butlermom

We have a set of certified weights that we use every day to perform QC on our digital scale. It's part of our daily QC. We use 3 different mass weights: 100g, 200g, and 500g. Some of our therapeutics are for only 250cc to be removed. We sometimes prepare aliquots in bags for pedi patients, thus the 100g weight. We don't have an acceptable range for therapeutics; I should probably add that! I would think plus and minus 25cc would be acceptable. Our manufacturer's guide that came with our scale has a procedure for an annual calibration using the 1000g mass weight. We perform this annually and document. It's very simple to maintain.

We recently went Live with Cerner Millenium and Korchek performed our history upload from SafeTrace. I highly recommend them.

In a couple of months we will be relocating our entire laboratory to a new building. I know I must re-certify all of our equipment after the move and this includes our ProVue. Our field service engineer will be onsite to prepare the ProVue for transport. Once in place in the new location, he will perform his magic to re-certify it meets required specifications. Ortho has no recommendations on re-validation, but I'm wondering if I have to validate it as I did when it was first installed new or only perform an "abbreviated" validation this time. I think some regression testing should be included as well. Has anyone re-validated their ProVue after a move and if so, how extensive was your process? Thanks for your input! Kathryn

Our OB/GYN department is located in another building across the street from the main hospital (and lab) so all blood products must be sent via pneumatic tube. All OB/GYN patients have an admitting type and screen performed. The physicians are later ordering crossmatches claiming they have to wait too long for the blood if only the type and screen has been done. The C/T ratio for OB/GYN is very high because of this. We are trying to define a smoother process in which the physicians can have confidence that they will get the blood in a hurry if needed. They have defined "a hurry" to be about 8 minutes! I'm wondering if this is even possible with all the steps we must go through: find patient's sample (if not electronic) and select a unit, remove a barcode label and segment from the unit, perform an immediate spin crossmatch, print a donor tag, compare request sheet with donor tag, issue the unit in the computer then wrap it in a plastic bag and tie it shut, place unit in pneumatic tube and send. Of course, this requires no other distractions for the ONE tech like issuing blood to someone who comes to the window or answering the phone. In theory 8 minutes sounds do-able, but in reality it isn't working. For other facilities who have already performed the type and screen and then have a stat order for RBCs, approximately how long is your process from receipt of order (phone call and required paperwork) to sending the blood through the tube system? We use electronic crossmatching where appropriate or immediate spin. (Patients with antibodies already have 2 units fully crossmatched.) Thanks for your input and/or suggestions. Kathryn

Johnv, I know this was posted many months ago, but I wanted to ask a question. We recently went live with Cerner and our IT dept. built the access file for the PTC Export. The Ops job for it is running. The problem is they are having trouble getting it to export automatically onto the standalone PC. Does the first upload have to be done manually before it will automatically update or is there some trick to making the process automatic?

We will be moving to Cerner Millennium early next year and will use the PPID barcode scaners at the bedside that will print labels. I too have thought about dropping the Typenex armband but until we can get Bridge Transfusion (new at Cerner) I am not willing to drop the BB armband. Without an armband I just don't know how to positively keep the "identity chain" from specimen collection back to transfusing the patient. Currently we require the BB armband sticker be brought with the pick-up slip for blood. No number=no blood. The techs enforce this 100%. As for pre-op patients, we ask them to wear the armband, but if they really don't want to, they are instructed to bring it with them the day of surgery. If they return and either don't have it, or it is illegible, they are redrawn and we do everything all over again. Mabel, I like your idea of a radio chip!

A sales rep has informed us that the FDA is recommending "day of transfusion" bacterial testing for plateletpheresis units. This would place the burden on the transfusion service to perform the testing, and is in addition to the 24-hour culture done by the blood supplier. Supposedly, even though there may be bacteria in the unit, there may not be bacteria prevalent in the sample used for the culture because there are not enough bacteria in the whole unit yet. By testing a sample on the day of transfusion, more time has passed allowing more bacteria to grow and therefore a greater likelihood of detection. There is a nice little kit to perform this testing and it is fairly quick and easy. Again, this is not mandated, YET, but apparently the FDA and AABB are discussing it. Has anyone else heard of this?

Thanks Mabel, and you're not rambling! We always run the screen--I wouldn't consider NOT doing that. I like the idea of running one D cell along with the @ cells (plus the other 1 or 2 that I usually add to have homozygous Kidds and Duffys).

Thank you for your responses, but I think I need to clarify what I intended to say. I was referring to those patients whom we do NOT have any history, but strongly suspect that they have anti-D due to RhIG (Rh neg, labor & delivery patient). According to the note on Ortho's panel sheet, the Rh negative mini-panel cells may be used to rule out all other antibodies in patients for whom there is ALREADY a history of anti-D. My question is, if they rule out everything else, why does it matter whether you have a history of anti-D or not? (I always make sure there are homozygous cells for Duffys and Kidds so we often add another cell or two in addition to what Ortho has designated with the @ symbol.) Thanks.

Is there anyone out there NOT using a separate blood bank armband system, and if so, how does your process work from specimen draw to transfusion? We are about to begin a new LIS project for our entire lab and are considering various process changes. We currently use a typenex band and require a sticker on the the transfusion pick-up slip prior to issuing blood. We anticipate changing to the barcoded armbands, but we were questioned about having a separate blood bank armband at all. (almost heresy to this old-timer blood banker!) Thanks for your comments.

