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CM2

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Everything posted by CM2

  1. We purchased the thermoscientific Hera freeze 13cu ft -86C model 8933 cat# HFU240BA, around $13000 with warranty and 7 day chart recorder. It is used mainly for reagent storage and as a backup method for dump freezing stem cells if our controlled rate fails (stem cells need colder than the standard plasma storage temp of -30ish to maintain viability). The door is opened only maybe a couple times a day. We received it 9/13/12 and by 12/19/13 it had a compressor failure which required factory repair offsite. I got it back 2/10/14. Because we had the 3 yr warranty, it didnt cost us anything, but I am still not real impressed by getting 1 year of service out of something that has such light usage. I would not recommend this particular unit. From talking to our facility HVAC guys, I get the impression a poorer quality of manufacture (less insulation, underpowered compressors, etc) is becoming much more common in the units currently sold. Management always wants to spend the least money, and these cheaper units are a response to that niche. So whatever you get, I would definitely recommend the extra money up front for extended warranty/service contract (compressor rebuild on our last freezer cost $5000) -C
  2. They are switching to win7 in our facility also. One unexpected problem we had was with the default settings of login security. When Win XP was left idle for a period of time, it times out to password lock, previously anyone with a valid network windows account could log in (so multiple users could use the same pc). With Win 7 they changed the way admin accounts are structured, now only a true IS admin can boot someone out once it goes to lock. For added difficulty, there are no longer 'shutdown/log off' options shown on the login screen, and going to screensaver now also forces password lock. This means if someone is logged in and goes home or to break, you have to depower the pc and sit through the extended boot because 'windows was shut down improperly' So besides the major issue of whether your bbis is compatible with win7, you definitely need to proactively request from IS to disable screensaver lockout as well as extend idle time to lockout to infinite. Because they do not generally seem to understand the concept of shared workstations common in the lab environment.
  3. Our medical director is over both transfusion services and HPC lab, so if she is notified they have a suspected transfusion reaction to a product (usually a known mismatched product, marrow is the worst culprit with its huge volume/hct), yes, she requests a limited hemolytic workup to be done in transfusion services. It's more of a monitoring panel for severity than a 'find that the patient was misdrawn/wrong armbanded' type of workup. Identity of recipient during a stem cell transplant is so thoroughly monitored backwards and forwards, and they and donors are drawn so many times for ABO confirmation thats never been the source of the problem. Its more frequently something like donor specific proteins in plasma causing hives, or a stronger than normal expected hemolysis to a mismatched product. It's a whole blood product so really any type of reaction can occur. We do purple top for hemolysis/DAT, chemistry tube is sent for LDH/bilirubin/haptoglobin.. i think also bun/crea, urine is sent for positive blood strip/free rbcs present. If they suspect TRALI/TACO they may also request things like chest films, but that is usually initiated in conjunction with the clinical team at bedside. We pull micro cultures at time of issue for fresh products and have a reserved vial of frozen products if microbial contamination is suspected, so that end is usually already covered. I would be very surprised if your center doesnt do these things, it may be coming through a different pathway than your usual, especially if the blood bank is not the first point of contact to notify of problems.
  4. My short answer would be No, it is not necessary UNLESS you have a conflict between your results and the donor workup documents that come with the product. Here in the US, the NMDP coordinates the majority of our searches. We get paperwork from the collection center that screens the donors which includes donor virals and the blood type they got in testing on the donor. We also get the HLA results performed (here in NJ by the sharing network) which also includes the blood type. So you already have 2 separate sources of a blood type which are done with a high standard of accuracy. So if they say A neg, and I test and get an A neg on immediate spin, why would I spend energy looking for zebras? The worst that is going to happen is the patient will receive Rh neg units unnecessarily. It is also possible for a tiny subset of weak D people to make anti-D anyway, so to our minds it is taking the path of caution. If you work in a region with very limited blood supply this might be a stronger factor to consider. But Im guessing if you have the capability to perform bone marrow transplants, you have a fairly robust transfusion service as they can be pesky to support (HLA immunized patients needing lots of platelets comes to mind). A few thoughts. Its great you do the antibody screen, I was suprised to learn the NMDP does not require these to be done on donors, and we had one case where a transplanted patient who was rh Pos suddenly acquired an anti-D, which caused a bit of confusion. We never knew if it was because the transplanted T cells from Rh neg donor decided they didnt like the recipients Rh pos remaining circulating cells, or whether the donor was already immunized from a pregnancy/rhogam greater than a year ago (thats the time frame on donor questionnaire) and already had circulating anti-D in the plasma which was also infused with product. (gel method is so darn sensitive) In any event it did not cause any harmful sequelae/DTR or anything. My other thought is, you can probably save yourself the crossmatch, unless you are at one of the unlucky institutions that still has not instituted electronic crossmatch (patients with a negative antibody screen receive ABO compatible units without a physical crossmatch of serum and donor cells). The hct on products we receive is 4-8% which usually translates to around 20-40 mls of rbcs. Much less than a unit of blood.. if electronic crossmatch is safe for 250mls, why not 20-40? We have a cap of 10mls of mismatched rbc allowed per day. If we have a patient with antibodies or a major ABO mismatch we prefer to go the conservative route and break up infusions either into sessions 4 hours apart, or over 2 days, with hemolysis workups in between issuing the next piece to be sure some crazy hemolytic cascade hasnt started. With this amount of rbcs and good kidney hydration, its a pretty self limiting reaction.. once those rbcs are gone, no more is coming in. At least not until the recipient immune system finally dies out and the new one is established and starts making rbcs..and the new immune system doesnt fight itself.
