is transported. Maybe a reminder that they should donate? If they are that squeamish they probably shouldn't be in a hospital...you never know what you may see.
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We have a "pick up slip" if the nurse comes in person to pick up the blood. It must have the two identifiers on it (name and medical record number).
We have a pneumatic tube request form that we use for units that we "tube".
We also require a transfusion order form faxed to the Blood Bank before we release the blood.
The only "verbal" orders we allow is for traumas, which we personally deliver to the ER.
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The physician has to be at the bedside to evaluate the emergency, has to state in the medical record:
The nature of the emergency
That the patient cannot consent
That the health care proxy is not able to consent
Also, they have to check the chart for any advance directive that may have been signed by the patient that refuses blood products.
We have to see proof of this documentation in the Blood Bank before we can release the blood.
Centrifuge calibration: optimal spin time
in Equipment
Posted
Alas, I live in NY State, which requires it to be done annually as well as initially and after repair. New Hampshire is starting to look really good....