Auntie-D
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Posts posted by Auntie-D
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Firstly - as was mentioned before, did you have anti-D after the miscarriage?
Secondly - have they said that the antibody was Anti-D? It could be a whole range of other antibodies that may or may not affect the pregnancy.
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I've never yet had a blood bank sample where lipaemia has been an issue. I can't see it being 'allowed' based on laboratory validation alone as there is too much risk of it knocking off antigen sites.
- David Saikin, amym1586 and AMcCord
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I think I must be getting old - I find it a bit 'busy'.
I always used to hit 'new posts since last visit' - this is now a bit of a chore to do.
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On 12/4/2015 at 5:09 PM, mollyredone said:
That's a great idea, but our shelves are stainless steel and magnets won't work.
You mean aluminium? Stainless steel is magnetic.
We use little sucker cups with a hook on to hang laminated signs (also great for putting lights around the window). Velcro isn't liked by the H&S bods...
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Malcome that is a fantastic explanation!
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It is acceptable in the UK, as long as it is used on that same patient within 4 hours. No idea about the US though.
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We fully XM as our 'abbreviated D-screen' doesn't exclude anti-Cw and that other pesky one which I forget right now.
In theory we can assign antigens to the units, select antigen neg units and EI but management are twitchy about that idea...
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Alas, when Auntie D had her 3 instruments in 1989
Hey don't add years on me! I was only just starting secondary school in 1989
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Well, Malcolm, Ill be there too, dreaming of precipitin tubes. We had a system where one person read the froward group and wrote that on one side of the page - and the end of the page folded over to write the reverse group, but with the forward group results hidden - and then you could fold back the page and make sure the two results matched. It actually worked quite well - for the limitations of the age (I'm talking 40 years ago too, when we didn't even have calculators, never mind computers. Anyone else remember log books (as in logarithms)?
I why don't we still do this for manual testing?
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P.S. - I was trained and train my students to check the tube label every time you touch a tube. Different focus, same end.
Oh we have that focus too - each sample undergoes 3 (signed) checks against the form before 'filing' just for a G&S. When you add a (a manual) crossmatch to that you add a further 2 (signed) checks - one person doing the testing, another checking the interpretation, plus a check that is unsigned at every step - it is the unsigned checks that people may be lax with, that I am talking about splitting the testing to cover.
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Type them - we have had patients giving their friend's names to cover up the fact they are pregnant. I have known this happen 4 times in my 14 year career so far and they haven't all been young girls either...
- amym1586, Malcolm Needs and Dr. Pepper
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Maybe in the UK. I was actually polling other regional hospitals last week and after speaking with the blood bank supervisor/lab admin director for 31 institutions, 20 of them perform manual tube blood types. Three were still doing tube antibody screens.
I've never actually been able to get my head round this... In my first job when I started as a trainee in 1998 and the analysers were 3 years old even then.
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In the UK the guidelines are that it has to be risk assessed - a 1:20,000 risk has been calculated that both samples are incorrect. The first sample must be both forward and reverse, but the second may be forward only. It really reduces the number of weak reverse group investigations in older patients when you do this
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And idiots like me make even you have to think
Grief that's dreadful grammar!
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Found it! It's talking about a rapid group/tube testing. Although it is only referring to testing when red cells are being selected, it would be good practice to extend this to all manual testing, including gel/column/card.
- 8.6.1.Following a rapid group, at least one the following should be performed before issuing group specific red cells:
- a reverse group, using a new aliquot from the patient's sample;
- a repeat forward group using a new aliquot from the patient's sample;
- a saline spin crossmatch (see 7.4).
- 8.6.1.Following a rapid group, at least one the following should be performed before issuing group specific red cells:
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Do other labs really do this? I've never heard of it and my initial reaction is one of confusion and opposition. Is this more common in UK/Europe and the US is behind the times?
Why are you opposed to the idea? It's effectively a serological double check that you have the right patient.
Very very few labs do routine manual testing now - almost every lab uses analysers. Some of the very small remote labs however do not have automation and may do 20-30 manual groups and screens a day.
I cannot find the direct reference and it is frustrating me... There is a reference to forward and reverse groups being separated to remove risk of errors (effectively two aliquots)
''4.5.4.
Where manual systems are used, the risk of error can be minimised by separating the procedure into distinct tasks and, wherever possible, using different members of staff to perform each task. Suggested options for achieving this are:
- Separating the documentation of reaction patterns from the final interpretation.
- Separating the interpretation and documentation of the forward and reverse groups.''
