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Posts posted by DOGLOVER
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I do not think it is reportable as it was not a Blood Bank error.Nursing may need to report to someone, depending on the state you are in. They certainly need to do a root cause, but as long as the BB issued appropriately (issue slip from the floor, or whatever you call it) then you are really not involved.
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Iwould not wash for one reaction. If pre-meding (new word) doesn't work and the patient continues to have febrile reactions then maybe washing could be worth a try. Is your doc that requested it, an experienced Blood Banker or was he/she just covering? In 35+ years of Blood Banking I have only seen two or three patients that required washing. One was IgA deficient and the other had febrile reactions and most everyone thought that the resutls were mostly in her head anyway. Kind of like the A pos patient who said she got reactions to A neg blood and that God tole her not to get any more A neg units. Who were we to argue? Made sure she always got A pos.
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Our supplier uses only male plasma but due to supply problems our platelets (we get all apheresis plts) are from both male and female. They couldn't meet the need using only male plt donors.
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When reporting CAP proficiency tests for all other areas of the lab we order the test in the LIS and report. For blood bank we do not do this because of the needing to use a unit of blood. Should we be creating fake units so techs can report their proficiency tests into the LIS?
Thanks!
The gen lab orders and results CAP or API samples in the LIS (Cerner Classic) but in the BB we use our paper downtime system. I have never had an inspector even mention it. It also is a way of making sure people are proficient with the downtime system. Results are entered on-line to CAP and API.
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Sounds like fun. I will be arriving Sat., Sat night sounds good. I will be trying to spend time with my daughter (lives in Cambridge) but want to meet you guys. How about Union Oyster House or the North End.? Both are so Boston..
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We went live with Cerner hospital wide MAR in Feb. Definitely a learning curve involved but really went pretty well. We still give paper tags to the OR's because they say they don't have time in an OR setting to put the info into the computer. It is scanned in later. We also supply blood to a pediatric outpatient clinic and they are not on our system, so they still get paper. Tricky part for us is that nursing is on Cerner Millenium and the lab is still on Cerner Classic so we are not seeing the same screens they see. Also, different areas set their screens up differently. Makes it a little difficult to help them with ordering questions.
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Welcome, this is a great site. I have many fond memories of a week in Ireland, starting in Dublin and ending in Shannon about 11 years ago. Beautiful country and friendly people.
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If you are using these surveys to meet regulatory requirements you need to be also getting a survey which covers the manual work you are doing. It sounds like you may also need the comprehensive blood bank survey. Call CAP for advice..
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Why were you doing gel crossmatches if the antibody screen was neg? Was there antibody history? Did you run a panel? Did you try other enhancement media such as PEG?
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Everyone gets leuko-reduced (CMV reduced-risk). If CMV neg is required the physician must order it and if it is for other than a progenitor cell transplant patient who is CMV neg and receiving a CMV neg product it would need to be approved by a pathologist.
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1 degree C = 1.8F, so if you are using 2F now, you can switch to 1 C. See AABB Technical Manual 17ty ed page 728. Good luck with the new computer system.
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We do ABO/RH and DAT on cord blood. If baby needs blood it is done from baby's sample ( just 2 little hemettes) and is good until 4 months of age no matter how many units are given. All neonates receive group O red cells except for the rare occassion when we have to deal with a directed donor. We get a lot of transfers so don't have Mom's sample, also cord blood labeling has the Mom's sticker and ID on it rather then the baby. If Mom has an antibody we would be using the Mom's sample for antibody ID.
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If you have a low incidence antibody/ies do you just use crossmatch compatible red cells or do you request antigen negative? What if the antibody is historical only and not currently demonstrating so that you cannot trust the crossmatch? (the blood center does not have Jsa typing sera, patient has anti-Kpa, Cob,Jsa as well as E and S. 52 year old sickler who evidently did not get phenotype matched blood earlier in her life. Thanks for the input.
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I see in one post above where someone has a policy about gel typing for D having to be at least 2+. What is everyone doing about tube typing. Do you call 1+ positive or do you require a weak D test be done if under @+. We are having a discusiion about this with some disagreement. Thanks for the input from this great group.
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I guess we are being backwards. we are still using them. When the unit is loggedin, the computer prints 3 stickers. One goes on the unit which has the # and the product code(ex. R1MJ). The techs like seeing the product code as it makes it easy when choosing units where it has been a double donation. Then we use the other stickers to label 2 segments, one for saving and one for typing. After reading this conversation, we will discuss possibly changing our process and saving a little money.