  5. Orders are placed and resulted in the computer, slips print at nursing station when we result ready. We will call OR's if we get TS while they are in the room, esp if we've issued emergency release already. Very few other calls. No pneumatic tube. We didnt want to validate its a safe way to transport blood for one. And its hard enough to be sure the units are hung in a timely fashion when they are picked up by hand. Our old super was afraid we'd have a real problem with things ending up sitting in the delivery station. Its also hard enough to unjam/clean the system when a urine cup comes open, 250ml blood would be a nightmare. Nurse, CCT or unit clerk are all ok. Must be employee (no volunteers) with badge and we request they have been given at least an inservice on what they are looking at. In the old days we did have one unit that would send the housekeeping staff on short staffed days... Computer ordered units should be finalized as complete by the nurse on their end, which takes care of the majority of billing. Softbank has usage reporting for our end. Paperwork wise, we retain the printed orders we use to issue from as well as the pickup slips and the returned completed transfusion hangtags. And of course copies of any emergency release/downtime/OR manual orders. -c
  6. Hello All, We are starting to look at new database software for our HPC Lab to replace our current Microsoft Access database. I went to the CTTXPO in oct and have to say mediware's transtem and stemsoft's stemlab look the closest to filling our needs. Does anyone have experience using either of these from the stem cell lab side? Pros/cons about your system? Other suggestions? We want something that stores the data locally, not web/cloud based. We are a moderate sized processing lab handling maybe 200 products/yr, mainly apheresis HPC, occasional marrow/cords. Feel free to respond in private message if you want to give feedback in a nonpublic forum Thanks! -C
  7. One easy workaround for printing tags ahead of time to "save" special units for someone (besides handwritten scraps of paper tucked in the holder), is to have a regular laser/paper printer also set up which you can print to. You can just send the tag there instead, have all the info on the paper about when xm done, who its for, etc, but theres no holes or 3 part paper or unit sticker, so it cant be mistaken for a ready to issue tag. Its a quick way to see physically which units are on hold for someone and cue the door/issue person to investigate if say a crossmatched platelet near expiration might be able to be freed.
  8. To freeze cells and store cells usually requires different equipment. I only know about freezing stem cells, which requires a controlled rate freezer that drops the temp gradually to -80, at which point the cells are transferred into the long term storage freezer at -190 ish. For controlled rate freezing we use a Cryomed model 1010 (ancient) purchased from Custom Biogenics systems http://www.custombiogenics.com/ I dont know whether this would be appropriate for freezing rbcs, Im sure a blood supplier reader is out there and will chime in For long term LN2 storage, we use the Chart MVE 819 with TEC 3000 controller http://www.northeastcryo.com/pdfs/10934034.pdf Dont know where you are located but we purchased ours from northeast services in south plainfield NJ, which also provides service (great company) http://www.northeastcryo.com/ It holds a very stable temp for a long time (approx 2 days between fills) on a full charge. We run with btw 4-6 inches LN2 which keeps temps around -190 continuously. The controller unit tracks LN2 levels, and when you drop below whatever level youve set it opens the fill valve automatically, until your target level is reached, at which point it shuts the valve. All you need is an external supply tank, although it is possible to run a permanent piped system for supply. Which model you buy is going to depend on the number of products you anticipate storing. Most companies that sell these support a variety of racking systems and which one you choose will affect the total number of bags that can be stored. Id strongly suggest something with built in temp/Ln2 level monitoring and alarms that can be wired to a remote monitoring system. We needed an external chart recorder to maintain a record of our continuous temps since our Isensix monitoring system does not have its own temp probe for LN2, it only says yes/no you are in alarm state. Other monitoring systems may offer this capability.