There is definitely a reference somewhere though lol
When I say we type one sample at a time, I mean from start to finish (edit: i.e. set up everything, drop patient cells, spin, read, result, move to next patient). Our sister hospital still does all manual testing and we use manual testing quite often as well. I've got no problem batching up to four samples at a time for a screen, setting up tubes for the typing and all that -- I drop all my reagents at once but I will only have one patient suspension active at a time, drop the cells and complete the typing before moving on to another patient.
I'm not sure what you mean by "ABO incompatibility isn't an issue" because isn't the more important issue the fact that you have the wrong patient's sample in your hand? You wouldn't catch it -- what if you'd dropped a manual screen with the plasma from it thinking it was a different patient?
But if you accidentally pick up the wrong sample? How would you know?
Even if you mix up two samples and one has antibodies, you are not going to (probably) get an immediate and life threatening transfusion reaction - for the wrong ABO you would. Hence why we still do immmediate spin crossmatches when crossmatching in gel.
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Do other labs really do this? I've never heard of it and my initial reaction is one of confusion and opposition. Is this more common in UK/Europe and the US is behind the times?
Why are you opposed to the idea? It's effectively a serological double check that you have the right patient.
Very very few labs do routine manual testing now - almost every lab uses analysers. Some of the very small remote labs however do not have automation and may do 20-30 manual groups and screens a day.
I cannot find the direct reference and it is frustrating me... There is a reference to forward and reverse groups being separated to remove risk of errors (effectively two aliquots)
''4.5.4.
Where manual systems are used, the risk of error can be minimised by separating the procedure into distinct tasks and, wherever possible, using different members of staff to perform each task. Suggested options for achieving this are:
- Separating the documentation of reaction patterns from the final interpretation.
- Separating the interpretation and documentation of the forward and reverse groups.''
There is definitely a reference somewhere though lol
When I say we type one sample at a time, I mean from start to finish (edit: i.e. set up everything, drop patient cells, spin, read, result, move to next patient). Our sister hospital still does all manual testing and we use manual testing quite often as well. I've got no problem batching up to four samples at a time for a screen, setting up tubes for the typing and all that -- I drop all my reagents at once but I will only have one patient suspension active at a time, drop the cells and complete the typing before moving on to another patient.
I'm not sure what you mean by "ABO incompatibility isn't an issue" because isn't the more important issue the fact that you have the wrong patient's sample in your hand? You wouldn't catch it -- what if you'd dropped a manual screen with the plasma from it thinking it was a different patient?
But if you accidentally pick up the wrong sample? How would you know?
Even if you mix up two samples and one has antibodies, you are not going to (probably) get an immediate and life threatening transfusion reaction - for the wrong ABO you would. Hence why we still do immmediate spin crossmatches when crossmatching in gel.
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If you have the wrong sample the first time, wouldn't you have the wrong sample the second time as well? I don't really see how this helps. We shouldn't be doing blood typing on more than one sample at a time.
If you did pick up two samples, what if they were both group O or group A? Really common, and you would never know you'd picked up two samples. I'd much prefer relying on a double or triple check of the label on the tube and match with the requisition I'm working on. Maybe I am still missing something!
If they are the same group ABO incompatibility isn't an issue. In an ideal world only one sample would be processed at a time, but where labs are still relying on manual technology for all testing, samples get batched (as used to happen in the 'olden days'). Not sure what CAP regulations are but the guidelines in the UK state the forward and reverse groups must be from separate aliquots.
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Maybe it is just too early in the morning and I haven't had enough coffee, but I am not understanding what you're trying to accomplish here. What do you mean by
"lab generated" wrong blood in tube and how does spinning the sample twice help prevent that?
If you (accidentally) pick up the wrong sample and take sample it for the forward and the back group, there is no opportunity to identify you have done this (it shouldn't happen, but it can). If you sample the tube, respin, then take your second sample, if you have inadvertently selected the wrong patient you will have a discrepancy between the forward and the reverse groups if there is an ABO incompatibility.
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Then we have this for continuous temperature monitoring
(there are pretty pictures in it too)
Area of Application: Blood sciences, Transfusion
Document Title:
Comark – Wireless temperature Monitoring
Author : ZZZZZZZZZZZZZZZZZZZZZZZZZ
Responsible for document upkeep and review process: See Q-pulse owner
Number of paper copies (if relevant): 1
Persons authorised to carry out this procedure following suitable instruction, training, supervision and competence assessment:
· Lead Biomedical Scientist (Operational Manager)
· Biomedical Scientist, Advanced
· Biomedical Scientist, Specialist
· Biomedical Scientist, Trainee
Contents (CTRL & Click on heading to go to relevant section)
1) Environmental and safety controls
3) Principle and method of the procedure used for examinations
4) Performance characteristics
7) Type of container and additives
8) Required equipment and reagents
9) Calibration procedures (metrological traceability)
10) Procedural steps
12) Interferences
14) Biological reference intervals or clinical decision values
15) Reportable interval of examination results
17) Alert / critical values, where appropriate
18) Laboratory clinical interpretation
19) Potential sources of variation
20) References
1 Environmental and safety controls
1.1 Risk Assessment
Insert section heading or sub-heading number in ‘Step’ column
Step
Severity
Likelihood
Score
Risk Rating
Controls
Skin contamination
Insignificant
Rare
Eye contact
Insignificant
Rare
Inhalation
Insignificant
Rare
Ingestion
Insignificant
Rare
Electrical
Minor
Possible
6
Electrical
Equipment checked annually by independent contractors.