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What are peoplel using for coolers to transport blood to OR's ED's, etc. We have used the CELL-SAFE coolers by IGLOO but they don't appear to be made anymore. 10 of them fit between the freezer and the wall and they work well. Problem is , they are getting old and the tops don't stay in place anymore. Just slip and slide around. They came with validations, I am thinking about getting some PLAYMATE coolers and validating each one individually. They appear to be the same. Has anyone used them. Thanks in advance.
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I would not want my techs to empty blood in sink. If we have broken plasma bag, we let it drin in sink before placing bag in plastic bag and then we send it for autoclaving.
Nursing units dispose of empty bags. We only get it back if there is a reaction. We drain leaking (broken) plasma bags in a dirty sink. The waste from washed units goes in the bio-hazard containers. We were told not to drain it into the sink. Easier for us anyway.
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We are doing a lunchheon fund raiser for "Dreams Come True" to benefit kids with life threatening illnesses. It is appropriate for us seeing as we have a Children's Hospital. In another lab, (another life) about 15 years ago we did a lab cookbook and donated proceeds to a local charity. It was done in the format of a procedure manual and sold around the hospital. I liked the time line idea.
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We were inspected by FDA last fall and this was not brought up. The tag and label all print out together. We attached the tag with a TACHIT gun and stick the label on around the segment tail so it sticks to itself. 3 weeks ago we went live with the EMR so now we only put the label on the unit. Everything else is documented in the EMR so we would only use the whole tag during computer downtime. Satellite facilities put the tag on if the patient is being transferred to us (main facility) (for use in the ambulance or helicopter) and that would then be scanned into the EMR.
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We send them to our reference lab, where they do an absorption and crossmatch for us. We do not require phenotypically matched except for sicklers (who interestingly make up the majority of our warm autos). Sicklers who have made an antibody get full phenotype if possibe anyway. Absorption is done every time. If we can make it go away with PRG we will do that.
Malcolm, do you know what the mechanism is of sicklers making warm autos or a reference that I can use for our antiboyd writeups in these cases? Thanks
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I think this would be very hard to regulate and determine who was competent. I am guessing you are talking about using staff such as phlebotomists to issue blood. I have had some phlebotomists I would feel totally comfortable issuing blood and others I would not. How could you justify letting one issue blood and not another one.
We have a dedicated lab assisstant in the Blood Bank on day shift who we have documented training and competancy for dispensing blood. Question Who do you allow to pick up blood? RN's, associate care providers, volunteers, OR techs. How do you document training?
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For pedi-bags we use the original outdate. For syringes we use 4 hours. These are sterilly connected.
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Poor baby Why put the poor mite through the trauma if you don't need to? We take a cord sample at birth then crossmatch against a maternal sample if crossmatch is needed. I will add again that a newborn antibody screen/crossmatch is not required at birth as all the antibodies are maternal...
Also you are more likely to get a decent sample from the mother, than a traumatic heel-*****. Which, I would like to add, saves events from happening like the OP described.
These generally are not heel sticks but are drawn from a line. We do not crossmatch the infant, only a type and screen until 4 months old. Then reserve a unit and its good until it outdates. I think it probably started that way at this facility because so many babies in our NICU are referrals. We use gel and really do not use very much sample to do the TSG. This was also pretty much the same way we handled it when I worked in Boston.
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I would be interested in finding out what your final conclusions were. Sounded like junk reactivity maybe due to the infection. Were tube reactions neg? We also use baby's sample routinely for newborn type and crossmatch even if Mom is available. Only use mom if more sample is needed for antibody ID then what one can get from a newborn (usually a tiny preemie in the NICU).
Why put the poor mite through the trauma if you don't need to? We take a cord sample at birth then crossmatch against a maternal sample if crossmatch is needed. I will add again that a newborn antibody screen/crossmatch is not required at birth as all the antibodies are maternal...
Post-transfusion testing
in Transfusion Services
Posted
We ask for a 30 min post plt ct if we are using crossmatched or HLA matched plts due to refractoriness. Otherwise we don't do this. It is a challenge to actually make it happen, as we do not have a laboratory phlebotomy team for inpatients. Nusrsing does the blood draws so it is difficult for us to control what happens. But, we try.