Safety Vue Indicators

[melvolny]

Hi All,

We have been looking at ways to cut costs (who hasn't!) and we all have been wondering if indicators are necessary.

We have validated coolers. We have the 30 min rule in place. We have a temp check to take the temp when the product is returned. OR has a monitored frig.

It seems to me we have everything covered, but I wonder what am I missing??

Thanks for your input, in advance.

Melissa

[John C. Staley]

I am not aware of any regulatory or inspecting group that requires the use of temperature indicators.

I believe they came into general use based on the deeply ingrained sense of paranoia instilled in all blood bankers concerning the idea that no one else ever does anything right and we must catch them when they prove us right.

And I have to admit I was probably as bad as most everyone else is.

Frankly I hated using them but the corporate transfusion medical director and QA director would not listen to any arguments against their use.

[Brenda K Hutson]

How are you using your validated coolers? If blood is being stored in them for > 30 mins., then yes, you need monitors. The issue is not whether they are ok in the cooler for the validated time; the issue is whether the blood is at any time "removed" from that cooler and then returned in the cooler. You do not know what they are doing with the blood once it leaves your dept. and the only way to know that is with irreversible temp. monitors. In my 26 years, I have seen my share of red Safe-T-Vue Monitors coming back from the OR; especially if it was a bad case.

Not sure if I answered your question...you mentioned coolers, but also stated that OR had monitored refrigerators.

Brenda Hutson, CLS(ASCP)SBB

[David Saikin]

My experience with ORs is that they remove the blood from storage to the OR suite and replace it when they are done. We used the HemoTemp IIs and they were always converted. The OR swore they were in compliance and when push came to shove, they threatened political action against our Medical Director (State Hospital - politics rampant). We stopped using the indicators. My feelings are that you need to use the indicators . . . It is situations like this that has promulgated the FDA's coercion of the Red Cross to not allow returns.

[Mary**]

I glad I don't work for a State run hospital.

[Eoin]

Me too! Does the Hospital Transfusion Committee make policy? Is there an anaesthetist on it? Stops a lot of heart ache.

[Judy hedglin]

We use the HemoTemp II indicators. About 15 years ago the OR had a monitored refrig, we gowned up and manually took the temp every morning. We had an incident where an O patient was given A red cells--DIC, death. The refrig was taken from OR. We have six coolers and even though they are all the same type, each was validated individually. We could not be sure that the OR kept the lid on, etc after issue so we incorporated the indicators for patient safety.

[webersl]

We have had a rash of red indicators lately (which was causing us to destroy a lot of blood). I began paying closer attention to the circumstances and found that in at least one case (and suspected in another), the indicator was white (pass) upon return from ER and removal from the cooler. The unit was placed back into the fridge overnight. The next day, the indicator had turned red (fail). The refrigerator has integral alarms, in addition, there is an external montioring system (TempTrak). Neither alarm went off; temp graphs are all within range. Has anyone else experienced this?

[LAS]

We use the indicators for the same reasons Brenda mentioned. Even with a monitored refrigerator availalble there is no way to be sure O.R. didn't remove the units then put them back. We have had situations where we have issued blood to the the O.R. only to find that when they sent the patient to CCU, they sent the blood also. We learned this when hours later CCU phoned to ask if we wanted the blood back.

[David Saikin]

I have never used the SafeTVue, but I am wondering if they are only good for a certain time period after activation . . . this might account for the conversion in your refrigerator. I believe the HemoTemp II is only good for 72hr after activation.

[webersl]

I have never used the SafeTVue, but I am wondering if they are only good for a certain time period after activation . . . this might account for the conversion in your refrigerator. I believe the HemoTemp II is only good for 72hr after activation.

Thanks! That is a logical explanation that I hadn't thought of . Our "trauma units" (2 O negs) end up making multiple trips in the cooler (validated 1-6 for 23 hrs) back and forth from BB to ER. We continue to use the same Safe-T-Vue once it's been applied and don't remove it. Sometimes the same 2 units go back and forth from BB to ER for >2 weeks, yet the indicator remians white. The example in my previous post had only been out and back once. Hmmm. I don't know what to think. I had my staff review the insert and watch the video to make sure they were handling and applying them correctly to see if that helps.

[Judy hedglin]

I do not have any experience with Safety Vue. Our ER does not handle traumas and therefore we do not send blood to them unless one unit to hang while the patient is transferred to Intensive Care. Regarding the coolers and our use of HemoTemp II in OR, we give them a call 3 hours and 30 minutes post issue to ensure that the blood has been used or to have them return the cooler to us for reicing.

Any unused blood returned to the BB is inspected, HemoTemp temp recorded and returned to the refrig. We remove the temp indicator at that point. Our OR has been very receptive and cooperative in keeping the coolers closed when blood is in them. We do a daily visual check for hemolysis, etc when performing the daily inventory. Users of HemoTemp, should we leave the indicator on the unit on return from OR? Suggestions?

[melvolny]

Thank you for all your input! It has given me a wider perspective to ponder.

Melissa

[KathleenSL]

We use Safe-T-Vue 10 on units that are stored in a remote refrigerator. These units are placed in a cooler and taken on the medical helicopter runs. If the units are not transfused or wasted the inventory is rotated every 4 weeks. According the Williams Laboratories, Inc. information sheet the is no time limit on how long the indicators can remain on the units.