  9. As a student I initially thought saline replacement meant you did not use patient serum in the testing. This was very confusing to me in how it was supposed to yield meaningful (or any kind) of results... LOL
  10. Just curious if this might not have been started as a response to not being able to physically quarantine new incoming units from 'ready to use' units (as in, separate fridge or shelf). Thats about the only thing I can think of that having a visual cue might be good for.
  11. I perform all my product typing in tube, forward and reverse. After you have done them a while your eye just gets used to filtering out the white clumps that sometimes form vs red cell agglutination. You have to stop expecting them to be 3+ or better like blood and instead accept tinier clumps. There is a fine granularity to rbc agglutination that doesnt shake away the same way the white cells do. You are not truly typing the patient, just trying to make sure products collected at the same time werent cross labeled in some way. If I had a real question about what ABO/Rh the donor really was, I would go to the peripheral blood sample collected pre/post procedure and compare to historical typing done on the pre-collection screening. This way you could do Du, gel, A1 lectin, whatever you need to clarify confusing results. The HLA results often have subgroup information on them, at least from Sharing Network out here in NJ.
  12. I think what you have to check for isensix quarterlies depends on how far you have gone in the alarm response settings of isensix. Basic setting is alarm condition on the website which have to be manually reviewed and cleared with a comment through the website. Does the website show alarm condition when they are triggered? Next level is having a flasher/audible alarm set up - if you have one of those youd have to check it actually goes off and hopefully its in a place that Is staffed - do those personnel know how to respond? Highest level of response is enabling the remote calling feature of isensix where if alarms are not cleared in a set amount of time, it starts calling or texting whatever numbers you have put in. Do those go through in the timeframes you have set, to the right numbers, specifiying the correct equipment? We do both the equipment alarms and remote activation alarms (the hospital operator for us) bc our feeling is the equipment alarming is a part of normal functioning of the equipment. Isensix does have outages (most notably during generator tests for us) and we'd never feel comfortable imagining our freezers sitting there happily warming up and not saying anything about it We posted a sign on our lab door saying "alarm after hours/on weekends? call pager xxx-xxxx!" which at least gives passerby a chance to let you know if it's been going on a while. We have not gone live with using isensix solely for alarms and instead have a wierd chimera of using the operator for notification and the web system for nice documentation and temperature trend review.
  13. We've had a great lab committee, and every year they come up with a few new things. The basic idea is they acquire a few prizes from pathologist and vendor donation. We may even have a small budget for prizes, we had a ton last year. They set up some contests and activities available to every shift, and every thing you participate in earns you a lotto ticket for the prize drawings at the end of the week. Some of the contests are factual quizzes, like, how many manual diffs do we do a year, how many beans are in this jar. Some of them are dressup participation (depends on your corporate culture) - wear jeans, wear all your laboratory related buttons and pins, wear a silly shirt. The more popular quizzes were match this baby picture to grown tech, match this child to tech parent, match this pet to tech owner. One of the most memorable events was the scrubs fashion show where people dressed in their favorite scrubs and got to do their best catwalk while someone announced what they were wearing. As far as outreach to the rest of the hospital, likewine is right. Serve food and youll have all the interest you could want. (Why are people at work so hungry?) One thing we have done at our hospital is every department prepares a posterboard describing what it is exactly they do, and we get to display them for a day in the hospital atrium (big inside center courtyard area with lots of foot traffic). With candy bowls in front of the posters.
  14. We bought the standalone Hematrax and use it exclusively fulltime without interface to our BBIS (we use softscapes softbank module). Im not sure how you would create an ISBT label downtime without the standalone program. If you are used to your BBIS choosing the correct product code for you, its going to be a big adjustment during downtime using the standalone. The module does allow you to search product codes but due to complexity (of ISBT, not bad hematrax design) we found it very unwieldy. What we did was actually create manual tables we bound together in sheet covers at the terminals most often used to make labels. The tables broke down products into platelets, rbcs, plasma etc and basically one column was what 5 digit code is on the product now before you change it VS heres the 5 digit code for after you irradiated it, split it, etc. Then you can just go straight to the 'make full face/half face label' menu and print exactly what you need. It was a pain to make but as a part time blood banker, its a godsend compared to having to search through the elaborate combinations of anticoagulant, volume collected, leukoreduced/not leukoreduced, product type etc.