All equipment is checked annually by Cofley for electrical safety and by Estates at BGH.
Routine 6 monthly pms are carried out by OCD qualified engineers.
1.2 Risk assessment score matrix
Severity (S)
Likelihood (L)
Risk rating = S x L
1 = Insignificant
1 = Rare
1 - 3
Insignificant
2 = Minor
2 = Unlikely
4 - 9
Minor
3 = Moderate
3 = Possible
10-15
Moderate
4 = Severe
4 = Likely
16-20
Major
5 = Catastrophic
5 = Almost certain
25
Catastrophic
1.3 Manual handling assessment
Manual Handling assessment
Yes
No
Further clarification
Full assessment required
P
Weight guidelines exceeded
P
Arc or distance of move excessive
P
Twisting actions required
P
1.4 COSHH assessment
All COSHH assessment information is available via the Properties section of the Q-Pulse record for this document.
2 Purpose of examination
Comark provides: wireless, real time temperature monitoring of various areas within Pathology.
3 Principle and method of the procedure used for examinations
Comark's RF500 wireless temperature and humidity monitoring system is controlled by Gateway units, providing an economic and flexible solution to your measurement applications.
With self-healing network properties, data encryption and automatic retrieval ensures high data integrity and elimination of data loss.
The RF512 transmitter is for use with the RF500 wireless monitoring systems. Complete with an integral temperature sensor, connectors for an additional two temperature sensor are also built-in, and another for an external door sensor.
4 Performance characteristics
RF500A Gateway
Number of Channels Up to 256
Number of Transmitters Up to 64
Storage Capacity Up to 10 years’ storage
RF Frequency 2.4 GHz using IEEE 802.15.4
Battery Life 1 hour
Operating Conditions
Temperature 0°C to +40°C / +32°F to + 104°F
Humidity 10-90% RH non-condensing
Clock Accuracy 4ppm (2 minutes per year)
Temperature Measurement Range
Internal Thermistor Sensor – RF512, RF516 -30°C to +70°C/-22°F to +158°F
Humidity Measurement Range 10 to 90% RH
System Accuracy with Standard Sensors
Temperature
External Thermistor -20°C to +70°C ±0.5°C/ ±0.9°F
External Thermistor – full range ±1°C/ ±2°F
Internal Thermistor -20°C to +70°C ±0.5°/ ±1.0°F
Pt100 – full range ±0.05°C/ ±0.1°F plus probe
Humidity
10-90% RH ±3%
Storage Temperature -40°C to +85°C / -40°F to +185°F
Radio Range* Typically 50 metres indoors
Clock Accuracy** 20ppm (1 minute/month)
at 25°C/ 77°F
Logging Memory 32000 records
Logging Frequency Programmable between
1 minute and 60 minutes
Monitoring Frequency 1 minute
LEDs Red – Warning
Green – External Power
5 Type of sample
Not applicable
6 Patient preparation
Not applicable
7 Type of container and additives
Not applicable
8 Required equipment and reagents
PC connected to internet
RF500 Gateway
RF512 temperature monitoring transmitter
9 Calibration procedures (metrological traceability)
Not applicable
10 Procedural steps
1. Log in to Comark program on the designated PCs. BSC temperature icon on desktop.
2. The following screen is displayed:
3. Enter user name, click “ENTER”, then a password prompt will appear.
4. Enter password, click “ENTER”.
5. The home screen will then be displayed.
6. On this home screen: messages will be displayed on the top, in red. These can be assessed by “clicking” on them. The link will then take you into the probe that is in alarm.
7. By clicking on each individual temperature monitors, the following screen will be displayed (hover the mouse over the graph and “click”).
8. This display will show you the “tracking temperature” for the times (x-axis) indicated.
9. Turning the alarm limits to “on” (hover mouse over “off” and click to turn “on”), the following screen will be displayed
10. This presents a visual display of whether the alarm is within/outside the set alarm limits.
11. To get back to main screen click on “Home” button”.
12. An active alarm is display as a message across the top of the home screen ( as mentioned above) but is also highlighted as seen below.
