Use of blood warmers

[LaraT23]

I was wondering in what circumstances any of you recommend using a blood warmer. Our nursing service is looking for our advice about when to use them and I can only find rapid infusion and extreme cold agg. disease in the technical manual. This would mean we would use them very infrequently. I have an older tech who writes " prewarm" on units for reason such as: rouleaux, cold reacting antibodies and very mild cold agglutinins. Any ideas?

[Cliff]

I have an older tech who writes " prewarm" on units for reason such as: rouleaux, cold reacting antibodies and very mild cold agglutinins.

I recommend stopping this soon, unless of course that tech is also a physician.

While what we do greatly enhances the lives of many, and of saves lives, we are not physicians and should not be making medical decisions.

When to use one? When the physician feels it's appropriate. I am a big advocate for pushing medicine back to the physicians, and being a good blood banker.

[AMcCord]

We don't often use blood warmers here and not for years for the reasons you listed. Our blood bank medical director would recommend the use of the warmer, not techs. If the patient's physician requested infusion with a warmer, that would be his/her call, we don't worry about the reason.

[GilTphoto]

Blood warmers are recommended for rapid infusion of > 100 mL /minute and cold agglutinin disease.

Cold agglutinins that fall into this category:

1. Do not prewarm away. You may need to do multiple cold absorptions and prewarm before getting the crossmatch compatible at IAT.

2. Have a titer > 1000

3. Cause a hemolytic anemia. DAT will be positive for complement.

We have 4 blood warmers in our hospital. Up until now, our Bio-Med dept has only been doing an electrical safety check on them.

Anyone have a procedure to share for checking the temp and alarm, as required by JCAHO. see requirement below.

Blood Warmers - Alarm Check Documentation

Q: Is Pass/Fail documentation acceptable for recording blood warmer alarm checks?

A: No. While Pass/Fail documentation is commonly used for other biomedical equipment, it is not acceptable for blood warmer alarm checks. As required by standard EC.6.20 in the Comprehensive Accreditation Manual for Laboratory and Point-of-Care Testing, the actual temperature of the plates or effluent at which the alarm sounds should be recorded.

here is the link:

http://www.jointcommission.org/AccreditationPrograms/LaboratoryServices/Standards/FAQs/Management+Lab+Env++/Planning+and+Implementation+Activities/blood_warmers.htm