Transfusing neonatal aliquots in the OR

[dcharland]

Presently we make 100cc aliquots (in a bag with 2 syringes attached) in a cooler for many of our NICU babies who go to the OR (mostly G.I. type surgery). We have about 75% wastage on these aliquots. The aliquots are returned from the OR unused and expire within 24hours. To reduce wastage we would like to propose to anesthesia that they take a whole unit of blood that has been irradiated and the blood bank will send chatermed syringes along with the unit. If the baby needs blood, anesthesia can spike the unit and draw the aliquot into the Chatermed syringe. If the unit is not used it can be returned and then used for an adult and thus not wasted.

Our dilemma is what about labelling the syringes? We cannot count on anethesia labeling if the unit is spiked and we don't want to label an empty syringe.

Anybody out there solved this problem?

[Malcolm Needs ☆]

What worries me a little about your proposal (although I can quite see from where you are coming dcharland) is that, very often the units transfused to neonates have their haematocrits artificially increased by disposing of the some of the plasma. Will not the adult units have a "normal" haematocrit and, therefore, the neonates could be in danger of ending up with a form of iatrogenic anaemia or worse, if the anaesthetists adjust the haematocrit in an uncontrolled way, circulatory overload?

I don't know, I am only asking.

:confused::confused::confused:

[adiescast]

We actually have not been increasing the hematocrit of the unit unless it is for an exchange. Regular transfusions for NICU babies get irradiated leukodepleted red cells that could go to anyone.

dcarland: have you tried sterile docking the bags? That way you could still send an aliquot rather than a full unit. I don't think there is any way around labeling the empty syringe, although I would feel better about it if the syringe were attached to the bag. Charter Medical makes a bag and syringe set that you could sterile dock onto the original bag without affecting the outdate.

[RR1]

Do your suppliers not produce donor collection bags with paediatric satellite packs attached, so that when a small volume of blood is required you could directly transfer via the closed system , the volume required and detach this from the main bag?

Would solve all these problems- and probably be a lot safer.

[Malcolm Needs ☆]

Very expensive though.

[RR1]

Very expensive though.

Far cheaper than a lawsuit....and as for traceability??

[irshadaad]

you can use transfer bags in a closed sytem ,so you will not waist the blood even if or will not use you can recieve it back and keep it unto its normal expiry

[John C. Staley]

Have you approached them about sending the aliquots only when they are ready to transfuse the baby instead of "just in case"? I know of no more difficult group than anesthesia when it come to trying to work with them. What is your distance and delivery time to OR? Do you send "just in case" blood for any other group of patients? This may be just one of those "cost of doing business" things.

You know I really hate it when I use " " more than once in a post. Oh well.