Who performs therapeutic apheresis?

[bmarotto]

If your hospital offers therapeutic apheresis (TAP), is it performed by the blood bank? If it is a Blood Bank service, do you have a nursing staff or do blood bank technologists perform procedures?

Our blood bank techs perform close to 300 TAP procedures and stem cell collections a year. The service is available 365 days a year, meaning someone has to be on-call weekends and holidays. Our hospital recently added 36 additional inpatient beds with 18 more critical care beds and 4 new operating rooms scheduled to open this year. It is getting increasingly difficult to pull a tech off the bench to perform apheresis. It is also difficult to hire techs willing to learn TAP as well as the usual BB tech duties. It may be time for us to rethink how we staff TAP at our hospital. I would appreciate hearing how other facilities handle this.

[Eagle Eye]

We outsource the TPE procedures. Usually RN from the facility comes in to do the procedure but it's schedule through the blood bank. We get a order and ...we call the company and schedule the procedure. Don't we need a RN license to perform TPE??

[Laura Mc]

The Therapeutic Apheresis Unit is a part of our Transfusion Medicine Service. It is staffed with 5 RN, clerical person and an RN Supervisor. We perform about 750 TPE, 165 RBCEx, 170 PBSC Collections, 10 cytoreductions, 33 LDL Immunoadsorptions and several research protocols in a year. In addition this area also collects autologous WB and performs therapeutic phlebotomies. The nurses take call for emergent and after hour procedures.

[bmarotto]

Don't we need a RN license to perform TPE??

Not in Massachusetts, but that would help solve my problem.

[John C. Staley]

Our infusion therapy department performs the TPEs at our facility. Transfuison Service has nothing to do with it and I like it that way.

[jorlin]

Apheresis is part of the service provided by the transfusion medicine department. We perform approximately 220 therapeutic procedures per month. The staff are lab technicians - most of whom began their careers in the laboratory, but are now dedicated full-time to therapeutic (and donor) procedures. A few continue to do evening shifts in the laboratory.

[David Saikin]

I've been in places where it is both ways . . . bb techs or RNs. In all places, it was a bb operation - scheduled and performed by.

[TStec]

We have a very active Therapeutic Service in our Blood Bank. We have three nurses that do patient procedures and ~6 medical technologists that do platelet apheresis collections in our donor center. There are maybe 4 more MT that are cross trained for apheresis and serological testing.

We have an excellent competency schedule, last year we did ~350 assessments of ~40 staff in our Transfusion Medicine Service.

[MGYog]

In Illinois, both BB techs and RNs ( all should have appropriate TAP training) may perform TAP. However, nurses are the only ones allowed to administer medications.

[DFields]

What are the regs for an on-board BB Med Director/pathologist during a therap. apheresis procedure--do they have to be within a certain number of minutes from the facility?

Does it vary by type of ther apheresis (different for plasma than for red cell exchanges or for platelet or wbc reductions??) :confused:

[bmarotto]

We require a BB physician/pathologist to be in-house during a therapeutic pheresis. If you bill a professional charge I believe a physician must be on the premises.

[rcurrie]

I was trained as an MT to do TPE, but my donor room RNs perform them where I work now. We also have a contract with another blood center to help cover weekends.

BC

[MJDrew]

We used to have 3 FT RNs performing apheresis procedures and drawing autologous and directed blood donors. About 4 years ago, our biz in all these areas was decreasing, and it was increasingly difficult to staff the area when RNs could get paid more and work regular hours (without call every 3 weekends) in other areas of the hospital. So we first made the decision to remand the auto and directed draws to our local blood center, and then outsourced the apheresis nursing services to a contract company. This company also provides dialysis, bypass, and other services, but these RNs are specifically trained in apheresis & stem cell collection.

This has worked out very well. We currently do about 550-600 procedures a year, not counting stem cell collections, which are overseen by heme/onc. Blood bank MDs still write orders and are on call for patient problems, but we no longer have the "issues" with people staying after hours or coming in the wee hours to do procedures. We simply call an 800 number and let the dispatcher know when we need an RN at our hospital. Our only professional billing for these procedures is for the initial consultation.

[rcurrie]

We are moving in the same direction as far as outsourcing, MJ. But, it is not because of decreased business- ours is increasing to the point where we can't keep up. We do at least 2 TPEs a day, 7 days a week. We average 60 a month. We are losing nurses because they are working every weekend, not just every other weekend or every third weekend. We also collect autos for several other hospitals in the area. They will get the "Sorry, we are no longer collecting autologous blood for transfusion outside of our institution" letter next month. Once I shared our wasted auto rates with our main offenders (ortho, urology, and CVS), our autologous collections went from about ten a day to ten a month.

BC