Return to Blood Bank policy

[Deny Morlino]

Useful info on the IR thermometer as I will be validating one shortly.

[L106]

OK let me rephrase as I did not mean to be offensive and I think I was. What adiescast said makes MORE sense than the vague regs. That was what I was thinking as I typed the first reply, but my fingers obviously had a mind of their own. Sorry if I offended

Deny - Your original post did not come across as offensive to me. (I hope that I did not imply that!)

Donna

[L106]

I just ordered an infrared thermometer, too, so thanks for the info.

[Deny Morlino]

Donna,

You did not imply offense at all. I have enough history on user groups to know how easily what is typed can be taken the wrong way. I tend to re-read my posts after a break to see if what I have written may sound offensive. Just making sure I corrected my inference.

What IR thermometer did you go with? If I may ask, what prompted the purchase?

[L106]

Deny - I ordered a small, inexpensive one from Cardinal Health Care. (It is supposed to read +/- 1 C.) We'll just have to validate and try it a while to see whether it is reliable and whether we like it. I decided to order one and see how it goes. We currently are putting digital thermometers in the coolers when we send blood to our Out Patient facility (which is in a different building), and the digital thermometers don't fit in the coolers nicely, so I would like to find something different. I'll let you know more after we get our hands on them.

[Deny Morlino]

Do the digital thermometers record a high and low? I assume you are using the digitals to assure the coolers maintain temps on the units during storage. In your situation if you are looking at temps over a period of time, the Safe-T-Vue may be a good alternative (after looking at the specs). A neighboring hospital here has used these for a few years now with good performance. Just thoughts

[L106]

Yes, our current digital thermometers record high and low temps, so that is nice. Our current Thermo coolers have been validated, and we have a years' records of excellent, consistent performance, so I feel comfortable switching to trying the infrared thermometers and seeing how they do.

We have used Safe-T-Views in previous years and had a lot of problems with them. However, I suspect that they have improved since our experiences of many years ago, and I think maybe we should try them again.

[BBKT]

You will all find this interesting. We were sited on this issue just last month in my AABB inspection. The inspector stated - blood that is delivered to the floor (not in a cooler) is considered to be in a "ready for transfusion state" and therefore if it is returned to the blood bank the he blood needs to be verified upon return to be in the 1-6 degree C temperature range. (1-10 degree C range is for blood in transport state not "ready for transfusion state".) We kept the 30 minute guideline for nursing because we do not want them to rush through the proper patient identification steps. We have found that units out of the blood bank for more than 5-10 minutes exceed the allowable 6 degree C temp.

[L106]

Yes, that is interesting. I have never heard of the term "ready for transfusion state". Do you think this is really AABB's intent, or do you think it was the inspector's personal interpretation of the standards?

Seriously, if we transfer a shipment of Packed Red Cells to the hospital across town, it's OK if the units end up being at 9 degrees C for 45 minutes, but if a nurse returns a unit of blood from the nursing unit and the temp of the unit is 7 degrees C we are supposed to destroy it??? How many of you have harmed a patient by transfusing a unit that has been in the 7-10 degree range? There are so many more important things that we could/should be spending our time on to improve patient care.

[Deny Morlino]

I suspect we all transfuse blood outside of the 1-10 degree C range if the unit istransfused over a 4 hour period . I do agree that there should be one temperature range for us to work with. It does not seem to be a truely different situation as to whether the units are "ready to transfuse" or "stored". If the temperature for storage is 1-6 egrees C then make that the temperature range for both scenarios, allow us to adjust, and let's move on to more important things.

[Mary**]

:clap:Right on!!

[Deny Morlino]

A bit of progress on this topic. I was at our regional Red Cross yesterday for a technical advisory committee meeting (great meeting by the way!). Part of the presentation was by Fenwal. Fenwal is a primary supplier of blood product bags for the regional ARC. I posed the question about temperature rise to the Fenwal representative. He was not able to provide me with an immediate answer, but requested I send him an e-mail detailing the information I was looking for. He indicated that there were people assigned to this issue and said he would forward my request for information to the correct people. I sent that e-mail this morning and will await a reply.

I also received a thermometer from Thermoworks called a Thermapen. I have validated it using our certified thermometer across the temperature ranges we are likely to utilize it within. A quick preliminary check of a unit of expired LRBC's pulled from our unit refrigerator at 4.2 degrees C and placed on the blood bank counter in an air temp of 21.5 degrees C took 24 minutes and 42 seconds to reach 9.6 degrees C. The thermometer is accurate to +/-0.4 degrees C in this temp range. I plan to repeat this testing at least 10 times over as many days to see how much variation we experience. The other trial I hope to perform is the same starting temp but instead of placing the unit on the counter, the unit will be hand held until the temperature reaches the same 9.6 degrees C. This is to simulate a maximum exposure to body temperature during transport by nursing to the units for transfusion. Any further suggestions on details to look into are certainly appreciated. I will keep an update going as I have more information to add.

