lwalton

We are just finishing up a JC inspection today and may or may not be cited for our blood issuing practice. The concern has nothing to do with how we check the patient and unit identification, but rather on our infection control process. Our lab policy/procedures state that the Blood Bank, as part of the clinical lab, is a biohazardous work area, so therefore we wear lab coats and gloves. The inspector had an issue with the tech signing out a unit of blood while wearing gloves. Our practice is to put the units into plastic Biohazard bags, but because the tech did not remove his gloves, it was felt that now the Biohazard bag was contaminated and we were endangering the transporter and others down the chain as the blood is delivered to the nursing unit. Has anyone else been cited for this? What are your blood issuing practices, from an infection control point of view? We are thinking that we will have the transporter pick up and open the plastic Biohazard bags and then the Blood Banker can just drop the unit into the opened bag. Hopefully that will suffice. I'm very curious as to what others are doing. I've never been in a Blood Bank or any section of the Lab where we were cited for WEARING gloves, but I guess I can see the concern from an Infection Control aspect. Regardless, it looks like we need to come up with some sort of corrective action.

We are also struggling with this issue. We have prepared a reconstituted product 2 or 3 times in the last 14 years since I've been at this facility, and at least one of those was not transfused. We struggle with the concept of maintaining staff competency for a procedure that is done so infrequently, however the director of our NICU does not want us to remove the policy/procedure, "just in case". At this time, we have a policy/procedure in our manual but we are not FDA registered as we don't perform any other procedures which would require registration. I guess we're living dangerously. One of our sister hospitals was told by their FDA field agent that since they also did it so infrequently, registration was not necessary.

My hospital recently purchased the Aeroscout system. At one point I was asked for some information regarding Blood Bank requirements and I took that opportunity to suggest several other vendors that I know are familiar with our requirements (having never heard of Aeroscout). Regardless, they purchased the Aeroscout system. I later arranged a conference call because I wanted to know what other facilities were using their system in their blood banks, what kind of validation support they might offer, etc. When I asked for a local reference (I live in California), they referred me to a hospital in Sao Paulo, Brazil! Needless to say, they are newcomers to this industry. I volunteered to move the blood bank to the second phase of our installation; to my knowledge they have had multiple problems with phase one and are still not getting reports (it's been several months). Wish I had something positive to say as this will be my system, but so far, not so much.

We are finding the Echo to be very sensitive to Kidd antibodies. Just recently we had a patient test negative in tube/PEG but who had a 3-4+ anti-Jk(a) on the Echo. This is not the first time, just the most recent.

Are you using Safe-T-Vue 6 or 10? And how did you validate them? We tried using the Safe-T-Vue 6 but didn't like them in practice, although I love them in theory! Thanks.

Thank you both so much for your responses! PAWHITECAR, do you also use CPD units?

Does anyone have a protocol for use of ECMO in adult patients? What products and how many are used for priming the circuit? Do you send blood up in a cooler when the patient is first put on ECMO? Any info would be helpful. Thanks.

Has anyone tried using the Traceable infrared thermometer for taking temps on red cell units returned in the coolers?

Am I the only person out there who has trouble reading the Safe-T-Vue monitors? No, actually I know I'm not the only one, because my entire staff had trouble with them! The brochures show a very clear white and a very vibrant red, but all we could see were shades of pink! We thought they would be the perfect indicator...available in 6C or 10C, non-reversible, etc., but we weren't happy with them so are now looking at HemoTemp II and temperature data loggers.

Actually you can enter multiple apheresis FFP "parts" with the same DIN and same 5 digit product code in Meditech. Meditech doesn't really do aliquots/divisions the way ISBT intends, but they do have a work-around that is feasable. Meditech can capture first and second level divisions, so all you have to do is bring the parts in as first level divisions. I just tried it in our test system and it worked just fine. I have the ISBT products built as the 5-digit ISBT E-codes, for instance E0898 is FFP APHR ACDA <200ML. If you bring a unit in as a first level division, Meditech will capture the A in the seventh character (E0898VA0) and bring the unit in as W200608062601A, for example. You can then bring in the next part as another first level division, W200608062601B. The information is all trackable in the system; look at the E/E Other prompt. We were very confused at first too because we were also under the impression that Meditech only used the first 5 digits of the product code. But they put on some seminars that better explained it. The information you need to read the last 3 digits of the product code is hard-coded into the enhancements that provide ISBT-capability. That's why you don't need to include it as part of the product code. We have built 110 ISBT products and have found Meditech to be quite workable overall.

We purchase custom labels from Shamrock, but will eventually move to printing our own on a Digitrax printer post ISBT implementation.

We have recently begun using FP24 at our facility, essentially as a substitutable product for FFP, but with a few exceptions. At the same time we have also gone to 5 day dating. When we thaw FFP, we assign a 24 hour dating; if not used, we relabel the product as Thawed Plasma and add an additional 4 days. If we thaw an FP24, we call it Thawed Plasma and go directly to 5 day dating. We have just started this new process, so we are still experiencing something of a learning curve, both on the floors and within the Blood Bank....despite a huge training and communication effort. Hopefully things will settle down shortly. In the long term, we hope to decrease the wastage we have seen in the past.

When we submitted our next year's budget figures we included a spreadsheet provided by our Ortho rep detailing the price increases. Our finance people initially thought the figures were a mistake, and were shocked when they realized it was not a typo! Our 2004 costs were in the $5000 ballpark; our projected 2005 costs will be near $50,000! If we switch to an Immucor 90% agreement, we can bring it down to around $35,000.

Thank you all for your input, although now the issue appears to be murkier than ever! Appropriate for the kind of day I'm having..haha! Dr Werch, do you have any references you can point me towards regarding the viability studies? I can always be conservative and go with the 4 hr limit; generally we make aliquots immediately prior to use anyway. However, it's always nice to have a little breathing room for those times when things don't go as planned! I was originally hoping to go with the 24 hour manufacturer recommendation; am in the process of trying to obtain information from them regarding the basis for their claim.

Not that straight-forward, sorry. My fault...I forgot to mention that we are using a sterile connecting device, so we have a functionally closed system. If we were making aliquots into bags with the SCD, the aliquot would retain the primary unit dating. I believe the syringe set manufacturer states the 24 hour limit due to the change in O2 permeability of the syringe. I just want to know if anyone has any independent references on this. Another hospital that I know of applies a 4 hour limit to syringe aliquots created this way, despite the manufacturer recommendation of 24 hours.