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ISBT 128 & Split/divided units


How do you handle splits/divided unit with ISBT units?  

35 members have voted

  1. 1. How do you handle splits/divided unit with ISBT units?

    • Change parent to A0 and first aliquot is B0, subsequent aliquot as Aa, Ab, Ac etc.
    • DO not change product code of the parent and 1st aliquot A0, 2nd B0, 3rd, C0 etc.
    • Modify unit in several aliquots in computer and process each time the order is received.
      0
    • different than what is described in 1, 2, or 3


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How is everyone handling divided products with ISBT codes?

1) Do you change product code of the parent after first division? In other words do you have A0 as your parent after first division and B0 is your first division? Subsequent aliquots from A0 will be called Aa, Ab, Ac etc.

If yes what computer system do you have?

2) Do you call first division as A0, 2nd division as B0, then C0 etc? Are you using this path because system is not able to do as in 1)?

3) DO you modify unit in several aliquot and then process each aliquot one by one as order is received?

4) Using different apprroch? Please specify?__________________

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I was first to answer poll!! The truth is, I am not live on ISBT yet. I just help others get ready for ISBT. In a perfect world, I would divide product (changing to "open" code unless sterile docked) making parent unit A0 and each division B0, C0, etc. If I divide a second time, lets say unit A0 is to be divided in syringes, A0 would remain as such as long as it has volume. Each syringe pulled from A0 would then become Aa, Ab, Ac, etc.

Most computer systems can not do this in one fell swoop if they can do it at all. Some have to develop work arounds whereas first you modifiy the unit from a 'closed' to an 'open' system, then divide the 'open' code. Other systems are still caught up in appending the DIN instead of creating divisions in the product code. And then there are still others who can not make more than 2 divisions at a time.

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I heard Pat Distler (fron ICCBBA) give a talk on this and she described it that if you are making one aliquot at a time, you should give the first aliquot made the division A0, and then also relabel the remainder of the volume in the original bag as division B0. All subsequent aliquots made from the original bag would then be labeled as divisions Ba, Bb, Bc, etc. We are a pediatric facility so this is how we are doing it... lots and lots of times every day! If you are splitting a bag into 3 or 4 pieces all at one time, then you would make them A0, B0, C0, D0, etc. We have MediTech and it has no problem doing this... it actually gives each split the correct division code for you when you use the "Make Aliquots" routine.

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We did something similar to Pat Distlers solution above since we are also preparing successive aliquots in syringes. We have built a 2 step process in Cerner Classic. When we get ready to make the first aliquot we convert the original RBC into a divided "parent" product. We transfer the entire volume into the divided "parent" RBC. This product is assigned division code A0. This product is relabeled with a Divide RBC product label and division code A0. We then immediately make our first syringe aliquot product from the divided "parent" product. Each syringe aliquot is successively assigned Aa, Ab, Ac... as it is made. These are automatically assigned by the LIS. This solves the issue of relabeling the original product when the 1st aliquot is removed and it assigns consecutive letters to the aliquots instead of having them jump from A0 to Ba between the 1st and 2nd. We did email this to Pat Distler before implementing this alternative solution. We also use this same scheme for syringe aliquots prepared for apheresis platelets.

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Our facility is using MEDITECH. There is a problem in that Meditech only recognizes the first 5 characters of a product code. The product code would look like this:

E0224V00 (parent)

E0224VA0 (aliquot)

In MEDITECH, the system would see this as the same product and therefore could not coexist in inventory. When using the make aliquot routine, the product name stays the same, and the unit number changes by adding a suffix to the end (W1234081234A). With ISBT, the unit number is to stay the same. Meditech created a program that would exclude the suffix from the issue form, but it is still there in the unit number. This will be a problem when we have to scan barcodes at the bedside because the unit numbers won't match.