  15. [/quote=Malcolm Needs;43626]If you don't bring it up, who is going to give you the answer????????????????!!!!!!!!!!!!!!!!!!!!!!!!!!/QUOTE] Im terribly afraid the answer will be from a regulatory agency that says "We'll be sure to address that in the next issue of standards" and then I'd be marked for death by anyone in the real world who has to ship or receive products.
  16. I would say the choice of who does it is going to be largely dependent on A) having an adequate 'clean' area and media on hand to avoid introducing contamination on the front end and whether you are having ongoing problems with cultures returning positives you cant synch up with clinical outcomes/expected patterns. We had longstanding issues with culturing CT products and having positives come back that were non-reproducible (repeat cultures on backup vials coming back either negative or different ID). We did an investigation of all parts of our culture process and found some things that surprised us. For instance our cultures are broths held for 14 days and micro was doing blind subs at multiple points to plate media since they did not have confidence in being able to distinguish growth solely by eye. They are now subbed out only on day 12 (unless there is suspicious appearance) so they can be finalized on day 14 as neg. We have our own biosafety hoods so we were able to innoculate our own media. Our positive rate is now easily 1% or less from these 2 changes. We had tried other measures like having the micro intake tech change to sterile gloves and amphyll the work surface before subbing our cultures but this was not successful in reducing rates. I guess bottom line is - its more cost and labor effective to let the pros do it, but if you're having problems dont be afraid to walk around and ask people how they actually do things.
  17. There is a set resting period immediately after collection, and a set requirement to Store on a rotator, but no requirement that they be rotated some amt of time before issue. I always wondered though, why it's ok for platelets to sit unrotated in a box thats packed up for transport, but not ok if they were out on the counter for the same amount of time. Although I probably shouldnt bring it up!
  18. Yeah they tried that here too, but I think its a good example of the people making a policy not being aware of how the drawing process works. It might be fine for say, a single patient redraw in OR, but not for general rounding. I never thought it was practical to expect the nurses to follow CCT's from room to room or making CCT's work in teams or however else it was envisioned to work.
  19. Cool! Thanks for the neat info! -C
  20. Yanxia, I have read it is the year of the water dragon, which only happens like once in 60 years. I was wondering if you know what the special significance is and does this mean I should go to the beach or stay away from it
  21. If it was just one site I would say doublecheck your centrifuge settings/speed and the storage conditions of cards. We had boxes stored sideways once so the gel was all slanty that ended up having to be tossed. Youd think they would have spun out flat but no. That camera can be pretty sensitive and I think it sees little cardboard particles on the outside of the well too. Curious what you find! Oh Provue, You so crazy!
  22. Its not a set length of time, its a separate stick signed by a different phlebotomist who ideally has repeated the same identity checks and agrees armband vs label etc is correct. If for any reason someone needs blood and the second specimen has not come in yet, they are issued blood under the standard emergency release policy - O Pos uncrossmatched (unless woman of childbearing age) with ordering doctor accepting responsibility and stating life threatening need. Having to order under a special pathway and explicitly stating they are putting patient life at unknown risk issuing blood without full compatibility testing generally squashes circumventing the system.
  23. If it is their practice to irradiate in batches with only one black indicator sticker per batch I could accept someone forgetting the plain purple sticker - as long as they could show the logsheet from the irradiator itself showing that unit number had gone through the process (not printscreens from blood bank computer just showing code changes made - proves nothing) Our irradiator is run by laptop which requires entry of each unit number at the end of a cycle and printing of the report. It's useful for lookbacks at times if there is confusion in blood bank computer entries and you want to see what physically happened. I would assume all blood banks with an irradiator have some sort of equivalent report or manual logbook. CYA!
  24. I would recommend separating out autologous whole blood units from everything else since they tend to have a lot higher percentage of wastage which will drag your results down otherwise - and you dont have any control over whether they are drawn or used.
  25. I am wondering how this is going for you! Our cells are collected by our inhouse FACT accredited donation center which also collects volunteer and directed blood as well as providing photopheresis and therapeutic exchange services. Hospital administration has been giving them the stink eye for several years now wanting to axe them since its very difficult to operate a small volume donor center with any kind of a profit margin. The idea that the benefits provided by an onsite collection center can be hard to quantify numerically is a foreign concept to business :-\ I would hate to have to start factoring in courier delays for all our autologous and related donors the way we already do for the unrelated NMDP products. Anyway, sympathies!
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