[melvolny]

I suppose my thinking is: when the blood comes back from OR/ER or the floor we take the temp, using a Temp-Check - why would we need the indicators? I can see using them for our FFL blood - but even then when the units come back we take the temp. So I'm not sure they are even necessary then, but it feels safer to have them on those units, due to the fact we really do not know what they are doing with the blood.

I have seen many turn red in the frig. The first time it happened, I thought for sure the tech put the blood back into the frig with a red indicator!!! But it has happened too many times for that to be true.

With the validated coolers, the monitored frig's, the Temp-check - I think I have pretty much decided to forego the use the indicators. Plus, there is nothing in the Standards or Cap.

Thank you all again for your wonderful insights.

Melissa

[Brenda K Hutson]

There is a very good reason for placing "irreversible" temperature monitors on blood that is Issued into a cooler. You make the assumption that if it comes back cold, it was always cold. I can tell you after 26 years and numerous Intitutions, that would be an erronoeous assumption. For all you know they could have taken it out of the cooler for an hour, then put it back in. So it comes back to you cold; but that doesn't mean it stayed in the acceptable temperature range. By putting the monitors on the units, if "at any time" they are outside of the acceptable temperature limits, the monitors will change colors and this will be evident to you when the cooler is returned. So, cold units do not always mean units that were within acceptable temperature ranges while out of our possession. I have pretty much "seen and heard" it all.

Brenda Hutson, CLS(ASCP)SBB

[Brenda K Hutson]

Someone mentioned having recent problems with the Safe-T-Vue Monitors lately. We too have experienced that.

We Issue them, then take one last look (also showing the Transporter) to ensure it is white as it leaves our dept. We have had numerous come back red, with the OR swearing they never removed the blood (granted I have seen some horrendous things from ORs at various Hospitals in my years; like falsification of temperature charts on OR refrigerators, and falsification of Patient Transfusion Records; documenting what time the transfusion was started and what the vital signs were, only to have the entire unit returned to the Blood Bank intact). However, because this is being said by multiple people in various OR rooms, and because we are having situations where one unit in the cooler comes back with a white temp. monitor while another in the same cooler comes back red, it has caused me to look at other issues.

Our Blood Bank Dept. is extremely warm; we are finally going to get a portable air conditioner this week. My concern is that while the units are out being Issued in the computer (which will multiple units and a read-back, can take some time), that they become too warm to meet the 4.5 start point that the insert states you need when placing the temp monitor on the unit. Perhaps then it is some kind of "delayed" changing of color?? Anyway, I am now having staff Issue only 1 unit at a time (for blood going into coolers) and to place it on a cool pack when they do that. Then put them back in the refrig. as they are Issued, and put all monitors on at the same time, while the units are in the refrig.

We are swtiching to the Safe-T-Vue 6 Monitors so I really need to get this solved.

Any other methods/thoughts would be welcomed!

Brenda Hutson, CLS(ASCP)SBB

[BBK710]

Someone mentioned having recent problems with the Safe-T-Vue Monitors lately. We too have experienced that.

We Issue them, then take one last look (also showing the Transporter) to ensure it is white as it leaves our dept. We have had numerous come back red, with the OR swearing they never removed the blood (granted I have seen some horrendous things from ORs at various Hospitals in my years; like falsification of temperature charts on OR refrigerators, and falsification of Patient Transfusion Records; documenting what time the transfusion was started and what the vital signs were, only to have the entire unit returned to the Blood Bank intact). However, because this is being said by multiple people in various OR rooms, and because we are having situations where one unit in the cooler comes back with a white temp. monitor while another in the same cooler comes back red, it has caused me to look at other issues.

Our Blood Bank Dept. is extremely warm; we are finally going to get a portable air conditioner this week. My concern is that while the units are out being Issued in the computer (which will multiple units and a read-back, can take some time), that they become too warm to meet the 4.5 start point that the insert states you need when placing the temp monitor on the unit. Perhaps then it is some kind of "delayed" changing of color?? Anyway, I am now having staff Issue only 1 unit at a time (for blood going into coolers) and to place it on a cool pack when they do that. Then put them back in the refrig. as they are Issued, and put all monitors on at the same time, while the units are in the refrig.

We are swtiching to the Safe-T-Vue 6 Monitors so I really need to get this solved.

Any other methods/thoughts would be welcomed!

Brenda Hutson, CLS(ASCP)SBB

I wish I had the answer because we have been having the same problem. Our department is usually very cool so I don't think that the blood is getting too warm while being issued. I find that the safe-t-vues will turn red if you are not extrememly careful how you apply them. We are switching to the Safe-T-Vue 6 as well and I am worried that we will have even more blood wasted.

[Karen Olsen]

We use Safe-T-Vue's on blood that is issued in a cooler so we can be sure that the proper temp was maintained the entire time the units were out of our control. We then remove the Safe-T-Vue as soon as the unit is returned to us before we place it back in our monitored refrigerator- because we too have had issues with them turning red while in the refrigerator- leaving you with the question - what now??!!

We also are having a lot of trouble with our current box. They turn as soon as we put them on. We have to keep trying new ones til we get one to work. Once we do we don't seem to have any issues with them staying white in the cooler. We are very careful when placing them on - I believe they are just defective somehow.