[Microwave for plasma thawing]

The microwave's have improved since 25 years ago.  They now have safe guards that automatically shut down if the temperature in the bag increases too much to avoid the cooking aspect.  The temperature is monitored constantly throughout the thawing process to ensure it never gets to high.

[Microwave for plasma thawing]

We got caught up in the FDA issue over two years ago.  We had a microwave on order for over a year.  We finally got one from the distributor in Florida but it was a demo model.  I think that is the only distributor in the US and the manufacturer in Canada has submitted the paperwork to the FDA but it has not yet been approved.  Since our demo model was manufactured prior to the changes it was acceptable for use and FDA approved.  Good luck.  We actually contacted the manufacturer in Canada and were in discussions with them.  Perhaps they have more information on the FDA hold up.  We do like our microwave plasma thawer and it has been a cost saver.  We were thawing plasma and discarding it just so it would be available for the ED.

[Neonatal transfusion]

 We very rarely transfuse neonates and when we do it is emergent.  We give the entire unit of O neg for babies and they transfuse what is needed  .  We also do not label products and do not have an ISBT printer. 

[Nursing Order]

We have had similar issues with nursing coming to get the product for transfusion but not checking the physician order to transfuse.  We now have it on the check list which they have to approve in the computer prior to transfusion.  This change did make a difference however we still had one nurse check the box and they did not confirm the order.  There was a great deal of discussion about why the blood bank released the unit when there was no order to transfuse, however I explained we often do not have access to physician orders.  I suggested  a solution was for nursing to bring the printed order down each time a unit was released.  This would ensure they checked and had the order and we could then easily verify it.  Needless to say nursing did not go for that solution.

[multiple health facilities using one specimen]

We are a community hospital and  frequently transfer patients to a larger facility.  We also have had issues with dialysis patient's needing a blood transfusion during dialysis where there sample has been collected at another facility.  We do not crossmatch or transfuse blood from a sample that has not been collected within our hospital system governed by our patient identification and labeling policies.   The  larger hospital where our patients are transferred does not crossmatch or transfuse based on any tube we have collected at our facility.  There is far too much risk in patient safety in my opinion when you loose control over collection and identification of the patient.

[Verbal orders for blood]

Sorry I am just checking in but your question about do we enter orders through OE or LAB.  We enter the orders through LAB and IT set it up so the physician would be prompted to sign the order if we enter VERBAL instead of Written

[Antibody Panel QC]

For years we have been using our QC antisera and rotating one cell from the panel each day and testing it with our routine daily tube QC.  It was not so overly burdensome( one additional cell)  and even though we are testing only one cell each day we make it through the entire panel at least once during the month.  This way we are testing the "panel" if not every cell each day of use and  we have some quality control.  Everyone is correct there is no way to check every antigen so we felt this was a good compromise.

[Verbal orders for blood]

We are able in the blood bank to receive verbal orders and to place them into our LIS system which is Meditech.  We realized this could cause issues so there is a field in Meditech when you place an order that defines whether the order is written or verbal.  Up until this time it was set to default as Written.    We requested a change from our IT department and now we have the option of selecting Verbal with the default setting of Written.   When we select Verbal the ordering physician is electronically prompted to sign orders.

  It worked much the same way verbal physician orders to the nursing units worked at our institution.  It seems to be working well.

[FFP and RBC's Administered through same line simultaneously]

I appreciate your responses.  Does anyone have any references supporting the protocol to use the same line for administration providing procedure and guidance? 

[FFP and RBC's Administered through same line simultaneously]

I am looking for the answer to this question posed by one of our physicians.  Can FFP and RBC's be administered through the same line at the same time in a trauma situation?  This has never been the practice where I have worked however when I checked for standards that might apply I could only find AABB 5.28.9  Addition of Drugs and Solutions which really did not seem to answer the question.  Looking for any input with regard to this question and making the assumption the FFP and the RBC's would have to be  compatible.

[Microwave plamsa thawer]

I ordered a microwave from Ark Bio-Medical in 2016 and waited a year to receive one.  It is true they have had a manufacturer of some of their parts go out of business and it has taken time to find another.  They have found a new manufacturer and are in production, however now all the paperwork must be re-approved by the FDA and that is where the problem lies.  They have complied with all FDA requests but are awaiting approval.  In the mean time the distributor just installed one he had in stock for us and we love it!  It works very well.  We were instructed to make sure the sensor in the microwave was not placed on the side of the unit with a bubble.  We are a small hospital and it has saved us over $3000 dollars a quarter in wasted plasma.  Now we thaw on demand and it takes about 8-10 minutes to get a fairly large size unit ready.  We still have the Helmer water bath plasma thawer for cryo and units that do not fit the carrier but the microwave is great in a trauma.  We are also taking the temp of every unit we thaw upon completion at least for a while.  I am an old blood banker and I was very skeptical at first but so far we love it!!

[Culture of blood products]

Could you have the community hospital inoculate the Blood culture bottles used by your main Microbiology laboratory and transport those instead of the bags themselves.  When we wish to culture a blood bag we inoculate the blood culture bottle here at our facility as well and set it up on the Bacti Alert. 

[ECHO D typing Discrepancy]

We reported the patient as a weak D positive patient.  Due to cost cutting we no longer have a different Anti D sera on site.  We use the same reagents on the ECHO and for Tube typing. That is why I was concerned when we were able to pick up the D in tube testing using the same lot number of Anti-D typing sera and we did not even see a ? on the original ECHO run.  We are a community hospital and most of the time there are no problems.  Cost vs Benefit indicates the few patients that have typing problems are more cost effective to send out for resolution.  Gone are the days we can do our own work ups I'm afraid.  In this case it was safe to call the patient Rh negative for transfusion purposes.  Since she is prenatal the physician can order molecular studies to get a more accurate picture.  Thanks for all of your help.  Some great ideas!