13. Repeat point 7 to access the individual alarm.
14. The alarm can be acknowlegde or put into snooze mode, depending on the circumstances presented. You may want to monitor the alarm over a period of time, hence snooze. Or acknowledge an alarm as already action and this will close out the current alarm condition.
15. Depending on the alarm condition it might be nessecary to access whether to:
1. Leave contents in location as it was only a temporary shift in temperature conditions.
2. Relocate the material in the unit due to equipment fault.
3. Escalate the issue to a more senior member of staff.
16. For more detailed use of the Comark Sytem, refer to document:
1. Comark System manual BS/DT 70
2. Comark Web view help BS/DT 71 (IFU).
11 Quality control measures
The Comark probes are subject to annual calibration by a UKAS calibrated probe, supplied by Comark.
12 Interferences.
Possible interference of signal between monitors and gateway.
Network issues.
13 Principle of procedure for calculating results including where relevant, the measurement of uncertainty of the measured quantity values
Not applicable
14 Biological reference intervals or clinical decision values
Not applicable
15 Reportable interval of examination results
The individual probes have temperature limits set, in accordance to what materials are stored in that location.
16 Instructions for determining quantitative results when a result is not within the measurement interval
Not applicable
17 Alert / critical values, where appropriate.
Laboratory clinical interpretation.
Not applicable
18 Potential sources of variation.
Not applicable
19. References.
BS/DT 70
BS/DT 71
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Ours...
We also have charts for recording them
Area of Application: Blood sciences, Transfusion
Document Title:
Blood Bank Alarms , Fridge Cleaning/Temperature Chart Checking
Author : ZZZZZZZZZZZZZZZZZZZ
Responsible for document upkeep and review process: See Q-pulse owner
Number of paper copies (if relevant): 2
Persons authorised to carry out this procedure following suitable instruction, training, supervision and competence assessment: (delete this bracket and edit list below as required)
· Lead Biomedical Scientist (Operational Manager)
· Biomedical Scientist, Advanced
· Biomedical Scientist, Specialist
· Biomedical Scientist, Trainee
· Healthcare Assistant (Medical Laboratory Assistant)
Contents (CTRL & Click on heading to go to relevant section)
1) Environmental and safety controls
3) Principle and method of the procedure used for examinations
4) Performance characteristics
7) Type of container and additives
8) Required equipment and reagents
9) Calibration procedures (metrological traceability)
10) Procedural steps
12) Interferences
14) Biological reference intervals or clinical decision values
15) Reportable interval of examination results
17) Alert / critical values, where appropriate
18) Laboratory clinical interpretation
19) Potential sources of variation
20) References
1 Environmental and safety controls
1.1 Risk Assessment
Insert section heading or sub-heading number in ‘Step’ column
Step
Severity
Likelihood
Score
Risk Rating
Controls
Minor
Unlikley
4
Electrical hazard
When cleaning fridge avoid liquid around electrical components
Minor
Unlikley
4
Biological hazard
Contains Blood and blood products
Use gloves if required
Minor
Unlikley
4
Biological hazard
Disinfectant used to clean fridges
Use gloves if required
All equipment is checked annually by balfour Beatty for elextrical safety and by Estates at BGH
All the reagents and blood within the fridges are sourced from donors tested to be negative for high risk infective agents
1.2 Risk assessment score matrix
Severity (S)
Likelihood (L)
Risk rating = S x L
1 = Insignificant
1 = Rare
1 - 3
Insignificant
2 = Minor
2 = Unlikely
4 - 9
Minor
3 = Moderate
3 = Possible
10-15
Moderate
4 = Severe
4 = Likely
16-20
Major
5 = Catastrophic
5 = Almost certain
25
Catastrophic
1.3 Manual handling assessment
Manual Handling assessment
Yes
No
Further clarification
Full assessment required
P
Weight guidelines exceeded
P
Arc or distance of move excessive
P
Twisting actions required
P
1.4 COSHH assessment
All COSHH assessment information is available via the Properties section of the Q-Pulse record for this document.
2 Purpose of examination
Monitor Blood Bank/Freezer Temperatures. Change chart each weeks on the fridges and freezers. Clean monthly. Change pens as required. Act on any problems encountered.
3 Principle and method of the procedure used for examinations
N/A
4 Performance characteristics
Blood fridges, freezers and incubators must be within stated temperature range.
5 Type of sample
N/A
6 Patient preparation
N/A
7 Type of container and additives
N/A
8 Required equipment and reagents
Charts, pens, cleaning equipment.
