Temperature monitoring of coolers in the O.R.

[mwlister]

How is everyone handling temperture monitoring of coolers in the O.R.? I know most people are using devices such as the Hemo-Temp II but I was challenged by an assessor that said blood that remains in the O.R. and returned to the Transfusion Service Department is considered STORED and it must be monitored and be maintained between 1-6 ^c.

In an effort meet this challenge we put thermometers in the coolers and required them to record the temperature every hour. Request for coolers dropped by 90%. Even though the need seemed to drop dramatically I have been asked to look for a better solution. The remaining 10% are stubborn.

I recently purchased a digital temperature monitoring device that downloads the temperatures. Don't you know they take it out and put back sending tempertures up and down. A Hematemp II monitor is attached to the units so I know they do not exceed 9^c. They insist on doing clerical checks when the units are brought to the room and do a second before transfusing.

Don't argue with that except the temperature monitor is extremely sensitive.

Comments to this challenge and/or other monitoring methods are appreciated.

Thanks, mwlister

[Lcsmrz]

The latest guidance from the FDA says that coolers not engaged in transport are indeed considered storage devices, and therefore to subject to the 1-6 C rule -- and probably the audio/visual alarm and recording graph requirement as well. Whether we agree with that ruling is immaterial at this point ...

We've reduced our validated cooler storage time to 4 hours to stay within 1-6 C, and we still have plenty of takers! Our transfusion committee will take up compliance with the other requirements, but it looks like we're going to be forced to regress in getting an OR storage refrigerator, even though I think that's less safe of an alternative.

[bmarotto]

As far as I am concerned, this is yet another example of a regulation that can have a negative impact on safety. It is going to be difficult to meet the monitoring requirements of O.R. coolers since we are not there to monitor them. Am I missing something, or have we been killing patients with blood that became contaminated from improper storage in O.R. coolers?

Reverting to having blood refrigerators in the O.R. takes even more control away from the Bood Bank. Sure, the refrigerator is monitored but do you think the O.R. staff will remove units one at a time as needed? What if they remove a unit meant for another patient? These are the reasons most of us went to a cooler system years ago. One patient's blood in a cooler means less opportunity for a mix-up and the cooler allows the blood to be available in the room but still maintained at refrigerated temperatures.

So now some company will come up with monitored blood coolers that have temperature and "lid open" alarms and built in temperature recorders. And there should be video surveillance cameras in each O.R. feeding video into a master console in the Blood Bank so we can make sure they use each unit within 30 minutes of removal from the cooler. How much should I plan on budgeting? My blood bank has 16 coolers that can hold up to 5 units and four that can hold up to 20 units.

Sorry for venting. I guess I have been a Blood Banker for too long.

[Mary]

I enjoyed your venting "bmarotto"!

Also along the same vein, what is everyone doing about transporting blood with a patient in an ambulance or helicopter? They don't want to take a blood box because they take up too much room. If we give them one of our blood bank coolers, sometimes we don't get it back. We spend a lot of time and money QCing these coolers, I don't want to have to buy new ones and have to QC them again.

[adiescast]

At the risk of being lyched, we do not use coolers in the OR. We use refrigerators. The coolers were getting left in the room and another case started before we knew about it. Or they were moved to another room without our knowledge. Voila' - opportunity for blood to the wrong patient!

Our refrigerators are secured with a magnetic lock that must be released from the blood bank. When we issue to the refrigerator, we have a log sheet for tracking what units went into the refrigerator. The same sheet has a place for recording when they removed blood and if they returned blood to the refrigerator. The OR person calls us, identifies themselves and the patient, and then tells us what unit(s) they are taking after we unlock the door. The lock button lights up when the door is open, so if the door isn't fully closed after blood removal, we know and can act on it.

The system works well here. If we get someone who calls to get the lock opened who will not identify themselves or the patient, we don't open the lock. If they fail to give us the unit numbers, we have information to call the room and find out which unit(s) they took. I also report failures to the OR manager, who is very keen on cooperating because we told them that we don't have to keep a refrigerator there at all.

If someone sneaks a unit into the refrigerator while the door is opened for someone else, they can't get it back out without calling us. If someone sneaks a unit out of the refrigerator while the door is opened for someone else, at least we know a time frame when it might have happened to begin tracking it and catch the thief (in addition to later data we get on what units were transfused).

We also put temperature monitors on each unit that goes to the OR, in case they don't observe the 30 minute rule.

[kelliott]

I hate to say it but I have been in the field long enough to have seen reports of coolers left in OR for a 2nd case years ago. So the report of a member on this forum of that same scenario does not surprise me - only validates the concern I have about that process. Thats why I have been ignoring the JCAHO recommendation about blood in OR refrigerators. OR refrigerators work well for us - we limit the number of units in the refrigerator and with implementation of the electronic crossmatch we will be educating surgeons to order blood for most cases on demand thus fewer units in surgery. Having said that we still monitor each individual donor unit with safe-T-vue temp monitors. Some anesthesiologists will request that a unit of blood be removed from the refrigerator, take it to the operating room and then return it to the refrigerator. We don't know how long the unit has been at RT but with the monitors we catch the units that have exceeded 10 C.

For those of you who use coolers routinely Williams Lab has manufacturered safe-T-Vue temp monitors for the 1-6C range. They will be sending out the information on these next month. They are user friendly and their use precludes the need to have the OR record temperatures.