massive transfusion units, do you tag each one?

[suhu]

The hang up with our current Massive Transfusion Protocol is the computer. We order an Emergency Release Test and then allocate each unit to the patient, put in the required comments and print out individual tags. We then remove a peelable sticker containing the Transfusion Record info and affix it to each unit. We then place the units and corresponding tags in a cooler for pickup.

It's a cumbersome process. Since the MTP pack is 6 red cells and 6 FFP, the time consuming part is waiting for the printer and "tagging" each unit. There doesnt seem to be much advantage to making them up in advance, because each unit needs to go through this process to be tagged with the patient's name/ID.

I read through most of the MTP threads but it's not clear to me. If you make up the coolers in advance, are you still tagging each unit with patient name/ID at issue? Another related question, do you issue the units in the computer at time of issue, or after the fact?

[Eagle Eye]

We do exactly same as you described. Our computer system allows us to issue multiple units on one screen and it would print all tag same time. We have 20 mins we get between two pick up and we prepared plasma ans red cell in cooler.

We attach tag to each unit.

For us it is very essential to issue unit in computer...my techs are not allowed to print tag without issuing in computer.

amount of stress they have during massive transfusion, you do not want an error..you want your computer to catch the error (eg. ABO incompatibility). We have zero tolerance for those who do not issue unit in computer when computer system is up and running.

[rravkin@aol.com]

The hang up with our current Massive Transfusion Protocol is the computer. We order an Emergency Release Test and then allocate each unit to the patient, put in the required comments and print out individual tags. We then remove a peelable sticker containing the Transfusion Record info and affix it to each unit. We then place the units and corresponding tags in a cooler for pickup.

It's a cumbersome process. Since the MTP pack is 6 red cells and 6 FFP, the time consuming part is waiting for the printer and "tagging" each unit. There doesnt seem to be much advantage to making them up in advance, because each unit needs to go through this process to be tagged with the patient's name/ID.

I read through most of the MTP threads but it's not clear to me. If you make up the coolers in advance, are you still tagging each unit with patient name/ID at issue? Another related question, do you issue the units in the computer at time of issue, or after the fact?

Suhu,

We pre-tag each unit prior to need and store until needed; receipt tags and segments are already seperated with an "Emergency Issue Card" containing the unit numbers, medical director signature, numder of units, and unit type. When needed all we do is write the pt medical record number and issue manually; that means just write the time of issue on one of the receipt tags. We can deliver 6 PC's to the ER or OR in under ten minutes. There was a time that we didn't pre-tag the PC's and our TAT was approx. 20 min. As far as the actual computer end is concerned we usually back issue the units with appropriate date and time of issue. Hope this helps.

[David Saikin]

Do you all really believe that the unit paperwork is looked at during a massive transfusion event? Or is it checked afterwards?

[Eagle Eye]

Surprisingly at our place it seems like they do look at the tags. Few months back, during massive transfusion one of my tech switch tag for two red blood cells (units were for same patient but unit123 tag appliied to Unit 345 and vice a versa) and anesthesia called BB and returned those units.

[David Saikin]

I am definitely impressed

[Malcolm Needs ☆]

I, on the other hand, am completely and utterly amazed!

:rolleyes::rolleyes:

[Dar]

Thanks for your posting. We have been struggling with the same issue. It is much easier to release uncrossmatched massive transfusion packs. Once the specimen is type & screened, the process boggs down. We would like to be able to pre-tag, but we are afraid we might forget to issue. It would be so much easier if we could just hand out a cooler, which is the expectation.

[Shaundrey]

For our MTP's, on the 1st pack we issue as emergency release 5 RBC's and 5 Liquid Plasma's. We use manual tags that we pre fill out with the donor information and add the patient information when we get the call. The segments are already attached and we put the date and time that we issue them on the tag. We continue this process until we get a sample. Once we get a sample, we stay 2 packs ahead and post issue in the computer after the runner has left. This keeps us from getting bogged down with the computer at the time of issue and we always have products available. The person issuing the products does the final check before the products leave the BB. This is all outlined in our SOP for massive transfusion protocol and emergency release of blood products. When they are not in a mad rush to have products, we will issue in the computer if time permits.