Along these same lines, I have a question regarding the "mini-panel" (the Rh negative cells from the Ortho panel to rule out anything else) that we perform for patients with history of anti-D. The majority (about 99%) of our Rh negative Moms receive antenatal RhIG. Many receive it in the physician's office so the first time we see them is at delivery and they have a positive screen. Since the mini-panel cells will rule out everything else, why must we do a complete panel?

No, if the timer or the thermometer is brand new (and comes with a certificate) I see no reason to verify prior to putting them into use. However, your question gives me pause to think about this some more. I guess an argument for verifying could be to ensure that nothing got "jolted" or "misaligned" during shipment. I'll be interested to read other replies. BTW, we are CAP and JC inspected only. Kathryn

I contacted the manufacturer and was informed that Rhophylac is stable at room temperature for 24 hours.

Our shipment of Rhophylac (Rh Immune Globulin) was delivered to pharmacy by mistake and was brought to us a day later. It remained at room temperature in the pharmacy for just under 24 hours. Will the potency or integrity of the product be significantly affected that we should discard the shipment, or is it safe to use?Thank you. Kathryn

CMedina84, I would be very interested in knowing how you mapped your cord bloods with ProVue and Safetrace. Also, do you use the ABD&Reverse card or the ABD/ABD card? Thanks.

We will recollect using the current band number, insisting the red sticker, if available, be placed on the properly labeled tube. (If no more Typenex stickers, the code must be clearly written on the label.) We will perform a forward and reverse type on the specimen, but not the screen, and proceed with crossmatching.

Oops! My bad. I know where my mistake is. I was thinking of 50ul instead of 5ml when I initially multiplied. This does make it look much more cost effective now. Thank you Deny. Kathryn

I have started the process of validating antigen typing in the IgG gel cards for Duffy and Kidd antigens but need to do a cost analysis to be sure it is really cheaper. One variable I don't know is how many drops (tests) can you get from the 5ml vial of antisera? I've always believed that 1ml=20 drops, so 5ml=1000 drops. Therefore, one 5ml vial would run 1000 tests using the tube method. Using a gel card, it would be 25 microliters which is half a drop (so twice as many tests per vial and half the cost per test). Am I on the right track?

I too am beginning to think through the process of electronic crossmatch. Like others, our system requires us to scan a specimen barcode for any testing, and currently, I require a forward re-type for samples pulled from the fridge for add-on crossmatches. Brenda, I am curious, how do you plan to implement the 2nd specimen draw? I fear there will be rampant revolt from nurses and patients, not to mention the burden on our already understaffed phlebotomy personnel. Same subject, different topic: Has anyone done any sort of cost analysis on the savings from electronic crossmatching? I am actually being encouraged by hospital administration to implement electronic crossmatching as a cost savings measure. Our computer system has already been validated for it so we just have to figure out our process. Kathryn Butler MT(ASCP)SBB

Is there anyone out there who has successfully interfaced their ProVue with Wyndgate? We are currently in the process and are having problems "mapping" our cord bloods. Thanks.

Patients come with a written order on a prescription pad slip. Occasionally the order will be written on a hospital order sheet. We draw a sample for ABORh and antibody screen and the Rh Immune Globulin is picked up from us and injected by a nurse in our outpatient infusion department. We don't require any detailed info from the physician. Many of our patients receive their 28-week dose in the physician's office so we never see them until they come to deliver (with a nice anti-D due to RhIG)!

We have many boxes of printouts of patient results and QC from our ProVue. Since I've always done a monthly back-up, do I really need to keep all that paper? Patient resluts are manually entered into our computer system (Wyndgate). We are about to interface our ProVue with Wyndgate (finally) so am wondering how others are handling all this paper! If you are interfaced, do you keep any "paper trail?" Do you keep printouts of your QC?

We too have a similar "turnaround" system, however, it doesn't work that well for us. Our supplier is local but they cannot draw enough platelets in our area so must get them flown in from another center. We have to have a platelet in house for each open heart surgery case and we get them the night before the surgeries but they usually expire at midnight on the day of surgery. They may or may not be used for the surgery so if it is not used and no one else needs it, it expires. We lose about 4-6 a month. It kills me to waste them this way but we've not found any way around it. My monthly blood utilization statistics for wasteage is almost entirely platelets.

We've been live with our ProVue for almost a year and a half and we run it continuously all day long. Evening and night shifts tend to wait until they have a batch (3 or more) then put them on. We run QC every morning and print it out for review. We also print out the results after each run since we are not interfaced yet and I'm running out of space for all that paper. Does anyone know if we have to keep all those print-outs after we've entered the results into our computer system?

A 5-month old baby girl was recently admitted to our hospital for transfusion. Her antibody screen and panel cells were all positive as well as the auto control. Mother's antibody screen was negative when the baby was born and the baby was healthy. Further investigation revealed that when she was 4 months of age, she was admitted to another local hospital with a very low hemoglobin. Her antibody screen was positive and all panel cells were positive. The DAT was positive for anti-IgG. Her sample was sent to a reference lab who found anti-E and anti-Jka in the eluate. She had never received a blood transfusion. How can this be? Could these really be warm auto-antibodies that are appearing with a specificity of anti-E and anti-Jka, perhaps "pseudo" antibodies? We had to transfuse so of course gave her E and Jka negative blood. She did fine and was discharged. Any ideas?