My "work around" is to use the make component routine instead. In the component routine, the unit number stays the same, and the product changes. For example, frozen plasma to thawed plasma. In my dictionary setup, I did this to identify separate products to issue as an aliquot (or in this case, the components that can be prepared from this parent product):

PCILR.E0224 (parent product name)

PCILR.E0224A (1st aliquot name)

PCILR.E0224B (2nd aliquot name), etc

Each aliquot product (PCILR.E0244A) has the primary unit number remaining the same as the parent product. The aliquots are labeled with the division product codes (E0224A0). At the time of issue, only the unit number is scanned (not the product code). The user can select the appropriate product from the list that appears. I use the parent product code as E0224V00 and never change that. One advantage to using the make component routine is that the user is not allowed to issue the primary product once it has the status of component. Our facility does not allow units that are no longer a complete unit to be issued as a whole unit, so this helps eliminate that problem also.

We do not receive divided units from our blood supplier, so we don't have the problem of scanning divided products that would be perceived as being the same product.

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Sandy L,

DO you use DIgitrax for modified product? WHat kind of validation did you perform? Could you share your validation protocol?

I am going to use the same two step process you mentioned. Are you labeling parent unit with new product code (A0) after first aliquot?

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  • 2 weeks later...
  • 4 weeks later...

Hello all. I am new at the forum.

I've developed a computer blood bank application with ISBT 128 standard. Now I have a customer that do the following procedure:

Has 450 ml Whole Blood unit. When he needs a pediatric unit he divide it into two units, one of 400 ml and another of 50 ml. When he needs another one he divide the 400 ml into two units, one of 350 ml and another of 50 ml. And so on...

Example:

Original unit: 00 (500 ml)

First aliquot: 00 (500 ml) -> A0 (450 ml) and B0 (50 ml)

Second aliquot: A0 (450 ml) -> Aa (400 ml) and Ab (50 ml)

Third aliquot: Aa (400 ml) -> ??? (This is the problem)

My question is, is this procedure correct? How ISBT 128 implements this procedure?


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Reliegos,

This is probably the "most" correct way of creating modified units. Every facility has different needs. Pat Distler from ICCBBA states the the most important thing is traceability of the product(s).

At our facility, we are not creating a barcode label from a printer (HEMATRAX) for modified products. We purchase the overlay product code label (A0,B0,C0,etc) and blood type labels to keep the cost down.

Remember, the more complicated the process is for Techs to follow (part timers), the more likely it is that it won't be done correctly. I suggested to someone else who was using the scheme your facility is, to make the overlay for the modified products ahead of time and keep them with the parent unit. If you don't apply the DIN, you can keep using this overlay until you actualy create a product and add the DIN. This way, the next division that is supposed to be used will be known. If you are creating an entirely new label for the product (HEMATRAX printer), then this is not neccessary.

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Hello all. I am new at the forum.

I've developed a computer blood bank application with ISBT 128 standard. Now I have a customer that do the following procedure:

Has 450 ml Whole Blood unit. When he needs a pediatric unit he divide it into two units, one of 400 ml and another of 50 ml. When he needs another one he divide the 400 ml into two units, one of 350 ml and another of 50 ml. And so on...

Example:

Original unit: 00 (500 ml)

First aliquot: 00 (500 ml) -> A0 (450 ml) and B0 (50 ml)

Second aliquot: A0 (450 ml) -> Aa (400 ml) and Ab (50 ml)

Third aliquot: Aa (400 ml) -> ??? (This is the problem)

My question is, is this procedure correct? How ISBT 128 implements this procedure?

I think it is more correct this way:

Original Unit (500 mL) 00

It is split into two parts - 450 mL in original bag becomes AO, 50 mL aliquot and is B0.

Original bag stays A0. A second 50 mL aliquot is taken from the original bag. It is Aa. Original bag (A0) is now 400 mL.

A third 50 mL aliquot is taken from the original bag. It is Ab. Original bag (A0) is now 350 mL.

A fourth 50 mL aliquot is taken from the original bag. It is Ac. Original bag (A0) is now 300 mL. Etc

Belva in Lincoln, NE

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In response to Reliegos:

After the first split, A0 stays A0. The next split becomes:

A0 -> Ab

Then when the next aliquot comes off, it's

A0 -> Ac,

The next time, it's

A0 -> Ad

and so on.

When you split a unit, you must indicate it's no longer a full unit. That's why after the first split, the "parent" becomes A0 (divided unit). Thereafter, as long as it is coded as a divided unit, you don't have to change the code on the "parent".

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