Kathy

I also think I would need to do blood cultures on random units spiked upstairs after the 24 hours is up to ensure that they are using aseptic technique. Aaak.

I am new to this "supervisor" thing. Do you have any suggestions for what my policy should be? Maybe require the patient to be transfused with only Rh negative units except for the Rh positive autologous units? I don't even know if my computer system will allow the patient and autologous unit's Rh types to not match.

We do provide syringe aliquots to our NICU that are properly labeled with proper aliquot designations. However, it would not be practical to pull every unit destined for cardiovascular surgery into syringes in the blood bank, give them aliquot designations, etc. Not only would we waste a ton of blood, but we would need to hire an additional tech to deal with the extra work involved. My real concern is letting them have 24 hours to infuse a cold unit. My medical director is confident that our cardiovascular surgery team will follow the guidelines we give them for changing the expiration and labeling and he would like to move forward with this. Is there any rule anywhere that says that this cannot occur? If there isn't and we do go forward with this, what kind of extra documention should we require?

They already pull the blood out of the blood and put it into syringes. We have no way of controlling or documenting how many syringes they pull (is that really necessary???). The use of syringes for infusion of blood is mentioned in several places of the AABB Technical Manual, and it does mention blood being pulled from the blood bag into syringes at the bedside but does not address labeling. I figure if we can at least provide labels for them, it is better than them using unlabeled syringes. As far as the 6 or 10 degrees, we could err on the side of caution and use the Safe-T-Vue 6. How do I know they are changing the expiration time? Good question. My thinking is doing random checks (don't know how often) or requiring all unused blood to be returned to the blood bank, including spiked units and checking for changed expiration. I also don't know how to handle transfusion documentation in this circumstance.

The following is a proposed practice: We are a pediatric hospital, so frequently only parts of units need to be transfused, by syringe. We are considering letting the OR spike units, change the expiration to 24 hours, and pull off syringe aliquots, so long as the unit is kept cold. There are remote blood bank refrigerators in the OR and the ICU and we will soon be using coolers for transport. All blood that is issued for surgery has a Safe-T-Vue indicator attached. The blood bank would print out several ISBT labels for each unit of blood issued to the OR and attach them with a plastic tie to the unit of blood before it is issued. The perfusionist would change the expiration on the bag to 24 hours and the syringes would only get 4 hours. When the syringes are pulled, the perfusionist would take a label from the bag, put a 4 hour expiration on it, and put it on the syringe along with the patient's identifying information. Syringes would not be transferred with the patient from the OR to the ICU, but the spiked unit of blood would be transported by cooler from the OR to the ICU and put into the ICU refrigerator. The ICU could then pull off more blood into syringes and transfuse as needed until the 24 hours is up, so long as the temperature indicator on the bag is not red. No units of blood spiked outside of the blood bank would be accepted back into blood bank inventory. I know it is perfectly acceptable for the blood bank to pull off aliquots of a spiked unit of blood into syringes for 24 hours, but is it okay for non-blood bank personnel to do so, outside the blood bank? I know we would be giving up some control, but I can see this potentially being a very good thing in terms of reducing blood wastage, saving tech time, and having blood more immediately available to the patient. We would need to implement some sort of system whereby we could make sure they are putting appropriate expiration times on.

One other thing I would like to mention is that the tube is more sensitive for the reverse ABO grouping. We do both tube and gel typing on all new patients and were noticing that sometimes the tube reverse would come up (appropriately) positive, but the gel was negative. I called Ortho tech support and was told that for low titer ABO antibodies, tube is more sensitive.

What about patients who get autologous units? They would be Rh negative in the blood bank system, but their unit would be labeled Rh positive.

Our CV surgery team asked me if it was okay to transfuse a unit of blood with a red temperature indicator (Safe-T-Vue 10). Based on the fact that transfusions must be completed with 4 hours of issue and that the indicators turn red in about 15 minutes when a unit is kept at room temperature, I told them it was fine as long as the transfusion is complete within 4 hours of the indicator turning red. If they don't know when it turned red, it needs to be brought back to the blood bank and discarded. Please correct me if I'm wrong. I'm new to this supervisor thing.

I am considering these coolers http://bloodtransport.us/Page3.html for transport between the blood bank/OR/ICU. Does anyone have experience with them? I need something that is compact and does not require wet ice. We recently started using Safe-T-Vue indicators on units that go up to our remote refrigerators and are having troubles with them coming back red. If we use this system, we would have the transporters remove the blood from the red outer carrier and put the units of blood enclosed in their gel packs into the remote refrigerators. That way, the gel would stay cold and be ready for transport. We would still use the Safe-T-Vue indicators on the blood. The red outer zip containers would stay in an area close to the refrigerator until it is time to put the blood back in them for transport.

