Return to Blood Bank policy

[adiescast]

FDA also says that coolers to the OR are storage. I wonder about coolers in a helicopter? (I assume they would be the same, but it is kind of funny to think of a cooler on a moving vehicle as "storage" rather than "transport.")

[Sharion Marshall]

Our policy is to receive the blood back into inventory if it is returned back to the blood bank within 30 minutes from the time of issue.

[carolyn swickard]

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.

We were referred to a company named Global Sensors from the Minnesota Thermal Golden Hour blood transport systems web site

http://www.mnthermalscience.com/Index.aspx

http://www.global-sensors.com/

We have several of the Credo Golden Hour OR containers now - they are working for "storage" beautifully - really maintain <6C temp with ease. We also now have one of their platelet transport containers and one of their big blood containers (in a large igloo) - all work very well.

We bought an infrared thermometer Model 8889 from Global Sensors - it is traceable and they can do recertification for you on any schedule. The infrared therm works best for blood when you actually place the nose directly against the bag and take the temp. Avoid the paper and plastic coated areas if you can - move the blood around a little in the bag and take 2-3 temps and average them. Infrared therms will take temps from much farther away, but since the detection area is conical, it gets bigger faster and you get a lot of backgound averaging in the reading.

We also purchased some dataloggers form Global Sensors that came with a computer program - these are being used to validate the blood transport containers - working very well too. (And if I can get the computer program to work - you know it is "user Friendly!"). Global can also take care of the dataloggers when they need revalidating and/or new batteries.

I now have 9 blood transport containers running around this hospital (even across the street), all are clearly validated, hold temps very well and I have a nicely documented folder for the inspectors(!) - hopefully they will actually llike it all!

Hope this helps -

[EDibble]

We often get 25 to 30 units at a time from ARC. My procedure is to put the box at my feet, and pull three or four units out at a time, replacing the bag of ice on top of the remaining units and closing the box. Those three or four units are entered into the computer inventory, checked against the packing slip, and the segments for testing are pulled. Then those units are put into the fridge. The process is repeated, until all units are entered. The units out of the box at any given time are always processed in three to four minutes, staying plenty cold. As soon as the units are entered into the computer, the confirmatory testing is done and those results entered. The units are now available for crossmatching.

[AMcCord]

That's pretty much what we do, though the units go back in the box reversed so we can tell which ones are done. When all of them have been checked in, processing tag applied and pigtails pulled, they go in the fridge. They all stay cool and the fridge door is opened only once. The units are sorted by type in the box, so the fridge door doesn't stay open very long.

[xyzcaa]

100C or 100F? TYPO IN SOP?

[AMcCord]

100c or 100f? Typo in sop?

10.0 c

[bkrobinson]

What about thawed plasma return? For years we have been using 1 hour for platelets and plasma products. When I first came here 5 years ago, I was told there had been a study done for doing this. I recently found out there has not been. Also, how are you taking a temperature of the units? We have a infra red therma unit that we are valdating to use. Currently we use just 30 minutes for red blood cells and 60 for plasma and platelets. After reading the post from 2004, we need to do something using temperature but not sure what.

[Brenda K Hutson]

We also currently use that "30 minute rule" (though it isn't actually a regulatory rule per se). However, we have purchased a Digital Thermometer and my goal is to switch over to actually documenting that the temp. is acceptable after return; not just assume based on some arbitrary time. But even then, none of those approaches actually ensure that the unit was never >10C while out of the Lab. Theoretically, it could have been exposed to a high temp. somewhere, then come back down in temp. prior to return. Which of course is why we use irreversible temp. monitors on blood going into coolers for OR and/or Outpatient Transfusions.

Brenda Hutson, CLS(ASCP)SBB

What is your protocol for when the floor wants to return a unit of RBCs that have been dispensed for transfusion?

[rbayliff]

As I read this thread, there are a lot of places that are using the 30 minute standard for returns to the blood bank. I was cited for this during our AABB inspection last month and am in the process of updating our policy to reflect the current standard. The more I dig into this, the more questions I have. Thanks everyone for your insight.

[bkrobinson]

Soooo! We have just validated infrared temperature devices for taking the temperature of red blood cells and platelets. We were thinking of staying with 30 minutes for thawed plasma since we think it would require taking an initial temperature reading on those since some are just thawed and others are kept at 1-6C. Exactly what product were you cited for and did they mention anything about plasma? Thanks.

