Help ! Issuing soon to expire blood components.

[goodchild]

This might be a pretty obvious question but I've never run into a situation like this before. Issued cryo on a patient that was going to expire in <10 minutes. The nurse was unable to start it before the expiration time, is it still acceptable for her to start? Like, is it good to go as long as we issue it before it expires? Or is it good to go as long as it starts infusing before it expires? Or what?

[goodchild]

Just going to go with common sense with this one.

[David Saikin]

I had a Medical director once who told a nurse "it doesn't turn to mud at midnight". Our criteria was it was acceptable if signed out prior to expiration.

[khalidm3]

Actually there will be no big/risky changes in the Cryo unit with in this short time, but still no expired products should be transfused after expiry. All rules/mandatory guidelines should be followed strictly. If we relax like that, an other fellow may decide some thing wrong considering such examples.

[Likewine99]

We would do the same as David. The comment our Med director gave the floor was "it doesn't turn green at midnight".

[shelleyk482]

The Circular of Information states "Transfusion should be started before component expiration and completed within 4 hours". (pg 5, #12, Dec 2009). We would require Medical Director approval to start any transfusion after the expiration time based on the Circular statement. I hate to waste product but I would hate more to have to justify to an inspector or court why I didn't follow this for a "readily" available product.

[John C. Staley]

It seems like we "waffeled" back and forth between: Had to be started before expiration time. & Had to be finished before expiration time. My personal philosophy went alone the lines of the Circular of Info as noted above by shelleyk482.

:confuse:

[Mabel Adams]

At AABB meeting this year someone presented almost this question to "ask the FDA" and "ask the AABB." FDA/CMS said you could finish a transfusion that was started before expiration as long as the infusion was finished in 4 hours regardless of whether the product expired during the 4 hours. AABB said you can't. No one addressed starting infusion after expiration so I too think the circular is the basis for your decision. That is what the FDA people referred to to answer the above question.

The point above about stretching the rules is well-made. People that don't understand the logic will sometimes decide to stretch another rule (or the same one under different circumstances). You can always have your Med Dir. sign for it because we all know it doesn't instantly deteriorate. That could impress on your rule-benders that all must be documented and justifiable before rules are bent.

[khalidm3]

Yes Mebel, ur opinion and explanation is perfect. We never issued such short expiry product.

[goodchild]

I appreciate the responses. I've heard every variety of what you've all said during my career. At that moment, however, I realized that I had no idea what the "official" opinion is.

[Liz]

At AABB meeting this year someone presented almost this question to "ask the FDA" and "ask the AABB." FDA/CMS said you could finish a transfusion that was started before expiration as long as the infusion was finished in 4 hours regardless of whether the product expired during the 4 hours. AABB said you can't. No one addressed starting infusion after expiration so I too think the circular is the basis for your decision. That is what the FDA people referred to to answer the above qu

estion.

The point above about stretching the rules is well-made. People that don't understand the logic will sometimes decide to stretch another rule (or the same one under different circumstances). You can always have your Med Dir. sign for it because we all know it doesn't instantly deteriorate. That could impress on your rule-benders that all must be documented and justifiable before rules are bent.

That was me Mabel but I put it in writing to the Standards Committee and asked about

platelets, our precious gold commodity.

Their answer about the unit turning into a pumpkin at midnight was: You cannot use it if it will not be completed before expiry.

Then they did explain that if it is needed and the Medical Director is called and approves you can CONTINUE the unit if started before expiry.

I was very interested they did say that the rules are there not for us to toss out units that we need, but to use logic. So individualize your case. As you said Godchild this has never happened before, so it is an exception. And no they don’t turn into pumpkins at midnight!