ThermoFisher Blood Fridges 1 and 2 (RBH)
Lorne/fiochetti Issue fridge outside of Lab. BGH
ThermoFisher Blood Fridge: Stock fridge in lab.
Labcold plasma freezers (BGH and RBH)
Lorne platelet incubator (RBH)
Labcold platelet incubator (BGH)
Cleaned monthly as per blood fridge protocol.
9 Calibration procedures (metrological traceability)
Blood fridges, freezer and incubators are calibrated, maintained and temperature mapped yearly by Deva medical. Records and certificates are held in Q-pulse.
10 Procedural steps
Checking the Alarms on the XXX Site
The blood banks, at XXX have their alarms connected to XXX Workplace’s Help desk (Phone XXX) and Security (Phone XXX) at XXX.
The two blood banks and plasma freezer at XXX can be heard on site if the alarms are triggered as well as at XXX Workplace Help Desk (09.00 – 17:00) and Security (24 hrs) at RBH.
The blood banks all now register the type of alarm, whether it is a high or low alarm or power failure, on a VDU at XXX Workplace and Security, along with the location. The staff at XXX Workplace and Security also have protocols on local procedures.
The two blood banks and 1 plasma freezer conform to British Standard (BS) 4376 part I Type 2 cabinet conforms to BS 4376 part II and type A. Both blood banks and the plasma freezer have a temperature recording chart which runs for exactly seven days when the full one is replaced with a new chart. These are checked for any abnormality and stored in date order for future reference.
At the same time that the temperature recording charts are replaced, the audible alarms are intentionally triggered and checked and confirmed by Security (XXX Workplace also have a screen). This is normally carried out once a week.
The temperature recording devices in the blood banks are fed by a battery in the back of the recorder. Batteries are changed at least every six months (Set up as a scheduled audit)
Check of Platelet incubator at XXX
The alarm for the platelet incubator is located on the underside of the top panel (it’s a black wire with a probe at the end). To test the upper alarm temperature (24oC) take the probe between two fingers and allow the probe to rise to above 24oC. The alarm will sound once this temperature has been passed.
To test the low alarm (set at 20oC), place a cool pack up to the probe and allow the probe to cool. The incubator will alarm once the low end temperature (20oC) is passed.
Check of Plasma freezer
The chart on the front of the freezer is changed weekly, checked and stored in the correct file. To check the alarm, press and hold the telephone icon on the digital display on the front of the freezer. This will sound the alarm on the unit.
The temperature range is -32oC to -45oC and the alarm will sound if the temperature goes outside this range. To mute the alarm press and hold the thermometer icon on the digital display until it stops. The temperature should return to within range.
To change the chart open the cover with the key supplied and replace the chart with a new one.
Fridge/freezer failures at Royal XXX.
In the event of a fridge failure, transfer the stock within the faulty fridge to a working fridge. Try to ascertain the problem and report the fault to XXX Workplace’s Help Desk (42020) ASAP. In the case of a failure with the plasma freezer, transfer stock to suitable frozen storage. FFP needs to be stored at <-30oC. (Biochemistry’s -800C freezer would be suitable). Again, inform XXX Workplace of fault. Once Fridge / Freezer are in working operation, transfer stock back to original location.
Out of hours contact XXX Workplace on 42020 (this gets transferred through to security, 43030). The engineer then assesses the need to call out the refrigeration people. It is essential for the safety of the blood and blood products, that engineers are made aware of the priority of the fault, particularly temperature wise, and for staff to move the blood to another blood bank if the fridge is out of order.
Procedure for Security on alerting BMS of an Alarm
Security will only notify dept. regarding an active alarm after 17:00 hrs. The alarm is allowed to sound for 2 minutes, then the security person on duty will contact the on-call BMS via:
1) Tel numbers 85149 or 81083 or 84529
2) Pager 019
3) or via switchboard.
NOTE: Please check the alarms at XXXafter each generator test. This is to enable XXX Workplace to check that the “Black Boxes” (systems operators) have been re-booted. This will enable the alarms to be visible on security’s alarm panel.
Procedure for Checking Alarms on the YYY Site.
This procedure should be done each week to ensure that the blood fridge alarm is working correctly and that the alarm sounds in the lab. At present the alarms are not connected up to switchboard and will only sound in the laboratory. Any problems with the fridge or the alarms must initially be reported to maintenance on ext. 14777 (or shift engineer out of hours). If the hospital maintenance staff cannot fix the problem they will report it to Sweetmores who will come in and fix the problem.
Transfer stock to another fridge if the fridge is not working correctly.
Procedure for the Lorne fridges
A test button for each high and low alarm is fitted. Press the appropriate button to activate. The alarm is situated in the lab at YYY on the roof above the specimen reception bench. It will sound a siren if the fridge alarm goes off.
