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Posts posted by DOGLOVER
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What do you mean by non-BB personnel? We have a BB lab assisstant who we have very successfully trained to log in blood, dispense blood, wash red cells, and various other tasks that do not involve actual testing. This person was trained as a pharmacist in another country a long time ago(which training did not qualify in US, but shows her education level). I feel way more comforable with her, then I would with a med tech from another dpt who doesn't do BB very often. That being said, there is a valid point about only having one med tech in the BB on off shifts. This is common at night, including my facility, due to cost constraints. We did have a tech pass out once from an insulin reaction on the weekend. He had not shared the fact that he was diabetic and hadn't made sure to have emergency food handy. Also had one tech, recently end up admitted to the coronary floor after passing out. Fortunately he was not alone at the time. It is a risk that unfortunately many of us have to live with. We do have an on-call person on the weekend from 7A to 7P if things get to out of hand.
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We do a second type on everyone who has no historical type at any of our 4 facilities, unless they type as goup O.
Usually we can find a hematology or chem specimen that was drawn at a different time, so we use that. Pre-ops have to be done the morning of surgery. The cardiac ORs have gotten pretty good about calling and checking before they send someone to pick up blood. For pediatric OR they usually draw the 2nd sample after the child is under anesthesia (if it is a young child) and bring the sample when they come to pick up blood. The runner just waits while we do it. Its really quick because all we do is a forward type and Rh.
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It is my fondest hope that my physician daughter did not take what I hope was an elective course in medical school in Arrogance and Intractability.
All physicians should have to work in a lab in some way before going to medical school. My physician daughter did, as a phlebotomist and as a histology assisstant. It was invaluable to her. She also has told me that she learned her blood banking from me and nothing in medical school about transfusion. She also learned that when she has questions to go to the lab supervisors and ask. She told me that lab people know a lot of medicine.
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When I worked in the Northeast we did a 15 degree screen for the CABG's. Where I currently work we do not screen for cold agglutinins for open hearts, either adults or pediatrics.
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Each of our 4 workstations has fresh aliquots of the screening cells each day. The original containers are kept in the fridge. This works well with no degradation or contamination problems.
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What do you consider to be the outdate of saline which has been put in a plastic squeeze bottle? When we open the original 2.5L container of saline it is given a 30 day outdate. Do you outdate it with the carton it came from, the original outdate of the carton, 30 days or something else? Thanks for the input.
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Hi Malcolm, I guess it was so early in my career that it never occurred to me that it was something that would have merited publishing.
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Years ago, I had a patient who had had several fetal demises. Antibody screen was negative. We were sent a cord blood this time and it had a strong pos DAT. Mom and Dad were both B pos so I crossmatched them and 4+ incompatible. I was able to identify the antibody as Cw, so I am definitely a beliver in its clinical significance.
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We get 2 3ml purple tubes. (plastic)
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Anyone clear on the latest guidelines as to what can and can't be billed for FFP's/24 hr plasma and cryos which are thawed (pooled for cryo) which are not transfused. Thanks for your help.
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We also do a type and screen on all OB patients when admitted. That way we are ready for any emergency. We do not repeat the screen when doing a RHIG work-up. We also find positive screens due to RHIG at 28 weeks. We simply verify the date they got the injection and do a simple rule out panel, using the cells marked on the commercial panels.
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We use packed cells. If the child is under 5kg we wash irradiated units. Between 5 and 10 kg they get additive free units(less than a week old) or washed if additive free are not available. Over 10kg they get regular packed cells. Past the neonatal period irradiation depends on if the immune status.
We also use washed for babies going on ECMO or when the ECMO lines are beiong changed.
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A couple of years ago, an FDA inspector told me I had to apply for this variance. So I did and it was granted (of course) in Dec 09. I don't know what the FDA's current rule on this is. You might want to contact them directly. It sounds like maybe this has changed. This came about because many years ago, (showing my age) the outdate for FFP was generally considered to be 6 hours. The FDA just never caught up with the rest of the world.
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Do jyou use your CAP inspection as part of your JCAHO accreditation? If so, nursing is out of compliance with JCAHO. Remind nursing management of this when you and your medical director meet with them. That is more likely to get their attention, then if they think they are just causing trouble for the Blood Bank.
