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Posts posted by velliott
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Also let me add....this was an error. The original antibody screen that was reported as negative is actually positive. The pre sample was D, C and Fya and maybe E. The other scary scenerio is that the pre sample was still an indate specimen and an additional unit could have been added to it. The tech thought the sample looked hemolyzed and asked for another specimen to be drawn. So we could have given another incompatible unit.
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At the end of the tranfusion the patients temperature increased 1.8 degrees F. The patient has multiple issues one in which is HIT. The physician thought the patient was septic because they had been having febrile episodes during their hospilitization. The patients pre and post HGB were the same and the physician wanted another unit. We collected a new sample that was grossly icteric.....and the saga started. It appears that the only "immediate" symptom was the temperature.
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We just had a hemolytic transfusion reaction with a negative DAT and eluate. The antibody involved is Fya. The patient also has an anti D and anti big C but did receive an rr unit. Will the DAT become positive over the course of several days or has the unit already been competely hemolyzed and the DAT will never be positive? Another point the unit was transfused during dialysis and would this also be one of the reasons the DAT is negative? Also another question do you only, immediately, report a hemolytic reaction if there is a dealth? Is this currently on the list of "nevers" that Medicare will not reimburse for ?
Thanks:cries:
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Joint commission says that all staff that transfuse have to have competency. They also need to recognise signs and symptoms of reactions. If we send someone in an ambulance to the heli-pad we send one of our nursing staff to monitor the patient since they have had competencies and then they try to get the unit in before they hand them off. If by chance the staff has to take them with the unit hanging I hope an inspector would understand that it is a life and death situation. It's been my experience that helicopter staff have competency for transfusions. I don't know if this is something that is unique to my area or not.
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Most of the literature for "enhancing" antibodies talks about increased serum / cell ratio. This would be one such technique such as enzymes etc......
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Can someone tell me how you handle this standard in your SOP?
Interpreation criteria shall be established to prevent mistyping of Rh negative patient as Rh positive due to exposure to Rh positive red cells.
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So, what would you do? Only give O red cells? Just exactly what is CAT?
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We put the "sticky" label on the bag at time of issue. Do you really think a label on a platelet bag for 1-2 hours, during the infusion, could make a difference in the platelet viability? I also would be interested in see a reference to the type of glue we're suppose to use.
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We allow any employee, that has been trained, to pickup blood which includes nursing assistants or LPN's. All these employee go through orientation on blood administration and transfusion reactions.
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Also another comment. We dispense RHIG out of the blood bank. Once it is ordered we can make sure it is given. I've had to fight for this also but my story is that there have been 3 instances in the past 6 months where it was obvious someone who knew what the reasons for administration needed to be in control, e.g. blood bank.....
1. wrong dose - ED wanted a mini-dose. We stopped stocking mini-doses because of patient safety....everyone gets a full dose. The ED physician insisted on the mini and had many conversations with the techs.....the patient was 16 weeks.
2. inappropriate dose - patient had been an anti D titer of 128, we had performed titers throughout her prenatal....the floor wanted it because she was RH negative...didn't have a clue she didn't need it.
3. missed dose.....patient was discharged and dayshift found the injection in the refrig from the day before...patient was called back in to get her dose.
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Most of the policy for making sure RH IG is administered goes back to the OB floor. I've always worried about this standard and we currently do not have anything in place in the blood bank to make sure patients get their dose. I guess the LIS could write a crystal report that would include all RH negative patient's tested within the past 24 hours. Staff could then check the report and then see if the dose has been ordered.
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We record room temperature once daily but we have thermometers that store the min / max for the past 24 hours. You know there is cryo that is already pooled and all you have to do is thaw it.....would the expiration for that be 24 hours, since you're not pooling?
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Same as Malcom....there isn't a place to record additional controls...only on the original specimen.
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Donor hemovigilence tracks donor reactions and errors in the donation process. Patient hemovigilance tracks patient reactions and errors in the administration process. In the U.S. they will be tracked on two completely different computer programs. I don't know how other nations are tracking them.