[Brenda K Hutson]

Every place I have worked has used the 30 min. rule; however, it is also my understanding that we are now supposed to actually document the temperature on returned units. For coolers, not only are they validated, but we also put irreversible temp. monitors on them. I don't think those have to have the temp. taken (unless in a cooler, validated or not, that does not use temp. monitors). I am in the process of purchasing an IR thermometer to document the temperature upon return of units from the floors.

Brenda Hutson

[Deny Morlino]

Received a reply from Fenwal today related to this subject. Was a surprisingly direct answer given today's litigation based society we live in .

Deny,

Please see the response below for Allen Roberts. Allen is a Clinical Education WB Specialist with Fenwal. He is also an AABB inspector. If you have any other questions, please let me know.

Scott Stanton

Fenwal Inc.

Account Executive

Phone: 513-470-8742

From: Roberts, Allen

Sent: Friday, April 30, 2010 5:35 PM

To: Stanton, Scott

Subject: RE: Temperature rise time out of refrigerator

The “guideline for time out of the refrigerator†is the time it takes a unit of refrigerated blood to warm from storage temperatures of 1-6C to processing or transportation temperatures of 1-10C (not 21C). Each facility will be different depending on the facility’s environment during different times of the year. My suggestion is for the facility to purchase a Thermo Trace Infrared Thermometer with or without a laser. These thermometers are N.I.S.T. traceable and is CE marked. There are many different varieties such as the one I use from DeltraTRAK, Inc. The amount of total episodes and intervals of which components are out of validated storage containers e.g. refrigerators should be minimized. In the average facility with proper cooling circulation of air, it would take approximately 30 minutes to warm a unit of Red Blood Cells from a storage temperature between 1-6c to a processing/transportation temperature of 10C. Each facility must either calibrate their environment or take the once refrigerated temperature of the unit that is being process and return it to the refrigerator before the temperature is above 10C.

PLEASE DO contact me if additional explanation is needed.

This is the approach we are working on establishing. Am still working with the new thermometer to establish a base idea of "the quickest time frame for rise in temp". I will let you know the final policy we decide upon here.

[AMcCord]

We check temps when a unit is returned and document it. If it's over 10C , we give them a choice...can you get the unit started and infused within 4 hours of the original checkout? if so, then take it back upstairs and do so, preferably holding it in patient room, but don't put unit in the refrig or in an extra warm place while you are getting ready to actually hang it (works for situations like restarting IVs). If you can't get the unit started and realistically infused in 4 hours from checkout, then we'll take it back and the unit will be destroyed. Nursing service policy requires that a unit must be hung within 15 minutes of checkout so they are absolutely ready when a unit is checked out. Because of this, we get very few requests for return. Of those, there are only a couple of instances per year where the unit ends up being destroyed.

[Deny Morlino]

Nursing service policy requires that a unit must be hung within 15 minutes of checkout so they are absolutely ready when a unit is checked out.

This detail is worth looking into! We have very few units returned each year (1-2 usually), and this may take care of the few we do have.

[bxcall1]

To those of you that mentioned trying Infared Thermometers - how have they worked out? If you have had a positive experience please post the brand and model number and whether it is traceable. Since the recent editorial in the AABB News I'll bet alot of us will be re-thinking the 30 min. rule.

[elizabeth3801]

I agree. If any of you have IR thermometers that are validating and working well please post brands. We have tried an IR thermometer and also a temp plate for blood products and bothe validate and reproduce well for platelets and plasma from the thawer but not red cells or cold plasma.

[Mary**]

Our experience has been the same.

[heathervaught]

We use a Raytek.

[Mary**]

Do you know the model number? There are pages of them on the internet. Does it work well?

[heathervaught]

I believe that Raytek was purchased by Fluke. The thermometer says on the side "Fluke 63 IR Thermometer".

And yes, we love them! I think that they work very well.

Edited June 24, 2010 by heathervaught
answer 2nd question

[MHS]

The standards say red cells are to be stored at 1-6 and transported at 1-10. Based on the discussion threads it seems that most folks put issuing a unit to the floor in the transportation category. I was brought up that the 1-10 range is for units that leave a facility, such as back and forth to a blood center. Anyone else brought up this way? Also, what about units issued in a cooler that stays in the OR? Isn’t that storage? Looking forward to the responses...

[bduff]

Also, what about units issued in a cooler that stays in the OR? Isn’t that storage? Looking forward to the responses...

[tbostock]

This "storage vs transport for coolers" has been a big debate. NYS Dept of Health has determined that they are for storage, hence less than 6 degrees. So in NY State, it has been decided for us.