Pneumatic Tubes for Dispensing Blood

[Mary]

We are considering using our pneumatic tube to dispense blood one unit at a time.

Would anyone want to share their experiences or procedures with me?

[Cliff]

We don't have a procedure specifically for using the tube system. We performed a validation to each area we send to. We also needed to add some security measures to some locations as they are in a public area. So when they go to get the blood from the tube, they need to enter a password to open the tube system.

One problem we had, is too many areas want us to tube to them, and we overtaxed the system and needed to limit where we can send.

[Mary]

We don't have a procedure specifically for using the tube system. We performed a validation to each area we send to. We also needed to add some security measures to some locations as they are in a public area. So when they go to get the blood from the tube, they need to enter a password to open the tube system.

One problem we had, is too many areas want us to tube to them, and we overtaxed the system and needed to limit where we can send.

Thanks. What is the brand of your system? How large is your institution?

[Cliff]

Our tube system is Translogic.

We're big. The main hospital is 16 stories tall, and we have clinics attached running down the street (about 1/4 mile) and the tube system services all of those locations.

We transfuse about 60,000 products a year.

[John C. Staley]

Here's my old SOP. Don't tell anyone where you got it. We've been "tubing" blood for 5 years now and can't imagine going back. We can send up to 4 RBCs at one time but don't let the nurses know. Never, never, never will we put more than one patient in the same carrier.

[John C. Staley]

I had to reformat the SOP. Here it is.

ISSUING BLOOD AND BLOOD PRODUCTS VIA PNEUMATIC TUBE SYSTEM.doc

[Mary]

Thank you so much. My lips are sealed!

[Mary]

What validations do you do on the tube system? How often?

[John C. Staley]

Here is our plan and a blank form we used. This is how we did it. I know others have done less and still others have done far more.

Validation of Tube Transport of Blood blank form.doc

Validation of Tube Transport of Blood.doc

[rcurrie]

There is a nice AABB publication ($18 for members) on validating tube systems. I did something similar to John to validate my system (Translogic). We went a step further by actually taking pre and post samples of RBCs and measuring hemolysis using a special analyzer that measures free hemoglobin. We then calculated the hemolysis index for each unit used for validating the system. I will admit that this is probably overkill, but it was a good student project and the FDA was impressed.

We tube a bag of ice first, followed by up to 2 units of RBCs. We only tube blood to the ER right now. There is a way to require a code to be entered by the receiving station before the tube will drop. We don't use it for the ER, but we will when we send to nursing units where the tube station is unsecured.

BC

SD10211 Tubing Blood to ER.doc

[Janet Cass-Baxter]

We have been tubing blood in a Pevco Tube system for about 5 years now. We occasionally have a unit get lost in the twilight zone and we usually lose this unit because we can't track it quite fast enough to save it. This is not frequent, and we've never had it happen to an autologous unit. We validated much the same way that John Staley validated. We found that a unit could reside in the tube for about an hour before the temp rose above 10oC. We tube all over the hospital, including two areas that are in different buildings. We tried tubing syringes for neonates, and that usually worked (it worked when we validated), but occasionally the syringes would "explode" in the Ziploc bag. So now we send an aliquot bag and a syringe with filter attached and the nurses draw up the syringe.

We have the receiver sign that they have received the blood and tube that receipt back to us. This gives us the official record of who received the tissue, and assures us that the blood has gone to the right place and been noticed within 30 minutes.

[Cathy]

We do much of the same that has already been listed except we use the secure transaction. We type in the last 4 digits of the id number and the tube arrives at the nursing station and beeps until the receiver types in the same 4 digits. Then the tube will drop.

We have four new O.R. rooms. We can send the carrier to different addresses (same physical station located in the hallway) and the beep will be heard in the appropriate O.R. room so someone knows the products have arrived and can take care of them.

We send no more than 2 units per carrier and we use red carriers just to make them stand out.

The only time we have ever 'lost' a unit is when there has been a malfunction and there is an extra carrier some where in the system. The system appeared to be one transaction behind. So now after the system gets repaired, we try the secure transaction with an empty carrier to be sure all is well again.

[Mary**]

:confused:We will be moving to a new lab in April and have been requested to tube blood products.

I have a question for those of you who tube multiple units in one tube. If you are tubibg refrigerated components, how does the receiing location maintain the temperature if all of the units are not given immediately?

Thanks.

[tbostock]

We have the Translogic pneumatic tube system. We send to the critical areas of the hospital: Critical Care and OR. We tried it for the ER, but they would leave the blood in the carrier because it's just too hectic down there. So we have a deal with them that if there is a trauma or crisis, we will deliver it to them.

We send a requisition that they initial and send back; if we don't get it back in 10 mins, we start calling. We don't allow them to attempt to "maintain temperature" of the units...they only request it when they are ready to transfuse. Initially, the OR wanted units "just to have up there just in case", but we quickly nixed that when they wasted a couple, and we were able to show them that the transit time was less than 30 seconds, and that we would send it immediately when they needed it.

