planned surgery / type + screen

[intensivcare]

hi everyone

just a question : How is the procedere in your hospital if you have a patient with a planned surgery if this patient needs perhaps blood during the surgery ? Did you make the type + screen and eventually the x-matches from this patient the day before the surgery or at the same day ? For example the surgery is at 12 :00 pm the patient comes at the same day in the morning and the lab takes a sample from him and do all the prediagnostic work

thnk you very much for your answers

[Eoin]

In our hospital, we have mostly scheduled elective surgery. We have an active pre-admissions clinic and we take the group, screen and hold then. The work-up is done on this, and units (if required the night before - for early am surgery - or same day for the rest of them.

It works quite well. Work-up on same day admissions always had a very busy peak at early morning and just before midday (for afternoon surgery) and became impossible to manage. We store the patients plasma at -25oC until needed. We will keep for up to a month if no pregnancy or transfusion in the preceeding three months, or in the time since the blood was drawn (we have procedures and paperwork to cover this). If we detect an antibody, we ask for the patient to be admitted a day early and a fresh sample is taken (for full workup to be repeated on admission). Even if these are for an operation which would only be a group, screen and hold on our Maximum Blood Ordering Schedule (MSBOS) , we will crossmatch two units and make sure we have access to other phenotypical compatible.

Hope this helps.

Cheers

Eoin

[Steven Jeff]

Hi Iintensivcare

It is standard practice in my hospital for all patients wherever possible to attend pre-admission clinics some days before their admission date. At the pre-admssion clinic the nurse explains to the patient the surgery they are about to have and collects pre-admission bloods and swabs for MRSA screen if required and generally answers any queries the patient has. In general we encourage the collection of Group & antibody screens on all patients recieving a general anaesthetic and a surgeon with a knife, particularly abdominal surgery.

It works extremely well and there are less surprises. However, you will always be caught with the urgent case, but at least that is less frequent. I like to think that it is now recognised that placing unnecessary pressure on the BMS in blood bank is not good.

Steve

[Malcolm Needs ☆]

I would love to say that this planning goes on everywhere; unfortunately, it does not.

It is not unusual for us to receive samples with unidentified antibodies by courier on the same day as the surgery (not even the previous day) and then the surgeon/anaesthetist demanding compatible blood for the procedure in an impossibly small time frame.

:angered:

[David Saikin]

Most of our preop T&S are performed prior to surgical date. We will save samples for 7 days. About 15% of our preop T&S come in on the day of surgery. Fortunately, we have had no serological problems with these same day admits. Also, unfortunatel, some preops come in up to 2 weeks prior to surgical date . . . these patients are redrawn on day of admission for another T&S.

[adiescast]

We get samples up to 3 days ahead, but most people still do the sample same day as surgery. Ths explanation I get is that it is more convenient for the patient to do it when they come in for the surgery because the pre-op work is too far in advance. We do not use samples > 3 days to crossmatch for anyone. I know there are hospitals that use the samples up to 2 weeks for patients who have not been transfused or pregnant. It is frustrating, as Malcolm pointed out, to get a sample with an antibody on a short time frame with a demanding doctor. We have had to postpone surgery before. It doesn't happen often.

[Steven Jeff]

Dear adiescast

When they do the work up in advance of the usual three days notice do they collect samples for group and screen, which is the important bit for me? Forewarned is forarmed!!

Steve

[adiescast]

The answer to that is sometimes. We haven't been able to get it to be routine because of the extra expense and a reluctance to charge the patient for a second type and screen. We have already used the argument that we would really benefit from knowing and the argument that we would then have a second type on file so we don't have to stick the patient a second time day of surgery. Got any other really good arguments?

[mprandealr]

Hi,

We insist on two samples from any patient before issuing blood with the exception of the clinical emergency admission, bleeding/trauma.

All planned surgeries have a pre-admission sample anytime and a second sample sometime within 5 days of the surgery date; (5 days; as 7 day rule the last two days gives us 48 hours post surgery for any top-up's required).

The argument is risk reduction and we have now moved to electonic issue on demand where we do not cover operations by issuing blood if the patients are electronic suitable for blood issue.

April - November 2009 show a reduction of actual blood usage of 15.2%. Win Win situation, but also then that concerns us as it is evidence that we are over transfusing our patients! Nothing new there either unfortunately!

Evidence is a double edged sword, but we are moving in the right direction and the business managers are happy for a change!:mad:

[Steven Jeff]

The answer to that is sometimes. We haven't been able to get it to be routine because of the extra expense and a reluctance to charge the patient for a second type and screen. We have already used the argument that we would really benefit from knowing and the argument that we would then have a second type on file so we don't have to stick the patient a second time day of surgery. Got any other really good arguments?

Patient safety is always my argument and I also work in an Independent sector hospital which charges for the investigations. Even private patients understand the safety arguement. If the antibody screen is positive then I get them to return again for the workup and referral to Malcolm,s reference laboratory prior to the surgery. I will also speak to the surgeon if there I have any problems with the workup. Communication is key. This is for the cold case surgical procedures, emergencies are a diffrent ball game alltogether.

Steve

:o

[margaretcox]

Most of our preop T&S are performed prior to surgical date. We will save samples for 7 days. About 15% of our preop T&S come in on the day of surgery. Fortunately, we have had no serological problems with these same day admits. Also, unfortunatel, some preops come in up to 2 weeks prior to surgical date . . . these patients are redrawn on day of admission for another T&S.

We have an "RTS" order (redraw TS) for these people that had their TS done in advance. We repeat ABORh on the RTS specimen, but otherwise do nothing with it unless blood is needed - and then the RTS specimen is the one we use.