High temperature alarm button ( top )
Push in the HIGH temperature alarm test button.
The temperature display will rise above the set upper temperature level.
The alarm will sound at the fridge and in the lab and the red ALARM light will come on.
Release the button to cancel the alarm.
Check the temperature returns to display the current value.
Low temperature alarm button ( bottom )
Push in the LOW temperature alarm test button.
The temperature display will drop below 1.9oC.
The alarm will sound at the fridge and in the lab and the red ALARM light will come on.
Release the button to cancel the alarm.
Check that the temperature returns to display the current value.
These alarms are simulated for test purposes – the temperature inside does not change.
Procedure for the Thermo fridge
During normal operation pressing the ‘res’ button on the temp display will provide a 3 second display, buzzer and LED test. The probe inside the fridge that is in the bottle of water can be placed in warm water and then iced water to check that the chart responds and the temperature goes up and down.
The alarms can be tested by leaving the doors open until the temperature rises but this must only be done when there is no blood in the fridges.
Procedure for the FFP freezers
The chart on the front of the freezer is changed weekly, checked and stored in the correct file. To check the alarm, press and hold the telephone icon on the digital display on the front of the freezer. This will sound the alarm on the unit.
The temperature range is -32oC to -45oC and the alarm will sound if the temperature goes outside this range. To mute the alarm press and hold the thermometer icon on the digital display until it stops. The temperature should return to within range.
To change the chart open the cover with the key supplied and replace the chart with a new one.
It is recommended that the alarm systems be checked once a week. The functional test should be verified in the laboratory. The date checked sheet should then be filled in by the person checking the alarms who adds their initials and the date.
Procedure for the labcold platelet incubator at YYY
Press and hold the telephone icon on the display unit on the front of the platelet incubator to activate the alarm. This will sound at the unit. Labcold recommend using this technique to check the alarm.
To check the probe inside, hold something warm and then cold against it until temperature goes up or down.
To check door alarm, leave the door open for 3 minutes and the alarm should sound.
External Private Hospital Fridge
Private Hospital's (GPH) alarm sounds only at GPH and they arrange their own electrical/refrigeration engineer in the event of failure and they arrange their own servicing. Should ZZZ blood bank fail and it cannot be restored quickly within 30 minutes, all packs of blood contained within that blood bank must be returned to YYY or XXX immediately for correct storage at 4oC in a recognised blood bank. When GPH’s blood bank is functioning normally again, crossmatched blood can be returned for storage at 4oC. Transport of blood between ZZZ and YYY/XXX should be in the blood transfusion red transportation boxes only.
Blood Fridge Cleaning
Cleaning
The blood fridges should be cleaned every month to maintain a good standard of cleanliness. If there has been a spillage the fridge will need to be cleaned straight away.
The reagent fridge in biochem at YYY needs to be cleaned monthly as well.
Use Trigene disinfectant (or other suitable disinfectant) diluted 1 in 100 to wipe down the interior and exterior of each fridge. A spray bottle of the disinfectant and paper towels can be used to wipe the fridges. Dry the surfaces thoroughly after cleaning.
Take care when cleaning that the fridge door is not kept open for too long and the blood bags are not sprayed with disinfectant. It may be necessary to remove the blood before cleaning.
Fill in the fridge cleaning log as directed.
Fridge Charts
Temperature charts on the fridges are replaced every week (Friday on both sites)
with new charts. Charts can be found in the drawer labelled “Thermo Fridge Charts: New Charts” (by the tracesoft bench at XXX and next to the booking in bench at YYY).
To change the charts get the appropriate labelled keys from the box above the centrifuge at XXX and from the drawer in blood bank at YYY.
Open the cover and unscrew the screw in the middle of the chart holding the chart in place. Replace with a new one setting the day and time to the correct position with the pen recorder. Replace the middle screw and make sure the chart is held in place firmly.
The old charts are:
1. inspected to make sure they are running at the correct temperature (2-6oC),
2. then signed for against the “Cleaning / Temp Chart” log,
3. Then are filed away in a file named “Fridge Logs and Charts”.
Make sure the pen is working and there is ink in the pen giving a bold line on the chart. If the ink is showing a faint trace on the chart this may fade with storage and affect the ability to read the temperature after storage. A Q-pulse audit is set up to change the chart pens every 3 months. If the pen needs changing for any reason in between these times the pens are kept with the charts and just slide onto the pen holder on the chart recorder. The pen holder is hinged and will allow the arm to move out away from the chart to allow the pen to be slipped into the holder on this arm. Make sure that the pen arm is placed back on the chart surface.
