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April 2024 Challenge

DOGLOVER

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Everything posted by DOGLOVER

  1. DOGLOVER
    We use 2 packs at -30C and 1 pack at 4C with Playmate coolers. We make them come change out the packs at 6 hours even though they hold the temp considerably longer than that.Some of our older ones were OSC Cell-Safe coolers, which were really Playmates. (can't get them anymore)
  2. DOGLOVER
    We don't have that lot, however one of the other facilities in our system has been complaining about cell 2. We have VSS518 and have had several of this type of reaction with cell 1 (Mi(a+). Seems kind of strange.
  3. DOGLOVER
    If you are a small hospital are you part of a larger sytem? We are a 4 hospital system and we run C3s for the 3 smaller facilities, if needed rather than them sending it to the reference lab. Or could one of the facilities that your "once a week" pathologist is associated with, run them for you? This is way more cost effective than reference labs. Sorry Malcolm
  4. DOGLOVER
    Thank-you Cliff. Let us keep their families in our prayers.
  5. DOGLOVER
    If you had no sample and the anesthesiologist had asked for emergency issue blood, he/she would have delighted to get group O and would not have worried about it a bit, even if you had given 15 units. Unfortunately physicians are not trained very much in transfusion medicine. My daughter (a family practice physician) told me everything she learned about Blood Banking she learned from me and nothing from medical school ( a top school in the northeast). she now says if she has a question she just goes to the blood bank supervisor (trained her well, didn't I?).
  6. DOGLOVER
    All sickle cell patients (if we know they are sicklers) will get HGS neg rbcs. They will also get rh and Kell matched. If they have an antibody then we full phentoype match as much as possible. The majority of our sicklers come from the pediatric sickle clinic so there is never a question. Once in a while an adult sickler, who has been hospital hopping, may show up in the ED without us knowing they are a sickler. For anything else, it is up to the physician to order. Once we get an order for irradiated we enter it into the LIS and it stays there forever unless we are told that it is no longer necessary. CMV neg except for CMV- transplant cases must be approved by the pathologist and then would go into the ccomputer. Everyone gets leuko-reduced and neonates all get irradiated. Everyone gets irradiated platelets (we were having to much trouble with separate platelet inventories, and pretty much everyone except surgicals needs irradiated plts anyway.
  7. DOGLOVER
    If the patient had 2 blood types from different samples on record, the other type could be from a past admission, we would do an immediate spin xm on type specific blood and issue it. Forget the emergency issue, the paperwork would be more trouble than the immediate spin. If we did not have a 2nd type we would simply do the immediate spin on groupO blood. We do not require a 2nd type when the patient types as group O. j Of course, for the above to work, the patinet must still have their BloodBank armband in place. Merry Christmas everyone.
  8. DOGLOVER
    I'm not sure what my facility has done, however I will check. About I was working in a facility that went bankrupt and closed in 1999. At that time the court mandated where the records all went (Iron Mountain, I think) and it was funded by the court allocating the funds from the bankruptcy proceedings. Interestingly, a week after the closure there were 2 lookbacks which I was called back to look up. At that point nothing had been moved so it wasn't a big deal (paper records). Have never heard from anyone again.
  9. DOGLOVER
    Yes, let them know. If they end up changing his blood type with the transplant, things can get a little confusing anyway, and it would be helpful to them to know of any past issues.
  10. DOGLOVER
    What CAP standard was cited to show that it is Blood Bank's responsibility (rather than nursing) to monitor the filling out of tags or EMR seeing as the completion of these is a nursing function?
  11. DOGLOVER
    Hi, Just wondering, how do the rest of you handle anti-Lua? Our reference lab says it is clinically insignificant and shouldn't be worried about seeing as no typing sera is available. The scenario is this: 16 year old, sickler, on chronic transfusion therapy. We have had hime for 9 years, he has multiple antibodies and made Lua a year or so ago. It is no longer serologically demonstrable. We give him phenotype matched for everything else. Should I ignore the historical Lua or keep scrounging for blood which has at least been typed some time in the past for Lua? Thanks
  12. DOGLOVER
    We do not accept a type from another facility unless it is one of the facilities in our system of 4 hospitals. We have computer look-up access to all of the 4. Otherwise it gets done again prior to surgery. If the patient came in for pre-op testing prior to 3 days before surgery the PACE nurses draw and order an ABORH confirmation sample. (We don't expect them to figure out if one will be needed or not). If within the 3 days and they do the Type and crossmatch we let the OR holding area know early in the AM who needs the confirmations drawn. Our medical director backs us on this and thats what makes it work.