[Group A Plasma for Trauma/Massive Transfusion]

Does anyone use a FDA approved Microwave plasma thawer?  I have read about them and inspected a hospital that had purchased one in the past year.  They seemed to be pleased with it.  It would be great for trauma situations allowing us to provide plasma very quickly.

[ECHO D typing Discrepancy]

I have the initial EHCO printout which does not look grainy for the individual reactions but I will go back and check the reaction strength on the instrument for both runs to see how that compares.  You could be absolutely correct.  There has to be a break point somewhere and it could be that these samples just might have fallen into those areas. I do have techs review the reactions before reporting and I don't see anything on the printout that would have caused much alarm.   Unfortunately it is difficult to explain all of this to a physician or mid-wife to get them to understand why you "mistyped" their patient.

It is good to keep in mind  the probe sampling position in discrepancies with transfused patients. Should this occur again, it will be one of my considerations.   In this case my patient had not been transfused.  We learn  much from each other and I do appreciate this forum.

[ECHO D typing Discrepancy]

Thanks for some great ideas!  The suggestion that the EHCO is programmed to shake for a specified period which "shook off" the weak reaction producing the initial Rh negative result is very plausible however why then did it not repeat itself when we retested the sample?  Upon repeat after some time refrigerated the ECHO detected enough to provide us with the ?.  Call me crazy but I like reproducibility in my instrumentation! Instrumentation is great but I still say it is hard to beat an experienced Blood Banker on the bench.

[ECHO D typing Discrepancy]

I searched the forum and read some discrepancy info from back in 2013 and 2014 but most of those patients had history of transfusion.  Two days ago we had a prenatal T&S.  No blood transfusions involved.  We had no previous history of type or transfusions on file.  The sample was tested on the ECHO and clearly typed as D negative with no discrepancies or concerns with both Anti-D reagents.  Patient was reported as D negative.  The same day we receive a call from the patient's midwife stating the patient has a history of being B Positive.  We pulled the original sample and repeated testing on the ECHO.  The repeat testing resulted in ?  with at least one of the Anti-D reagents and resulted as NTD. (No type determined).  We proceeded to perform tube as well as ECHO weak D testing.  Patient was 2+ positive in tube with AHG phase using the exact same reagents used on the ECHO and 4+ positive with both Anti- D reagents ECHO weak D.  My question is why did the initial test not react?  If this was a particular variant etc., I could chalk it down to method or reagent but having one result on the same sample tested on the same day and then finding another result hours later when repeated does leave me wondering.  Any ideas??  I will say the sample was EDTA and was refrigerated for several hours prior to the repeat testing.

[Plasma Thawer]

We do convert our FFP to thawed plasma but still experience waste.  We are in a rural area and generally are stabilizing trauma patients to ship to a larger facility.  We attempt to use the plasma for other patients but often we do not have the need.  We usually end up wasting a little less than half of the units thawed.  I was hesitant at first to purchase a microwave thawer however after seeing one I believe it will be a good solution for our hospital.

[Plasma Thawer]

There are microwave plasma thawers.  They are used quite a bit in Florida.  I inspected a hospital that had recently purchased one and they were very happy with it.  I have ordered one and should be receiving it in the next 2-4 weeks.  They are FDA approved and have save guards to prevent "hot spots".  The plasma is rotated during the thawing.  It allows smaller hospitals to provide plasma for ED patients quickly.  We are currently wasting A FFP in an attempt to keep a thawed inventory available for most ED patients.

[Verbal Orders]

We accept verbal orders in emergent situations, however we recently configured our LIS system so we could record the order as verbal.  In the background the computer system generates a physician order and a notification that he or she must sign the order.  It solves the issue of policing up physicians and getting them to enter the orders after the fact.  So far it is working great.

[Alarm Activation checks for TempTrak central monitoring system]

We recently began using Temp Trak however we continue to have the manual alarms in each refrigerator.  We have been testing the manual alarm system as in the past however I would very much like to see how others are handling this issue.  I must say I have not completely trusted the Temp Trak as the alarms are fairly quiet and since during shifts our blood bank does not have a dedicated blood banker I am concerned they could silence the alarm and "forget" to follow up.  With the manual alarm it is so loud you cannot ignore it and it cannot be shut down except for a short interval.  It may drive you crazy but you can bet it can't be ignored.  Following.

[Blood Bank FTE's]

Thank you for those who have commented.  Are you including the supervisory FTE as one of your daylight FTE's? 

[Blood Bank FTE's]

I would like to hear from some smaller hospital transfusion services.  Anyone with a 250-300 bed hospital how many FTE's do you have for Blood Bank?  There seems to be a break point at which you cannot move below if you want to provide full service.  I would like to hear how you are meeting the current challenges we face as a small institution.

[Confirming order before issue]

At our facility the nurse who transfuses has the responsibility of checking the physician order on the chart.  They present a requisition for the unit of blood to the blood bank however prior to coming to check out the unit the RN is responsible for checking for the physician's order.  The Blood Bank issues units to ED, OR etc which may never be transfused, so it makes sense to place the responsibility with the parties actually performing the task. 

[Time Elapsed between Issue and Transfusion]

We currently have a policy that a unit of blood or product should be transfused within 4 hours.  Does anyone have guidelines as to how much time can elapse between issue and hanging the unit of blood?  A nurse returned a unit a few weeks ago stating she would not hang the unit because it was issued over 30 minutes ago.  Needless to say the product was wasted.    I have not been able to find a standard governing the time between issue and hanging of a unit.  Any one have a procedure or standard for guidance?