Returning thawed plasma into inventory after issued

[bkrobinson]

I added to a posting that was a few years old but thought I should re-enter as new so it would be seen better. How does your facility handle platelets, thawed plasma and red blood cells when they have been issued and later returned to the Transfusion Service? Historically, our institution has used 30 minutes for red blood cells and one hour for plasma and platelets. When I started here I was told that a study had been performed to valid the one hour but we can not locate it and we really need to change how we are doing this but are looking for suggestions. I believe we need to monitor temperature and we have an infra red temperature device but there is some debate about exacty how to proceed with changing our processes. Thank you for any assistance.

[Brenda K Hutson]

Currently, at our Institution, RBCs not Issued in a cooler (with an irreversible temp. monitor) can be returned within 30 mins. of Issue. After that, we tell them that if they can transfuse within 4 hours from Issue, they should keep the unit and transfuse it. If not, they can return it and we will dispose of it (it is better for us to do that because then we can properly update the patient's records; otherwise, it could appear a patient was transfused with a unit when they were not). FFP can also be returned within 30 mins. For platelets, I have written into our Policy what the Technical Manual states (16th ed. pg. 298); Platelets returned to the transfusion services greater than 30 minutes from issue may be placed back into inventory following a visual inspection of the component. The presence of swirling platelets in the platelet bag correlates with pH values, and is on e of the criterion for adequate platelet in-vivo viability. It says more, but I will leave that for you to read.

We have purchased an IR thermometer and I plan to change to actually taking the temp. on units Issued to Nursing Units upon return (rather than have an arbitrary time-frame; though I may state that it cannot be returned > 30 mins. and not if temp. outside of acceptable limits, even if within 30 mins).

For coolers, we use irreversible temp. monitors on our RBCs. You can use them on FFP but we do not. Therefore, we will not accept FFP back from the OR > 30 mins.

Brenda Hutson, CLS(ASCP)SBB

[adiescast]

The biggest problem with thawed plasma is that it is often warmer than 10 C when you issue it because it just came out of the thawer. So if you take the temperature on its return and it is > 10 C, what does that tell you if you don't know what temperature it was when it left the blood bank?

This is not a question that I have resolved for myself. Our plasma is thawed and kept for 5 days, so it is usually at 1-6 before it leaves the blood bank. The temperature can be taken and is an accurate indicator of whether the temperature requirements have been exceeded. We do not take the temperature when recently thawed plasma leaves the blood bank. (We are usually throwing it out the door as fast as we can at that point!)

[bkrobinson]

I really appreciate all of your respones. Your comments have certainly helped me decide how to proceed. We have data monitors in some cooling containers that we "store" products in and have validated our coolers but we really need to incorporate a temperature reading along with a 30 minute time frame. Thank you very much.

[lkalko]

We issue blood to the OR in a cooler good for 8 hours. Any blood not issued in a cooler must be returned to blood bank within 30 minutes. Our blood supplier is wanting us to take the temps of blood returnhed to the blood bank. Not familiar with infrared thermometer. Can you give me more info on that?

[bkrobinson]

We purchased it from Fisher Scientific but got involved with other issues and never got it completely validated so just wanted to check with what others first. It is hand held. Reads in degrees of C/F and you squeeze a button that emits the ray that takes the readings. I also had contacted AABB and they say that the current thinking is that a product should be in the correct temperature range to be returned into inventory. "If you want to use times you must validate the length of time a product can be out of the proper storage before going over the temperature limit. This works for rbcs and platelets, but not so well for plasma. If the plasma is thawed and issued right away the temperature at issue will be close to the temperature of the thawing device (37C or so) and will be cooling during the time out of the department. For this product you might want to define a time limit in your procedure instead of a temperature, or say that you will evaluate on a case-by case basis." Therefore at this point we will be revalidating the laser and putting it into use along with times, even though we realize that the product may have at some time during that been out of temperature range.

[suhu]

Brenda~

we used the irreversible flower stickers a long time ago and stopped because (1) we found them hard to read, ie. color change was not clear (2) difficult to properly activate. We had to hold them on a heat block for a few mins. Do you have any problems with activating them in a rush, and do you have trouble reading the color change?

we are looking at ways to monitor cooler blood, not comfortable assuming the blood remained inside the cooler for the entire time. thanks for your informative replies.