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We recently started charging for the 2nd type. What we do for notification is this, first we look to see if there is a suitable specimen available else where in the lab. If there is, we go get it and we're done. If not, we call the patient's nurse and tell her we need one drawn before any blood can be dispensed. (Nursing draws most of the blood in our facility). Also, we actually have caught people playing the game you mentioned of saving the 2nd tube . I think we pretty much have that stopped. The only problem comes when it is a pre-op patient and the patient won't show up again until shortly before surgery. I try to call the OR's in the morning and notify them and also the CV OR transport people have learned to call and ask before they waste a trip to the BB. Then they can just bring the sample with them and while one person signs out the units and gets a cooler ready, someone else does the confirm type(it is only a forward type). We also put a bright pink card on the units that say they need a confirm type so someone will not inadvertantly dispense them. You do have more challenges having to deal with 2 computer systems. I have worked with that situation in the past and it is a nuisance. Can you get your medical director to really push for an interface?
Good luck in the implementation. It won't be as bad as it seems.
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We have been having a 2nd sample drawn for about 5 years now. When we receive a specimen for crossmatch the BB tech does a historical record search. If we have no history and the patient types as anything other then O we request a 2nd draw. If there is a specimen in heme or chem that was drawn at a different time and labeled properly (date, time and phlebotomist ID) we will use that. The 2 draws must be more than 15 minutes apart. Pre-op patients who will need crossmatching upon being admitted but the pre-op work is more than 3 days out will have a ABORH confirmation ordered and drawn by the pre-op nurses. We can cancel it if there is history. This system is working well. In the beginning we had a few bumps and were called a few uncomplementary names but everyone got used to it. Our pathologist was the driving force and the docs didn't really want to fuss at him. This holds for the ED as well. The only place that is slightly different is the pediatric ORs. They will draw the 2nd sample once the child is asleep and the courier will bring it and wait while we run it and then take the blood units. We only do a forward type so it is quick.
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We use pre-storage leuko-reduced products for all patients except for CMV neg recipients of a CMV neg transplant or those with an immunodeficiency disorder such as deGeorge's. In addition these patients are also getting irradiated products.
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I don't know anything about your system, but in Cerner classic we were able to add a column to answer the IS with the XMG. Works well.
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We give ABO compatible to children under 12 and RH neg to females of child-bearing potential. Because we have an adult and a children's hospital often the adults end up getting ABO incomp due to us saving the A, B and AB for kids. Infants under 4 months old get AB platelets. We use all apheresis products, no random platelets.
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I have 2 Helmer fridges and 1 freezer. I feel like the freezer has had more downtime then a 6 or 7 year old unit should have had. Also have a platelet rotator and incubator as well as plasma thawer, both of which are over 10 years old (length of time I've been here) and they are great.
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hi, I meant matched for D C/c E/e and K/k. I',m too used to just calling it CEKell matched at work because that is how we refer to it here. Forgot that might not be clear to someone else. Sorry.
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We give sickle neg blood to those with the actual disease state. We wouldn't know about the trait anyway. While we do not have a large adult sickle population we do have a large pediatric population and I once asked the pedi hem/onc sickle specialist
about it. We had given a kid blood to a sickle kid without its being tested ( because we didn't know the diagnosis) and just filled the orderas written. She said the main reason was so that as they follow these patients on chronic transfusion therapy with hemoglobin electrophoresis they would get accurate HGBS results and not from a unit which had the trait. It wouldn't hurt them. We also provide c,E and Kell matched if there are no antibodies and fully phenotyped matched if there are antibodies.
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Thanks, the part of the form I was referring to was the transfusionist and witness signatures, vital signs pre and post and volume infused. The other points you refer are on a separate computerized order form. That part is monitored by Clinical Effectiveness. Have a great day.
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Does anyone monitor transfusion forms (whether paper or EMR) for completeness? If so, why? We have done it at my institution since long before I cam here and it was done when I worked in Mass. However, I have not seen an actual requirement to do so. It has come up as we are preparing to make the switch away from paper to the EMR. Logistically it seems kind of hard to look up 1800 products a month to see if they are complete. Relatively simple just to go through returned tags. I can't find where AABB or CAP require this. What about JCAHO? We are thinking it really should belong to clinical effectiveness, anyway. Thanks for any info.
Irradiation Question
in Equipment
Posted
Our blood supplier only puts the sticker on one unit in the batch. They have been doing this for some time, due to the cost of the irradiation monitoring stickers/ So, we just go by what the label on the unit says.