We still have the issue of anesthesia not checking the blood products but that will forever be an ongoing problem for us. I just write them up every time it happens.

[ChrisH]

A few years ago when I was working in a trauma hospital, all ours were per tagged and placed into coolers. In the cooler was a master sheet with the unit numbers. Segments were pulled and placed into racks. We had 10 and 5 packs of coolers setup this way.

This way we could have blood out the door in under 5 minutes. The time it took to bag up so ice, walk to the walkin fridge and grab a cooler...

[suhu]

thank you for all your replies, interesting to see what others are doing.

DAR, yes that's it exacltly. The expectation is we have the cooler all ready to just hand-out, when in fact its pretty high-maintainance. MTPs usuallly happen on shifts when we only have 2 techs working, and it takes full attention of both techs to get all the units properly tagged and packed up. Funny, our emphasis has been on "send us a speciman ASAP, and you can have all the crossmatched blood you want"....and now they're pretty good at sending samples. sigh, with the advent of the MTP , we are better off without samples, much faster if we could have everything waiting for just the patients ID to be put on..

[adiescast]

The main purpose for having the sample is to switch the patient to type specific blood. Every unit must have a tag on it. We may or may not have time to issue in the computer before the cooler goes out the door, so we make a list by putting unit stickers on a piece of paper with patient ID and issue in the computer as soon as posible (with emergency released blood we have that paperwork and don't have to take this step). Usually we can keep up once the first cooler is gone. We actually have found that we already have a sample and crossmatched blood in most cases before the patient breaks loose, which really surprises me. Of course, your two unit crossmatch doesn't amount to a hill of beans once they start the massive, but that is just the way it works. Electronic crossmatch makes a huge time savings for these patients.

[PammyDQ]

Do you all really believe that the unit paperwork is looked at during a massive transfusion event? Or is it checked afterwards?

LOL no, of course not. But I only have control over my actions and how I follow protocol. If the transfusionist errs by taking "shortcuts", it's their license, not mine on the line!

[suhu]

rravkin,

yes, this is helpful. We are considiering doing something similar. I have a few more questions...

Regarding the tags, to clarify, you just write the MRN on the tag, not a name? Do you put any type of Patient ID sticker on the blood bag itself?

Do you pre-tag only Group O units? Or do you pre-tag other blood types as well, for example patient already has sample processed, but massive bleeding situation is encountered and they want a cooler of products all at once?

[DPruden]

We have 4 O- units pre-tagged to Trauma, Patient. We photocopy the face label of the unit and then all we have to do when a trauma is called is pull the photocopy out and pull a segment and put the units in the cooler. We can then use the photocopy to issue the blood in the computer. We have enough time to setup and tag more blood before it is needed, usually.

[Mary**]

Where do the nurses write their nmaes for patient ID, vital signs, etc.?

[DPruden]

The tags that we use for the Trauma, Patient are the same as the tags we use for normal use. So, the nurses fill out the tags as usual.

[rravkin@aol.com]

rravkin,

yes, this is helpful. We are considiering doing something similar. I have a few more questions...

Regarding the tags, to clarify, you just write the MRN on the tag, not a name? Do you put any type of Patient ID sticker on the blood bag itself?

Do you pre-tag only Group O units? Or do you pre-tag other blood types as well, for example patient already has sample processed, but massive bleeding situation is encountered and they want a cooler of products all at once?

Suhu,

Sorry for the late reply, but normally we do not have a patient name for a trauma so we write the unique trauma patient number and the associated medical record number on the unit tag. We do pretag O Pos PC's containing all pertanent info except the the two unique patient indentifiers. We will opt for ABO Rh specific PC's when practicle, otherwise O Pos PC's are the red cell product of choice. I hope this helps and again I apologize for the late reply.:)

To answer Mary's question, our unit tags contain graphics for vital signs which the nurse fills in accordingly.

Also, I would like to ask what are the turn-around times practiced for Massive Transfusion products at other facilities, mainly PC's??; at my facility it is 15min for PC's.

Edited September 8, 2010 by rravkin@aol.com

[HALA HASSAN]

We do tag all single PRBC & FFB units ahead of time ,we get the pt # by having OR phoning them 10 min befor .