Deny Morlino

I seem to recall in my sievelike memory a discussion of PEG adsorption. Anyone care to offer some details and possible pitfalls? For whatever reasen I seem to remember David Saikin as associated with this post. Any help would be appreciated.

I just reread my reply and guess I should clarify. The RN signs the release for having been issued the units. The physician signs as to the necessity of emergency release, the number of units, etc. Sorry for the confusion.

Oh no problem Malcolm. I understand the sieve-like feeling. I am trying to decide how to proceed. The only copies I have been able to find for sale are used and start at $500!! I did find an option to download the book a chapter at a time for about $32 each, but hate to pursue that route if it can be avoided. Thanks for any help.

Whatever is necessary Cliff. I am certain maintaining this site is very time consuming. Thanks for all you do.

Nursing signs at the time of unit issue. If the doc is available we get that signature as well. Most times the physician is a bit "preoccupied" with the patient's care. After things calm down a bit we approach the physician for signature. This works well for our situations.

Thanks. If you learn anything please let me know.

Malcolm, I looked for the text you mentioned. It is out of print. Do you have any idea or any way of finding out (you seem to have an extensive network after all) if there is another edition in the works? The brief excerpts I could find looked promising. Thanks

Welcome Antti V!

We do this in difficult draw situations. No adverse results in over 20 years to my knowledge.

WHAT!!! People are amazing!

We handle it the same way as Bill. Be conservative, do the workup.

I would err on the side of caution and consider it clinically significant.

Goodness Malcolm!! Hope all are OK! Sorry to hear of the damage. Prayers for your family and neighbors.

Same as rcollins. Techs working 3rd shift usually handle the discard of urines. Stool samples occur on the fly as they are set up.

Make and stain a smear looking for platelet clumping. If present consider a recollection advising phlebotomy to collect a sodium citrate specimen in addition to the normal EDTA specimen in case of EDTA sensitivity in the patient. If the recollected EDTA specimen still demonstrates platelet clumping, run the citrate sample and correct the platelet result by multiplying by 1.1 for dilution correction.

Kathy, First breathe. From your presentation you seem to be very focused and a perfectionist to an extent. This is a mixed blessing as you are meticulous about the details, but drive yourself crazy at the same time. Relax (I know easier said than done). The end game of the inspection process is to improve patient safety throughout the transfusion process. With that approach in thought process none of us are perfect or do everything correct all of the time. With 20 years of experience and 18 months as chief tech, you are going to handle the process fine. Inspections are intimidating until you have been through several. The point of the inspection is not (usually) to pick apart your facility. It is to point out the places where there is room for improvement in your processes. Hang in there. I am sure you will do fine.

Welcome Ravi!! I must agree with you about the site.

It would be great and I would increase my knowledge 100 fold, but I suspect my brain would hurt!!

Eoin, I had a meeting with the medical director from our area Red Cross in July and this was one of the topics we touched upom. He was adament that we should NOT be involved with this in any way. As long as the salvage and re-infusion occurred entirely within the OR setting and we were not involved there was no processing associated with manufacturing (I think) to be recorded. If blood bank became involved or the process spilled over (pardon the pun) from surgery things become much more complicated. Stand your ground.

At best I count myself as a nerd want-to-be as I have too much to still learn!

I partially agree and partially disagree. While it is true we can't "tie a patient to a bed" I am forced to question how desperate was the need for the transfusion if the patient was able to walk out to his car for a smoke break. From a liability point of view the possibilities boggle the mind!! Any number of issues may have suddenly arisen during the transfusion! Because of the frequency of blood transfusions we are ALL numb to the seriousness of the process. I remind all of my students and any new nurse that a transfusion should be treated as the equivilant of an organ transplant. With that mindset, a patient should be limited in their travels during and immediately after a transfusion FOR THEIR SAFETY. Healthcare needs to be a partnership between the patient and the caregiver(s). If the patient cannot abide by some restrictions during such an important process (transfusion), then the transfusion would not occur and I would pull the physician in to discuss the issue with the patient. I would involve the Risk Management group in the discussion prior to waiting for the transfusion committee meeting. Be prepared for risk management to throw a fit about the liability (as well they should). Keep in mind our job is to try to heal patients with the procedures we perform. The patient's safety during these procedures should be a priority. OK, off of my soap box now.

We have been with API for many years.

Nursing handles the procedure.

Welcome!

Welcome Josephine! When nursing poses the question you described, explain that the unit is returned with the temperature below 10.0 C so it can be stored for future issue with reasonable assurance bacteria have not grown in the unit. The 4 hour window is for the same assurance, but applies during transfusion (blood will not be reissued).