  13. DOGLOVER
    I just tell the nurse that this uncrossmatched and if i her I wouldn't be hanging it without the physicians signature as then she would be repsonsible. This tactic works very well.
  14. DOGLOVER
    Yes, it is a completely separate test. We built the Confirmneed question as a detail into the crossmatches so that anytime we answer a crossmatch it asks if we need the confirmation. If we answer yes it automatically orders it. Also the pre-op nurses order it if they are seeing the patient more than 3 days out from surgery. Than at least that is already done when we get the type and crossmatch the morning of surgery. You may need to have your LIS person consult with Meditech as to how to do this so there is no conflict. As our chemnistry PHD person says" if we can imagine it, the computer can be made to do it". Good luck.
  15. DOGLOVER
    We created a test in our LIS called ABOCONFIRM which is a forward type and Rh only. We can order and run it on a hematology sample from a different draw time or if we answer YES to NEEDCONF? the system will order it and a label will print on the nursing unit. We are using Meditech so I don't know if that is an option for you. We use Cerner Classic.
  16. DOGLOVER
    I agrre, if you can't pre-warm it away, you need to consider it clinically significant. One caveat, antibodies don't always read the book about how they are supposed to behave. We have one kid who has an anti-M that pre-warms away amd dpesm't even always demonstrate but if we give her M+ rbcs the survival time is way shortened. sometimes you can't win. Malcolm, I am glad no one was hurt in the fire and hope you will be able to get your life back together soon.
  17. DOGLOVER
    I see Malcolm has posted a very helpful article. I agree, most have been doing this for 20 years at least. I think in addition to giving your techs the article to read, you really need to take the proverbial bull by the horns and with your medical director say that "this is the way we are doing it from now on." You are the leader and as such, you make the decisions and as was pointed out above, everyone needs to be following the procedure and not doing their own thing. That will get you on an inspection.
  18. DOGLOVER
    You will need to find out the state requirements for your area. Also, are you planning on being AABB and/or CAP inspected? Check their standards. Does your local blood supplier have a reference lab that would be willing to let you have some known samples? Also is this a part of a whole new facility or is the facility part of a system? If you are part of a system and are using same procedures and equipment you are in luck. This is quite a challenge, but should be very rewarding. Your vendor for the Gallileo should also be able to help you.
  19. DOGLOVER
    I worked with him at MGH back in 1999-2000 and he is great. Hope to run into him at AABB.
  20. DOGLOVER
    Sadly, it doesn't look like I can make it. Will not be arriving in Boston until late Fri eve. Sat and Sun my daughter (lives near MIT) wants to spend time with Mom (I want to spend time with her too). Mom would probably be the only possibility and it looks like Fri is the best for most everyone else. I'm sure we will be in meetings together and not even know it. We need some kind of special badge or something.....
  21. DOGLOVER
    That is the minimum. I am not sure what the average is, but is higher than that. If it is 2.8 or 2.9 it is considered for pediatric use only. Our supplier sends those to us as "extras" because we have the children's hospital and can usually use them up.
  22. DOGLOVER
    I write up all FDA reportables for our system, but I have each facility set up with them as their own entity. So, am not reporting variances as a system. The tech specilists in each of the other facilities give me all the info on any reportables and then I write it up.(lucky me)
  23. DOGLOVER
    We give AB or if not available, typecompatible for neonates. Kids under 12 get ABO compatible or AB. Adults get type compatible if possible, although because we have so many kids getting platelets often the adults end up with Group O. No problems. We give Rh negative to Rh negative females of childbearing potential. If not possible we offer Rhogam.
  24. DOGLOVER
    Our surgeons usually order 1 apheresis unit for regular CABG's and 2 if it is a redo or if it is a PLAVIX situation. We keep them in the BB and do not dispense unless and until they are ready to transfuse them. Most of the time they don't use any. Same goes for open hearts on our babies "1 apheesis" unit usually used when they come off pump. If a surgeon orders 10 plts we simply give them 1 apheresis unit. If there is a shortage of platelets we call the CVOR first thing in the morning and make sure they know if they use on one case they may not have any for the next.
  25. DOGLOVER
    Our local blood center does it for us. Nursing calls them and they come do it. We have an apheresis team of nurses who do plasma exchanges, red cell exchanges, etc and we thought about giving it to them but for various reasons decided not to. It works well the way it is being done.
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