I'm in the US....what computer programs or inspecting / accrediting agencies are this tracked for?
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I am not aware of a donor hemovigilance, can you enlighten what you are referring to?
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I had an AH HA moment last night and realized you asked about validation not calibration. We did not validate ours......because you are comparing apples to oranges if you use manual versus electronic. You know whats also ironic? We are a donor service inside a hospital......we do more maintence for our BP cuffs than nursing and they are using their for diagnostic purposes. Our calibration makes sure the instruments are in tolerance. We also do the same thing with our manual cuffs, even though we do not use them routinely to check BP. We put them on the donor's arm instead of a tourniquet. Every 6 months we check the bladders, tubing, bulbs etc and make sure they perform as expected.
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I also would like to mention that 2 people can be checking blood pressures on the same person, different arms at the same time and get different readings. We were a little skeptical at first....but remember everyone else monitors BP electronically...e.g. OR, ED etc.....no one in a hospital does manual BP anymore. We were also looking for efficiency and ways to move donors through faster. You can check a BP, temp and count their pulse in the minute that a hemotacrit is spinning (we use Hemestat).
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Yes, we use electronic BP / temperature instruments. We use Critokon and Welch Allyn. There are calibation keys to check the temperatures and there is calibration check for the BP. The calibration checks is for linearlity and for the transducers. :clap:The calibration keys and calibrator are calibrated yearly by an outside service.
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Would you by chance be an AABB accrediated blood bank? You can report quality issues to them. If you're not AABB isn't there a way to report issues?
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I'm pretty confident that if you went to an Echo with a tube back up you would never need to worry about your work load out growing it. We are a 300 bed facility and have only rarely over whelmed our Echo, maybe twice since December and then it was only for a short period of time until things settled down, maybe an hour or two.
:pcproblem
Hello John,
I am the process of purchasing Immucor and wondered since you have been using the ECHO for over 2 years if you are still happy with your decision? I am also wondering if you would share some of your process issues with me?
Thanks in advance.
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I divide up my survey and give a different sample to 5 or 7 techs depending on what the educational challenge is. I'm inspected by FDA, AABB and the Joint Commission and they have made comments about this practice. Especially on the transfusion challenges you want to make sure all your techs are performing unknowns.
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I bet your patient has ITP and they gave them IVIG, which alot of times is contaminated with anti D. I had a similar experience and the tech also didn't understand.
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The cost for a Raycell, X-RAY system, is around $300.00....but if you've had the security nightmare and all the regulations we have to go through most facilities would take up a collection to get the gammacell out of your facility.
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In my facility we require all blood bank specimens to be hand-written. The main reason is because long names will not print on the Sunquest label. Yes, we do require a full name. We also require the MR number, DOB, location ,date / time. We place an additional blood bank armband on the patient as another identification system. I have had many heated discussions about collection of specimens and other collection areas are not allowed to collect specimens for blood bank because they just don't get it. I also tell them we are the only facility in our area that has not had a near-miss. We do not accept names that are not perfect, no exceptions, they must be re-collected. Are your phlebotomy managers lab or nursing trained? One of the things we do when we train new phlebotomist is bring them into blood bank and show them what we check when we get our specimen. It shows them how good handwriting is a must. We also show them a unit issued and then I go with nursing to the bedside to check and hang the unit. Sometimes its hard to know the whole picture. Now if you issue blood thru the pneumatic tube this might be an issue.
Another point...we had Joint Commission watch a transfusion. When the nurses checked the unit one was at the patients armbands and the other nurse was checking on a bedside table. The patient was in a private room. The inspector threw a fit because the 2nd nurse wasn't "at the bedside". She was maybe a foot away. :mad:
Hemolytic tranfusion reaction
in Immunohematology Reference Laboratories
Posted
The plasma is the classic brown / green plasma....the unit was Fya positive.