If the temperature is not running within the specified range i.e. 2-6oC, inform a senior member of staff. Or contact XXX Workplace on 42020 and follow the SOP for Fridge Failure.
At YYY contact maintenance helpdesk on 14777.
Thermo Fridge LCD display.
The LCD panel displays the low and high settings and also the current temperature of the unit. Sometimes this display gets corrupted and displays a mishmash of characters. This can be rectified by resetting the display. This can be done as follows:
1. Stand in front of the fridge to orientate yourself. The switch to reset the alarm is located at the left hand side of the fridge and at the back.
2. The switch (silver paddle switch) is located on a small black box.
3. Flip the switch off and back on again. Doing this will result in a high pitch squeal from the alarm panel, this indicating that is has been reactivated.
4. The characters should be displayed as normal. If not, inform a senior, or ring Balfour Beatty Workplace.
11 Quality control measures
Charts are checked 3 times each week and changed one a week. Any problems with temperature recording must be reported to a senior member of staff in the transfusion department.
Fridges under maintenance contracts.
Yearly calibration are performed by Deva.
Temperature mapping is done on a yearly basis.
12 Interferences
N/A
13 Principle of procedure for calculating results including where relevant, the measurement of uncertainty of the measured quantity values
N/A
14 Biological reference intervals or clinical decision values
N/A
15 Reportable interval of examination results
Chart changed weekly
Cleaning done monthly
16 Instructions for determining quantitative results when a result is not within the measurement interval
N/A
17 Alert / critical values, where appropriate
Fridges normally run at 4oC to 5oC.
Low and high temperature alarm settings are 2oC and 6oC.
Plasma freezers run at -32oC to -45oC
Platelet incubators run at 20oC to 23oC
18 Laboratory clinical interpretation
N/A
19 Potential sources of variation
N/A
20 References
Blood fridge manuals are held in the transfusion departmentArea of Application: Blood sciences, Transfusion
BLOOD FRIDGE CLEANING/TEMPERATURE LOG
FRIDGE 1 (XXX) MONTH/YEAR:
Month
Visual Inspection
Write date in box below
Temperature Chart Check
Alarm Test
Sign
Note Predominant Temp
Inform Senior if out of range 2-6 oC
Did it sound at Security/switch?
(write initials)
Sign name in box below
Chart pens changed every 3 month
As per Q-pulse audit schedule
Week 1
Week 2
Week 3
Week 4
Week 5
Monthly
Clean
To be done on the first Thursday of every Month
Sign in column
FRIDGE 2 (XXX) MONTH/YEAR:
Month
Visual Inspection
Write date in box below
Temperature Chart Check
Alarm Test
Sign
Note Predominant Temp
Inform Senior if out of range 2-6 oC
Did it sound at Security/switch?
(write initials)
Sign name in box below
Chart pens changed every 3 month
As per Q-pulse audit schedule
Week 1
Week 2
Week 3
Week 4
Week 5
Monthly
Clean
To be done on the first Thursday of every Month
Sign in column
Platelet Incubator (XXX) MONTH/YEAR:
Month
Visual Inspection
Write date in box below
Temperature Chart Check
Alarm Test
Sign
Note Predominant Temp
Inform Senior if out of range 20-23oC
Did it sound at Security/switch?
(write initials)
Sign name in box below
Chart pens changed every 3 month
As per Q-pulse audit schedule
Week 1
Week 2
Week 3
Week 4
Week 5
Monthly
Clean
To be done on the first Thursday of every Month
Sign in column
Plasma Freezer (XXX) MONTH/YEAR:
Month
Visual Inspection
Write date in box below
Temperature Chart Check
Alarm Test
Sign
Note Predominant Temp
Inform Senior if out of range -32 to -45 oC
Did it sound at Security/switch?
(write initials)
Sign name in box below
Chart pens changed every 3 month
As per Q-pulse audit schedule
Week 1
Labcold
Chest freezer
Week 2
Week 3
Week 4
Week 5
Monthly
Clean
To be done on the first Thursday of every Month
Sign in column
YYY Logs
FRIDGE 1 blood bank (YYY) MONTH/YEAR:
Month
Visual Inspection
Write date in box below
Temperature Chart Check
Alarm Test
Sign
Note Predominant Temp
Inform Senior if out of range 2-6 oC
Did it sound in the lab?
(write initials)
Sign name in box below
Chart pens changed every 3 month
As per Q-pulse audit schedule
Week 1
Week 2
Week 3
Week 4
Week 5
Monthly
Clean
To be done on the first Friday of every Month
Sign in column
FRIDGE 2 Issue Fridge (YYY) MONTH/YEAR:
Month
Visual Inspection
Write date in box below
Temperature Chart Check
Alarm Test
Sign
Note Predominant Temp
Inform Senior if out of range 2-6 oC
Did it sound in the lab?
