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Would anyone be willing to share their SOP's for "tubing" blood products? I am trying to get this started at my facility (even though it seems like everyone else has been doing it for years!) and am already getting lots of questions. I figure being able to explain what others do might help! Thank you in advance! :)

 

Edit: we do not have the capability of "secure send" or scanning units/badges with our tube system

Edited by kaleigh
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On ‎10‎/‎23‎/‎2019 at 4:25 PM, Ward_X said:

The big thing is storage conditions and keeping the right temperature for each floor! My facility has 16ish floors, but we can only tube up to the 7th, otherwise products will get too warm on the way. So do bear in mind that tubing may not service every area

Why is the blood getting warm a problem (how warm is too warm)?  It's signed out; it's going to get warm.  The tube is not storage.  Don't need to maintain storage temp.

Edited by David Saikin
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5 hours ago, David Saikin said:

Why is the blood getting warm a problem (how warm is too warm)?  It's signed out; it's going to get warm.  The tube is not storage.  Don't need to maintain storage temp.

Good point David,  My first thought was, "why is your tube system so slow?"  Granted I have a fairly limited exposure to tubing blood but in what experience I've had I've not seen a tube system so slow the blood would get out of temp during transport.  :coffeecup:

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40 minutes ago, John C. Staley said:

Good point David,  My first thought was, "why is your tube system so slow?"  Granted I have a fairly limited exposure to tubing blood but in what experience I've had I've not seen a tube system so slow the blood would get out of temp during transport.  :coffeecup:

Tbh I'm also somewhat limited in my tubing expertise, but from what I've gathered, our hospital has a boiler system between floors 7 and 8, so the products would kind of get nuked on the way up...

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On ‎10‎/‎22‎/‎2019 at 12:33 PM, kaleigh said:

Would anyone be willing to share their SOP's for "tubing" blood products? I am trying to get this started at my facility (even though it seems like everyone else has been doing it for years!) and am already getting lots of questions. I figure being able to explain what others do might help! Thank you in advance! :)

 

Edit: we do not have the capability of "secure send" or scanning units/badges with our tube system

We only have secure send for two locations, and they're both ICU. Does anyone know if that's a requirement to have otherwise? Besides the fact the station just alarms when products come through, why else would you need secure send?

6 hours ago, David Saikin said:

Why is the blood getting warm a problem (how warm is too warm)?  It's signed out; it's going to get warm.  The tube is not storage.  Don't need to maintain storage temp.

It's not that the tube is storage per se, but I guess it's more about how the civil structure of your building is designed? Some of our tube stations are far -- you don't want to expose products to extraneous temperature fluctuations and have them susceptible to bacterial contamination. So sure, once the product is issued it's not entirely the BB's responsibility to keep it cold, but you don't necessarily want the product falling too far from that range before it gets to the patient.

I'm sure the actual physics and pneumatics and all that jazz for how its able to lift and keep suction is more on the engineering side, but I know my facility had to validate all the locations we would attempt to send products. We had techs on each side of sending/receiving at the tube stations and tested the temp. of the products. We even have a floor that is RhIG only via tube.

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On 10/25/2019 at 12:20 PM, David Saikin said:

Why is the blood getting warm a problem (how warm is too warm)?  It's signed out; it's going to get warm.  The tube is not storage.  Don't need to maintain storage temp.

We made up arbitrary values for min / max temps and time to reach destination.  They added an additional blower on the 7th floor for one of the main buildings (we have several buildings we tube too).  Whenever work is done on the tube system we revalidate it using said made up values.

If there were guidance documents, or an AABB Association Bulletin, we would follow that, but there isn't, hence, made up values.

After that 7th floor work the high temps consistently exceeded our high limit.  We stopped sending blood above 7 for years.  We reviewed the info with our medical director and agreed to slightly increase the upper limit.

Now we just need the time to validate the rest of the floors above 7.

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We also only tubed to certain floors. We sent a form with patient and unit  stickers with the unit that the person who removed the unit was supposed to time, initial, and return.  We called when tubing and they had 10 minutes for us to receive the form before we followed up.  If we tubed  to a floor, we had to have the form back before tubing for another patient.  To validate and to do QA checks, we sent a tech to each location  and tubed  an expired unit to each location with a temperature monitor. When we tubed, we called that tech and documented transit time and unit temperature on arrival.  Things happen even when we try our best.  One  time we tubed  a unit, got an order for another patient on same floor, received form for first unit back, tubed second unit - and nurse for first patient called upset because we had not tuned her blood. The nurse for the second patient had grabbed the unit for the first patient, signed the form without checking, returned the form, and started the unit on her patient, with two nurses signing off the bedside checks. 

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20 hours ago, mcgouc said:

We also only tubed to certain floors. We sent a form with patient and unit  stickers with the unit that the person who removed the unit was supposed to time, initial, and return.  We called when tubing and they had 10 minutes for us to receive the form before we followed up.  If we tubed  to a floor, we had to have the form back before tubing for another patient.  To validate and to do QA checks, we sent a tech to each location  and tubed  an expired unit to each location with a temperature monitor. When we tubed, we called that tech and documented transit time and unit temperature on arrival.  Things happen even when we try our best.  One  time we tubed  a unit, got an order for another patient on same floor, received form for first unit back, tubed second unit - and nurse for first patient called upset because we had not tuned her blood. The nurse for the second patient had grabbed the unit for the first patient, signed the form without checking, returned the form, and started the unit on her patient, with two nurses signing off the bedside checks. 

SCARY.  I've seen pts expire due to scenarios like this.

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