[rbayliff]

We were cited for RBC units. Her comment on plasma was to "give yourselves plenty of room, since sometimes the plasma is sent out before cooling to the 1-6 degree range."

[bkrobinson]

Give ourselves plenty of room? What does that possibly mean? When we are just thawing it and sending them out there is no way you can get them to be at 1-6 when they are returned. Oh Well. Thank you very much. We probably are just going to take temps on red blood cells and platelets and use 30 min for plasma and wait until they cite us on plasma so they will be more definitive about how to do temps on them. I appreciate your comments. Thanks much.

[bkrobinson]

I have asked this on other threads and not received a answer that fits. I even asked AABB. What about plasma? It gets issued at 1-6 when store thawed in the refrig. but when it is sent out immediately after thawing and then returned what is being done for temperature? It will never be between 1-10 in those cases. HELP! We are pulling our hair out over this one.

[adiescast]

Just for fun...I looked all the way back to the first edition of Standards. The rule for return of blood for re-issue has always been that it stayed within the appropriate temperature range. Here is the Standard from the First Edition (1958):

7. Reissue of blood

Blood which has been returned to the blood bank shall not be reissued unless the following conditions have been observed:

a. The container closure has not been pierced;

b. The blood has been continuously refrigerated at 1-10oC, preferably 1-6oC;

c. The blood has been allowed to settle long enough to permit reinspection of the plasma for appearance and color;

d. The records indicate that the blood has been reissued;

e. The pilot tube has been identified by label or has remained attached to the bottle.

[bkrobinson]

How interesting. I have also been an AABB inspector for years and I have known for a while that we want to move in that direction but I did not realize temperature was in standards that far back.

[Kathyang]

We are a smaller hospital and we take the temperature. We actually have found units that have been out for only 15 minutes that are above 10C.

[Kathy]

We just started using the 10 degree Safe T Vue indicators along with an infrared thermometer and are already having problems. Blood was issued to the OR this morning with temperature indicators and immediately after it got upstairs, they realized the patient needed irradiated blood, so brought the blood back down. It was 15 minutes, the temperature indicators were red, and the temperature was 13 degrees. I don't think it was an unreasonable amount of time. Would it be possible to find some kind of cheap insulated bag to send these units up in so they could at least not rise above 10 degrees en route to the OR refrigerator? I'm not talking about a cooler here...just a bag with a little insulation....like putting it in bubble wrap or something. I don't want to get into the whole cooler/validation/qc thing if at all possible.

[Brenda K Hutson]

A few thoughts come to mind as I read your response:

1. I don't view it as the temp. monitors being problematic because they came back red (since your

thermometer confirmed that), but rather that it may give more validity to the FDA's move in the

direction of taking the temperatures instead of assigning some arbitrary time (most places use 30

mins) in which to return the unit.

2. When I validate new coolers, I place temp. monitors on them as well as use a thermometer. I have

not noticed discrepancies between the monitor turning red and the actual temperature per the

thermometer.

3. I am "assuming" you placed the units in a cooler (your response does not state that but usually one

does not put temp. monitors on unless they are going into a cooler. So I am thinking that one of two

things occurred; either the OR had the units out of the cooler for an extended period of time (and as I

have said before, you would be shocked by some of the things I have come to learn occur in operating

rooms); or, perhaps the units were crossmatched just prior to being placed in the cooler, and warmed

up at room temp. I have seen that in the past and have seen that sometimes, the monitor may not turn

red immeidately upon placing it on these "warmed units," but by the time it reaches the OR, it has. For

that reason, when my staff are either crossmatching units that are going to immeidately be Issued to a

cooler, and/or, are Issuing units to be placed in a cooler, I have told them to place the units on coolant

packs. This seems to work really well.

Brenda Hutson, CLS(ASCP)SBB

We just started using the 10 degree Safe T Vue indicators along with an infrared thermometer and are already having problems. Blood was issued to the OR this morning with temperature indicators and immediately after it got upstairs, they realized the patient needed irradiated blood, so brought the blood back down. It was 15 minutes, the temperature indicators were red, and the temperature was 13 degrees. I don't think it was an unreasonable amount of time. Would it be possible to find some kind of cheap insulated bag to send these units up in so they could at least not rise above 10 degrees en route to the OR refrigerator? I'm not talking about a cooler here...just a bag with a little insulation....like putting it in bubble wrap or something. I don't want to get into the whole cooler/validation/qc thing if at all possible.

