ybunch

I am sorry. I did not have the researcher's CV handy. He is an orthopedic surgeon and researcher, not a sales rep. Platelet Gel got a bad reputation when banked blood was used. And, then some tried to capitalize on a product. There is a great difference between an autologous fresh product, used at the bedside. Also, Dr. Timothy Hannon with the Society for the Advancement of Blood Management and Strategic Blood Management is an expert on this subject.

We use autologous PRP for Tendon repair and in orthopedic surgery. Google Dr. Norman A. Marcus--he is a researcher in Virginia-adjunct professor Johns Hopkins--he had a lot of reference material. We have also used in non-healing diabetic wounds. We use an Angel, which is a total closed system. The manufacturer would have information on validation. Our perfusionists handle this. Hope this helps:) yvette

Our physicians are required to sign the consent form as well as a witness. In fact, in our state statute they are the only ones that can do the informed blood consent, nurse practioners can not even sign this form. It is noteworthy though that just the form does not constitute informed blood consent. Informed blood consent is really the conversation the physician has with the patient as to risks, benefits and alternatives available. We also give the patient the risks listed by the aabb.

Stale blood linked to dangerous infections Alison Branley November 24, 2010 AUSTRALIAN patients may be at risk of developing blood infections as a result of being given transfusions of stale blood, scientists have found. The research is expected to have a major impact on the way blood donations are handled. Researchers have recommended an immediate ban on all blood products older than 35 days to the NSW chief health officer, Kerry Chant, after a 10-year Hunter New England Health study of more than 20,000 blood transfusions. Advertisement: Story continues below The study, the largest of its kind in the world, found patients who receive blood more than 14 days old are up to four times more likely to develop potentially lethal blood poisoning. Dr Chant is expected to take the issue to the National Blood Authority. Under world health guidelines, blood donations can be stored for up to 42 days. Hunter New England Health has instituted an embargo on blood older than 35 days and is trying to reduce this to 28 days. Researchers emphasised the findings should not be a reason for people to stop donating blood but, rather, an encouragement to do so more regularly. The older blood is not infected but because it starts to break down over time, older blood weakens the immune system and makes patients more vulnerable to hospital infections. The lead author, Stephen O'Mara, said patients should not refuse blood transfusions but should question the age of the blood age and whether the procedure is necessary. ''Fresh blood less than 14 days of age is completely safe.'' Dr O'Mara said the use of old blood was a bigger safety issue than HIV-AIDS or ''mad cow'' disease. The findings meant surgeons would need to be more frugal with transfusions. In the 1990s a new preservative increased the storage age of blood to 42 days but it is only in the last three years researchers have questioned its use. ''There were no safety data published to determine if this older blood was safe,'' Dr O'Mara said. ''If this was a new drug it would never have been 'registered' to be given to humans.'' Blood poisoning is treatable but one in five affected patients die - about half from the blood poisoning and others from associated illnesses. Nationally, it is estimated there are 12,000 hospital-acquired septicaemia (blood poisoning) cases each year and up to 400 deaths. The study mainly involved patients receiving blood after general surgery, kidney disease, obstetrics and other medical admissions.

PBS ran a nice clip--www.pbs.org under What You Need to Know show--Transfusions. On going studies are in progress. Perhaps, they will help the transfusion industry to learn a better way to preserve cells. Also, The Bleeding Edge has information. "An airline accident is almost always the end result of a causal chain of events. If any one link was different the outcome may have been different Almost no accident was the result of just one ."• ØCapt. Chesley “Sully†Sullenberger in “Highest Duty†Nitric Oxide is just one link. We must learn from the aviation industry. And, just as we don't stop flying when a problem comes up, as the consumer, we want there to be an investigation. There are certain instances that blood transfusion may be medically indicated such as in an active bleed. Yet, at the same time we need to promote blood conservation that starts at the beginning of pre-operative planning.

One of my sons is a commercial airline pilot. I asked him what would happen if he did not follow a protocol. The first time, there would be a discussion to make sure he understood the protocol. If it continued to happen, he would be pulled off the line, brought back to flight school for remedial training. Once on the line again, if it happened again, he would be fired. All of this would be carefully documented for the union. Customer safety has to be of prime importance. Perhaps your HR does not understand how serious this can be and the liability involved. Your legal department should be informed of the problem. I would also recommend you review your training. I highly recommend the book Checklist Manifesto, written by a Harvard Physician. Aviation uses checklists. This has led to a safer industry. The adoption of checklists in surgery has greatly reduced mortality and infection when used correctly. Do you have a checklist for the techs to use? If you go on the World Health Organization website, (WHO) they have an example of surgical checklists that are well done. Also the New England Journal of Medicine carried an article on development of check list. They can be applied in every industry and increases safety. Hope this helps:)

This is addressed in our policy. Only someone from transfusion services has this authority. I understand why you were shocked. It is a dangerous practice.

We use TEG. Recently we had software problems that came from our system. CT surgeons wanted it fixed. So, evidently, they think it is valuable. We use it with in combination with a other systems. Our transfusion use is down, but it has to be a comibination of strategies. I know Englewood uses it and they have low transfusion rates with the lowest mortality rate in New Jersey.

Could you please send me your checklist too? Presently we check to see if the form was filled out correctly, things like witness, date. We also see if the transfusion met out guidelines. If there is a problem, the blood bank director send a letter to the physician. I don't think this is very effective. I would welcome other suggestions. I did a presentation yesterday at surgical grand rounds involving Informed Consent and basically the docs don't want to spend time doing it correctly. I understand some of their frustration in that the average person in South Carolina reads on a 5th or 6th grade level. Then, how do you reward good behavior practices? Thank you Liz for brining this question up! Bunches of thanks.

In this day and time it is a legal liability not to have cell salvage equipment. When you do a blood consent, you are saying the "risks, benefits and alternatives have been explained". Now, if you do not have an alternative that is widely accepted, you are putting yourself at legal risk. Blood transfusion is also expensive, time consuming and has risks. So, why wouldn't you want to use the patient's own blood? It is a safe and simple alternative. What is your cost to collect blood? A cardiotomy, double lumin, a bag of saline with some heparin. Maybe around $65. Then if you have enough blood to process, bring in your tech or trained nurse. It is very cost effective. Dr. Jonathan Waters has written several articles of this in peer reviewed medical journals. You may find the articles of help. But, I agree with your surgeon--you need a cell salvage machine. Hope this helps.

We are in the same process. www.sabm.org has some sample sets.

If the patient has a Healthcare Power of Attorney indicating refusal of blood we do not cross. Not only is it not fair for patient to be charged, you are setting your institution up for problems. Hope this helps, yb

From the Society of Blood Management or NoBlood.com

We use Cerner for our lab and blood bank. However, it is not compatible, or so I have been told with our Midas system, which is our hospital wide reporting system. So, data has been hard to pull. For blood conservation data is a must. I would just make sure it is compatible with your other hospital systems. Best Wishes, yvette bunch

Our trigger has been hgb of 8 and HCT of 24, however, we are trying to educate our physicians that is just one part of the evaluation. Many people can tolerate much lower hgb. Age, overall health, perfusion all play a role. Indeed, we are looking to lower this to hgb of 7., but this should not be the only guide. yvette bunch