[Brenda K Hutson]

Those are not the temperature monitors we use. We use the Safe-T-Vu monitors. I have used the flower (HemoTemp) monitors and I personally do not like them (i.e. for reasons you mention). The key to the Safe-T-Vue monitors is making sure your units are cold enough "while applying the monitors." When we take units out to Issue for a cooler, we place them on coolant packs so they stay cool; otherwise, we can have trouble with monitors turning red before they even leave our dept. This is also an important step when you are crossmatching units for a STAT (which will go in a cooler). I have seen instances where the units were out for a short time while the Tech. pulled segments, etc., causing problems with the monitors then.

There was an old type which I really liked (as far as what was the most stable) except that they were glass (BAD idea for bags of blood). I have not seen those in many years and my guess is they are no longer around.

Brenda

Brenda~

we used the irreversible flower stickers a long time ago and stopped because (1) we found them hard to read, ie. color change was not clear (2) difficult to properly activate. We had to hold them on a heat block for a few mins. Do you have any problems with activating them in a rush, and do you have trouble reading the color change?

we are looking at ways to monitor cooler blood, not comfortable assuming the blood remained inside the cooler for the entire time. thanks for your informative replies.

[bkrobinson]

Well for now we will be taking temperature for red blood cells and platelets (along with swirling the platelets). Our data show that at 15 minutes a lot of the readings were over 10C for the red blood cells. We will still use 30 minutes for plasma until one of the regulatory agencies comes up with a practical way to take the temp on plasma since some is at refrigerator temps and others have just been thawed and issued immediately. Our manager just does not like the Safe-T-Vu monitors due to the problems mentioned above.

[Brenda K Hutson]

Well, we are talking about 2 different scenarios (in my mind and experience) You are talking about taking the temperature on units returned after Issue (i.e. Issued to a Nursing unit). We are also going to start doing that as soon as we get the IR thermometer validated. The temp. monitors are only used for units going into coolers. If you use coolers, I personally would NOT recommend that you just take the temperature of the units when they are returned in the cooler. Why? Glad you asked! Because you have NO IDEA what happened to those units once they left you; and I can tell you, I have heard of a lot of scary things that have occurred in the OR (from 6 different Institutions). When you use these irreversible temperature monitors, you know if they ever took the unit out for too long. To take the temp. when it comes back in a cooler just means it was "back" in the cooler long enough to get back into temp. When I started at my current Hospital 3+ years ago for example; if units were Issued in a cooler but say someone forgot to put temp. monitors on them; they would "feel" the unit and if it felt cold, they would accept it back. BAD IDEA (for reasons above).

Just my thoughts on the subject...

Brenda

Well for now we will be taking temperature for red blood cells and platelets (along with swirling the platelets). Our data show that at 15 minutes a lot of the readings were over 10C for the red blood cells. We will still use 30 minutes for plasma until one of the regulatory agencies comes up with a practical way to take the temp on plasma since some is at refrigerator temps and others have just been thawed and issued immediately. Our manager just does not like the Safe-T-Vu monitors due to the problems mentioned above.

[bkrobinson]

Agree about the coolers. We still are not 100% on how to handle those without a data logger or monitoring device. Just today we sent up for an MTP 4 red cells and 4 plasmas in a cooler and 1 platelet pool (not in the cooler). They were later returned in a bedside wash pan with all products including the platelets in the pan with the gel packs on top of it all. Scary in deed. I will bring the monitors up aain and see were it goes.

[suhu]

Brenda

thank you for the info. I ordered some Safe T Vue to try out and had problems with them turning red also, but I didnt put the units on cold packs when activating them. I read where you can put the monitor on the units and store them that way, and just activate them directly before issuing. I want to prepare a bucket of units in advance (segs pulled, etc..) as much as possible for cooler use so it'd be helpful if the monitors were already attached and the techs just had to snap them closed. We are using 30 mins. for rbc and plasma due to not having a video cam on the cooler while it was out of the lab . Do you attach the monitors in advance?

thanks,

[Malcolm Needs ☆]

we are using 30 mins. For rbc and plasma due to not having a video cam on the cooler while it was out of the lab .

Love it!!!!!!!!!!!

[tbostock]

We don't use coolers here. Our criteria for return of blood products:

Red cells and plasma: within 30 minutes and within 1-10 degrees and meets all visual inspection criteria

Cryo and platelets: within 30 minutes and within 20-24 degrees and meets all visual inspection criteria

And yes, once we started taking temps on return, wastage increased. We have educated nurses that the 30 minute "window" is no longer valid, and they must return blood immediately if not to be transfused.