[JOANBALONE]

Just curious as why you use Safe T Vue and thermometer? Can you wrap the units in refrigerated gel pack? No need to validiate if using Safe T Vues and gel packs are kept in blood refrigerator.

[Brenda K Hutson]

Not sure if your question is directed to me, or to Kathy?

Brenda

Just curious as why you use Safe T Vue and thermometer? Can you wrap the units in refrigerated gel pack? No need to validiate if using Safe T Vues and gel packs are kept in blood refrigerator.

[JOANBALONE]

For Kathy..

[Kathy]

Brenda, we have a refrigerator in the OR. The units are out of refrigeration from the time they are removed from the blood bank refrigerator for issue until the time the transporter puts them in the OR refrigerator. I need to do some research on what, exactly, is a reasonable amount of time for the blood to be out in this circumstance. I like your idea about putting the units on refrigerated coolant packs during issue. It might just give us that bit of extra time that we need. I do not want have to put units in coolers just for transport from the blood bank to the OR.

Joan, we are taking the temperature on units with temperature indicators because the computer asks for an actual temperature reading when we return the unit. If the temperature indicator is red, we would discard the unit regardless of the temperature reading.

[LaraT23]

We had a few issues with this recently, as I was using just a 20 minute time limit, which made no sense to nurses. so, we have recently begun placing hemotemp stickers on every unit that leaves the blood bank. This was we have a documented temp if they want to return it. I do still tell them that they get about 17-20 minutes before we are getting in the dangerous temp range.

Cooler issued red cells also get stickers and for any that need to be in OR greater than the validated time of 4 hours, we switch out the ice pack. They get stickers too.

[Brenda K Hutson]

Well, at a former large Medical Center I worked at (which stored coolers and freeze bottles in the OR), we would Issue and then tube (pneumatic tube) units to the OR with Safe-T-Vue Temp. monitors on them (keeping in mind that the tube does not always leave it's destination the second you key in the code). So I think that one key element is ensuring they are cool enough when they leave your dept. But then I don't know how far your Transfusion Service is from the OR. But it "could" be a solution (if you find the monitors change prior to even reaching the OR) to have transport take them up in coolers; then bring the cooler right back (though that is a lot for transportation; or if your supply of coolers is large, they could bring them back when coming to the Blood Bank).

The first place I worked was another very large Medical Center. There were 3 OR suites (each consisting of many rooms) on 3 different floors; right above each other. There were large monitored refrigerators in each suite. With 27 years and 6 Institutions now behind me, I personally would not recommend this practice (and I would be surprised if they still do it); but what they did is this. Every morning, a Lab Assistant would pack up all of the units for all 3 suites for all surgeries in which there was blood crossmatched. She would layer them by suite, and take the OR schedule with her. She then knocked on the door of each suite; at which time one of the Nurses would come and perform a read-back with her of "how many units; for which patients" and check them off the list. The Nurse would then put ALL of the units for that suite, for that day, in the large refrigerator. If needed during surgery, they just went to their refrigerator and pulled the units.

To me, the risk of pulling the wrong patient (especially in an urgent situation; and this did happen once or twice in my 5 years there) is just too great. But I just really don't like the idea of refrigerators in the OR in any fashion (but that is just my bias). I would rather just Issue each patient; as needed; via a transporter (whether in a cooler or not).

Brenda

Brenda, we have a refrigerator in the OR. The units are out of refrigeration from the time they are removed from the blood bank refrigerator for issue until the time the transporter puts them in the OR refrigerator. I need to do some research on what, exactly, is a reasonable amount of time for the blood to be out in this circumstance. I like your idea about putting the units on refrigerated coolant packs during issue. It might just give us that bit of extra time that we need. I do not want have to put units in coolers just for transport from the blood bank to the OR.

Joan, we are taking the temperature on units with temperature indicators because the computer asks for an actual temperature reading when we return the unit. If the temperature indicator is red, we would discard the unit regardless of the temperature reading.