[LIMPER55]

We tube to the surg dept and emergency--but only two units at a time and we stay on the phone till we get confirmation of receipt. --a read back must be performed and documented.

[Mary**]

;)Does anyone use "liners" insdie of the tubes to protect the unit? Also, does everyone use plastic overwraps?

[John C. Staley]

We used foam padding inserts designed specifically for the carriers we used. They came in two sizes, thck and thin. Depending on how many units we were sending we could use any combination of the padding. Not only did the padding protect the units it also helped maintain temperature. We also put the blood in a "zip lock" over wrap just in case.

[tbostock]

We also use the foam inserts, along with a ziploc bag.

[Mary**]

The AABB Guidelines discusses taking the temperatures of the holding bins. What is an acceptable temperature range for these?

Hope you are enjoying retirement.

[John C. Staley]

I never worried about that. The units of blood I sent to the floors arrived at the patient's bedside in 15 minutes or less, (confirmed by semi-annual audits). The blood never really spent any time in the holding bins so I saw no need for concern.

[Thad Czuba]

This is our AABB Abstract, presented at 2007 AABB meeting.

The key is the use of "Memory Foam" Inserts on both sides of the blood product. Holds product firmly and acts as a great Insulator, for the product. We have tested when outside temperature is at minus 12 F (minus 24 C), and travels over 3 miles outside (using multiple loops) while not exceeding 1-10 C, for Platelets, Plasma and Red Cells. Translogic tube will hold: 2 Red Cells or 2 Plasmas or 2-3 plateletpheresis products at a time.

Use Of Above Ground Inter Hospital Pneumatic Tube Transport For Blood Product Delivery.

TL Czuba; DS Smith; SS Rothenberger; LJ McCarthy, Indiana University/Clarian Health, Indianapolis, Indiana.

Background: With expansion and consolidation of laboratory services between three hospitals, Indiana University Hospital, Riley Hospital for Children and Methodist Hospital, a level One Trauma Center; 1,399 combined beds, under one corporate entity, Clarian Health, combination of laboratory services became a paramount goal. It was determined that a centralized laboratory could be developed due to the relatively close proximity of the three organizations.

An, above ground, pneumatic tube system was constructed with the furthest distance between points of 2.25 kilometer (km), utilizing approximately 48.8 km of 15.24 centimeter (cm) pipe, to interconnect the new laboratory with three hospitals for a total of 211 station destinations. Six express pipes are elevated and attached to concrete pillars supporting a people mover Tram, exposed to weather conditions to transport blood products between new central laboratory and patient care areas. The average speed of a pneumatic carrier tube is 6.1 meters per second. Transit time between Central Laboratory and nursing stations was between 6.5 and 7.5 minutes.

Method: We needed to determine that blood products can be safely transferred to all stations regardless of weather conditions and temperatures. This was accomplished by changing the 15.24 cm diameter transport carrier insulation to a two piece “memory foam†(MF) insert. These inserts provide insulation as well as stable support of the blood products and specimen test tubes, during transit. To record blood product temperature during transit, an electronic device, programmable to record time and temperature every 15 seconds, was used, with probe to be placed in direct contact with blood product being transported Leukoreduced Packed Red Blood Cells (LPC), Leukoreduced Apheresis Platelets (LAPL), Thawed Cryoprecipitate (TCYO) Thawed Plasma (TP) products. Each blood product was placed in a protective sealed transport bag with the electronic device, sandwiched between halves of MF and placed into a pneumatic carrier tube. To provide worst case situations, in transit times and weather extremes, test runs were performed in double distance return cycles. Tests were performed under weather extremes of 33.9 C and lows of minus 25 C. Data from the electronic device was down loaded, at the conclusion of each test cycle to produce a table that then could be graphically demonstrate the temperature over time changes.

Conclusion: While using MF as carrier insulation in above ground pneumatic transport system, LPC, LAPL, TCYO and TP blood products can safely be transported up to 2.25 km.

[Mary**]

Thanks neighbor! Do you buy the "Memory Foam" from Translogic also?

Mary in Columbus

[Thad Czuba]

Swiss-Log, the supplier of Translgic, supplies the "Memory Foam" product.

[rcurrie]

Great job in increasing the safety of tubed blood, Thad.

BC

[Franklyn]

Hey Thad! Nice to see you on the forum!

We have used the translogic system (in various incarnations) for more than 15 years. The only thing we do not tube is RhIgG (too much agitation - it gets 'frothy' and we worry about loss of potency). We do not use the memory foam but our products to not travel the torturous route that they do at Thads facility. We have, on occaision, had a floater 'bump' a unit to incorrect location but it isn't all that common. Our biggest issue is on big cases, if the nurses do not retrive the blood from the station fast enough we can fill it up and shut it down. That can get pretty ugly pretty quickly.