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    Transfusion Service Supervisor

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  1. We're in the process of building weight based pediatric red cell orders at my hospital . Once the patient reaches a certain weight it will only allow them to order full units instead of the partials aliquots. We stock the transfer packs that go up to 300 mL, but do not routinely make aliquots larger than 270mL. Our inventory is mostly whole blood derived (doesn't state the actual volume of the bag), and based on my estimate calculations ranges in volume from 300 mL to 378 mL (very fat bag). The average was about 325 mL. How do you handle the pediatric patients that fall in that middle ground between 270 and a full unit? Do you routinely aliquot to the full 300 mL transfer pack and the doctor just deals with the extra? Ideally the nurses would just take the full unit and transfuse to the desired amount based on rate, but we have multiple instances of them failing to do so which is why we're building new order sets. . Our peds doc seems to be ok with some extra but wants us to never give more than a X mL unit when transfusing full units to peds patients (still deciding what is acceptable for X).
  2. Is there any regulation that requires Transfusion Services to have a massive transfusion protocol? My hospital system has two facilities- one is a trauma center with a very active MTP that works great. The other hospital is much smaller and in theory does not accept any trauma patients. I found a mini MTP policy at the smaller facility today- it basically states exactly the same thing as the normal Uncrossmatched policy does. The only reason I can think of why this mini policy exists is because some regulating agency says so.
  3. My facility's current SOP is to transfuse O red cells and A FFP in trauma situations until we have all the testing completed (including the second ABO typing) and enough compatible products are available to switch. We've not had any problems with following this process in the past (our trauma surgeons are amazing!) and we've always had enough O red cells and A FFP. However, last month we had a horrific trauma case come through that just decimated our inventory (hundreds of units in <24 hours) and the patient was AB Neg. Between this one patient and an emergency bleeding TTP patient we used almost all the A and AB plasma in the surrounding areas. What do you do in these situations when you can't provide type specific products? Giving a patient incompatible red cells is a huge red flag, even though I have heard of other hospitals having a protocol in extreme emergency situations. After 100-200 units does it really matter as long as the transfused combo of FFP and red cells are ABO compatible? I'm not particularly worried about running out of O red cells units (our blood supplier has a very healthy stock), but at what point do you flip plasma to whatever type you have available? And when do you flip back?
  4. You can link order numbers??? That would be amazing! I'm going to reach out and ask SCC about this, but would it be possible to get a little bit more information about how the process works? Thank you!!
  5. My hospital recently went live with EPIC’s BPAM module, because of which we had to increase the amount of data being sent across the interface (more OBX segments cross into EPIC for the patient/product matching aspect). The Transfusion Service uses Softbank and we've discovered one the main Soft interfaces into EPIC can only process so many lines of data at one time. How did we discover this? We broke the interface! One massively transfused patient sent across so much data that it crashed. Soft is currently working on a fix for this, but the main workaround they gave is to limit the number of products you can crossmatch/dispense on each order (recommended max =16) and create a new order when that amount is exceeded. For most patients this isn’t a problem, however I am at a loss for what to do with the massive bleeders. In order to be electronically crossmatched the red cell product needs to be on the same order number as the Type and Screen. So when a liver transplant takes a turn for the worse and you transfuse 80 crossmatched red cell units emergently, what do you do? It seems ethically wrong to flip to the uncrossmatched status just because the software doesn't like more than 16 units on one order. Another suggestion was to create "fake" type and screen specimens for each set of 16 units, which also doesn't sit well with me. Does anyone else have Soft and come across this problem? Thanks!!
  6. When reviewing our utilization data in comparison to the AAP nomogram I think our neonatologists are doing too many neonatal exchange transfusions. We're a hospital of approximately 600 beds with a level 3 NICU and are performing on average 1 every 18 months. How many is everyone else doing each year?
  7. It does require FDA registration- just had our every two years inspection because of this... Such a pain
  8. Shipping the baby out is really not an option unfortunately. Strangely enough the neonatologists here do not seem concerned at all about the mannitol in the ADSOL units. It's what they've been using for neonate transfusions for years before I came, which was a change as my previous hospital was very anti-ADSOL for babies. With the blood supplier restructure we have been starting to get in the CPDA-1 units for the other babies , but for the exchanges the docs want the ADSOL units. Carrie- does your facility have an SOP on how to do the aliquots specifically for exchanges or are you providing normal aliquots and they do all the fun calculations on the NICU side?
  9. My hospital is currently is the process of discontinuing making reconstituted whole blood in house due to multiple factors (competency, FDA license/inspection, equipment, etc...). Due to some restructuring of our blood supplier we now have access to ordering this product through them (yay!) with a turn-around-time of about 6ish hours. Our neonatologists have been understanding of the reasons and the move to the new process, however, they do want to set up an alternative option for emergency situations (extreme bad weather that would significantly delay the TAT). I've heard of some hospitals that are using alternating aliquots of red cells and FFP in place of the reconstituted whole blood which seems like it would be fine, but I can't find any good procedures/guidelines outlining this process or any evidence-based journal articles. Has anyone else come across this before or have access to any guidelines/articles about this? Or how does your hospital handle neonatal exchange transfusion without whole blood? Thanks in advance!
  10. Has anyone ever used the Value Stream Mapping that Haemonetics offers? We are looking into this at my hospital, but I really want input from other users before I commit the time and money to this. Thanks!
  11. With the two gel packs they will only hold one unit. Since we've decided to define these as "transport", we only validated them for 30 minutes for the 1-6C range.
  12. We do take the temperature of all units upon return. Before the red pouches we were wasting almost every unit that was returned- even at ten minutes the units were coming back at 11C. With the red pouches our wastage has significantly gone down- at 30 minutes the units are coming back at 8 or 9C. One of the locations I had worked at previously actually was adding a single 5C gel pack along with a single unit in a normal ziplock bag and even this helped with return wastage.
  13. I completely agree that coolers are cosidered storage as they are validated for longer periods and the units are in not necessarily going to be transfused (temporary storage). There is a small excerpt in the 17th Technical Manual Edition: "The Food and Drug Administration considers coolers used to store blood and components in the operating room to be a storage situation" pg 289. Do you consider the clear ziplock bags that most facilities for dispense to be storage? We use these red pouches just like these ziplock bags- just transport from the blood fridge to the patient's room. I do have plans to call CAP/AABB to get their take on this situation- just stinks because I'm in Pacific Standard Time and in comparison they close so early! Thanks!
  14. The Transfusion Service where I work dispenses single red cell units or thawed plasma in a red insulated pouch. Before I started working there, the blood wastage was so significant that the company held a Kaizen work process session (think Six Sigma or Lean). It was decided instead on dispensing in clear ziplock/biohazard bags that the TS would purchase these red insulated pouches with two 5C gel cooler packs (made by Duramark advertised as an insulated pouch for specimen transport). When these were brought in, they we validated to prove that they hold temperature for at least 30 minutes. Our wastage has gone significantly down-yay- however I'm concerned that they will be considered in the same line of thought as coolers that will have to be revalidated every six months (or is it a year? Brain fart). We have over 50 of these red pouch things and I really don't want to have to revalidate them. In my mind they're just like a "super" version of the normal clear ziplock bag which we don't have to validate. These are definitely not storage. All of our return criteria are based on normal acceptability criteria:1-10 and visual inspection (not time ) regardless of if it was dispensed in a red thing vs. a bio bag. Has anyone seen something similar to this before? What's your take on this: do I have to revalidate these?
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