(write initials)
Sign name in box below
Chart pens changed every 3 month
As per Q-pulse audit schedule
Week 1
Week 2
Week 3
Week 4
Week 5
Monthly
Clean
To be done on the first Friday of every Month
Sign in column
Platelet Incubator (YYY) MONTH/YEAR:
Month
Visual Inspection
Write date in box below
Temperature Chart Check
Alarm Test
Sign
Note Predominant Temp
Inform Senior if out of range 20-22oC
Did it sound in the lab?
(write initials)
Sign name in box below
Chart pens changed every 3 month
As per Q-pulse audit schedule
Week 1
Week 2
Week 3
Week 4
Week 5
Monthly
Clean
To be done on the first Friday of every Month
Sign in column
Plasma Freezer 1 (YYY) MONTH/YEAR:
Month
Visual Inspection
Write date in box below
Temperature Chart Check
Alarm Test
Sign
Note Predominant Temp
Inform Senior if out of range -32 to -45 oC
Did it sound in the lab?
(write initials)
Sign name in box below
Chart pens changed every 3 month
As per Q-pulse audit schedule
Week 1
Week 2
Week 3
Week 4
Week 5
Monthly
Clean
To be done on the first Friday of every Month
Sign in column
Plasma Freezer 2 (YYY) MONTH/YEAR:
Month
Visual Inspection
Write date in box below
Temperature Chart Check
Alarm Test
Sign
Note Predominant Temp
Inform Senior if out of range -32 to -45oC
Did it sound in the lab?
(write initials)
Sign name in box below
Chart pens changed every 3 month
As per Q-pulse audit schedule
Week 1
Week 2
Week 3
Week 4
Week 5
Monthly
Clean
To be done on the first Friday of every Month
Sign in column
Fridge Down Time/problems
Date
Description of Fault
Initial
Reagents Fridge Clean on the first Friday of every month
DATE
CLEANED AND INSPECTED BY (SIGN)
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An SOP for what? We have several relating to the one instrument but for different things.
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One question: in the UK, do you all share a blood bank computer system so that unit data is transmitted to you electronically when you receive the units? We had a prior computer system that made it too easy to scan in parts of one unit for a different one. I don't remember anyone ever doing it with blood type, mostly exp dates, but retyping would be one way to catch computer entry errors. Not to say there aren't better ways to solve that computer system's weaknesses. I'd favor not having to retype units, but we must think of the gaps and address them.
Quite recently this has been introduced (previously you had to scan the barcodes on the bag for the donor number, product, group and expiry). It is known as EDN - electronic distribution note. The box containing the blood has a tag with a barcode - you click a cog on the computer desktop and all units allocated your hospital download to an 'invisible' file. You then going into the hospital LIMS and barcode the tag in. This then imports all the units in the system. Some LIMS have it set up just to set the group but others to include the full Rh phenotype (genotype?), K type, any other antibodies that the units are antigen negative for, whether the unit is irradiated, methylene blue treated, and also CMV status.
It is a FAB system and virtually fool proof (I think)
ETA - hopefully I won't have offended Malcolm with my terminology this time. I'm hungry so not thinking on complete form...
- pstruik, Malcolm Needs and gagpinks
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3
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- Pipette 2 drops of patient plasma into the two reverse cell test tube - discard pipette, sometimes I will go ahead and make my cell suspension at this time as well.
Again - please don't do this. Forward and reverse groups should be off two separate aliquots to reduce the risk of lab generated WBIT (if the wrong patient is accidentally selected there will be a descrepancy between the forward and reverse groups if there is an ABO incompatibility).
There are two 'correct' approaches (IMO and also has been policy in all the labs I have worked)
1 - Do your forward group on whole blood with half the amount of dilutent (not ideal for patients with a low haematocrit but useful in emergency situations - though I have never seen a weak forward group due to prozone effect), then spin the sample and do the reverse group.
2 - spin the sample and set up your reverse group, then spin the sample again and set up your forward group. The 'waiting' time whilst the sample is respinning is a mini incubation period and will lessen the chance of you getting really weak back groups.
The chances are you aren't going to kill a patient due to ABO incompatibility (assuming they have a historic group), but what you could do is delay the provision of blood by crossmatching the wrong group and having to start again. But then you can't guarantee an AGH crossmatch to pick up ABO incompatibility...
Competency Assessment Cry for Help! =)
in General Information
Posted
If you select a female they may be pregnant and have foetal cells in the blood - thus making your negative control positive. I suppose for a dummy one it doesn't really matter but we just use our premade pos and neg controls for competencies and that's how we make them.