For our own purposes, we sterile dock the Charter Med syringe/filter, pull into the syringe, and label it with an ISBT label and 24 hours exp for the syringe. We give these syringes to our NICU patients, but now our CV unit is asking for them too. As far as the OR goes, we do not provide them with sets. I assume they spike the bag with a filter, attach a syringe to the set, pull out what they need, detach the syringe, and pull additional syringes. Since they do not have a tube sealer up there and the unit of blood almost certainly gets above 10 degrees, I don't see the wisdom in trying to keep the original expiration date of the unit. What my medical director and I have agreed upon and will need to discuss with all of the people involved, is that we provide extra ISBT labels for each unit that is likely to be pulled into syringes. That way, they can pull the syringes, label them with the ISBT label and the patient label, and use the unit for 4 hours. Webersl, I like your quote "never trust a nurse". How I wish that were not true.

David, our medical director is involved. He asked me to bring suggestions to the table for alternatives to their current practice. John, the ICU has a monitered blood bank refrigerator, so it is perfectly safe. If they kept that spiked unit cold, it could theoretically be used for 24 hours, but I don't think I even want to go there. And I definitely agree that anesthesiologists can be difficult.

I work in a pediatric hospital and have recently learned that during some surgeries, blood/blood products are pulled into syringes from the bags that we send up and are disconnected from the bag and transfused to the patient. Sometimes these syringes are not transfused right away and are sent with the patient label and a 4 hour expiration time to the ICU with no unit number identification or blood type. Obviously, the labeling is not correct at this point and I would like to stop this practice. However, the anesthesiologist says that the units in syringes are "in the process of transfusion". I could understand if the syringes stayed in the same room with the patient, but they are actually being transported and put in the ICU refrigerator and that is where I am concerned. They would like a practical solution to this problem. My inclination is this: it is okay to do this as long as the blood stays with the patient, but is not transported. As soon as the surgery is finished, they discard any remaining syringes and if they need more blood postoperatively, spike a new unit. The problem with this is that it exposes the patient to more donors. We could pull the blood into a bunch of syringes ourselves and label them properly in the blood bank, but that is a lot of extra work for the techs and it would probably result in wasting blood since the exact blood needs vary according to how the surgery progresses. One of our nurses said that she worked in a hospital where they have a Y - type filter that has a spike, a syringe, and an IV connection. They were able to pull the blood from the bag into the syringe and transfuse it to the patient without disconnecting the syringe from the setup. Do any of you know about this? Can anyone here give me some guidance?

I have recently been promoted to supervisor of the blood bank in a pediatric hospital. While I have tons of experience in pediatric blood banking as a technologist, I have very little experience in this particular hospital and no supervisory experience. I was promoted for my technical expertise, but I am very much concerned about the amount I have to learn as far as how this particular blood bank works, what the regulations are exactly, and how we follow them. I am fortunate that we just passed an AABB inspection, but we can expect a visit from the FDA at any time. If any of you have any words of advise for me, I would appreciate it.

Brenda, we have a refrigerator in the OR. The units are out of refrigeration from the time they are removed from the blood bank refrigerator for issue until the time the transporter puts them in the OR refrigerator. I need to do some research on what, exactly, is a reasonable amount of time for the blood to be out in this circumstance. I like your idea about putting the units on refrigerated coolant packs during issue. It might just give us that bit of extra time that we need. I do not want have to put units in coolers just for transport from the blood bank to the OR. Joan, we are taking the temperature on units with temperature indicators because the computer asks for an actual temperature reading when we return the unit. If the temperature indicator is red, we would discard the unit regardless of the temperature reading.

We just started using the 10 degree Safe T Vue indicators along with an infrared thermometer and are already having problems. Blood was issued to the OR this morning with temperature indicators and immediately after it got upstairs, they realized the patient needed irradiated blood, so brought the blood back down. It was 15 minutes, the temperature indicators were red, and the temperature was 13 degrees. I don't think it was an unreasonable amount of time. Would it be possible to find some kind of cheap insulated bag to send these units up in so they could at least not rise above 10 degrees en route to the OR refrigerator? I'm not talking about a cooler here...just a bag with a little insulation....like putting it in bubble wrap or something. I don't want to get into the whole cooler/validation/qc thing if at all possible.