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LaraT23

Time limit for starting transfusion after issue

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Hi Donna,

Do you have a reference for 4 hours from time of issue from Circular of Information, FDA or AABB?

JB

My post was off the top of my head, however, I did find a reference in the AABB Technical Manual, 16th edition, 2008, page 617, stating "...the unit must be infused within 4 hours of the time it was issued from the transfusion service, or it must be discarded." (So it does not state "removed from the refrigerator"; I just interpreted that to be their intent.)

Donna

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Our policy says that the unit must be ready to transfuse the unit when it is issued from the Blood Bank. If returned after 30 minutes it must be discarded. I'm not sure if there is anything that says it must be started within a certain time frame except for the fact that they must be ready to transfuse when it is picked up. I can check our nursing policy later.

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Nursing (and Blood Bank) policy at my hospital states that blood will not be checked out from us until nursing is ready to hang it - immediately after they get it upstairs. Their time limit for hanging the unit is 15 minutes from checkout. Returns must be made within that same time frame of 15 minutes, with the temp checked when it arrives back in the lab. If the temp is >10C they are given the choice to take it back to the floor and infuse within 4 hours of the original checkout, if they think they can solve whatever problem triggered the return, or we take it back and destroy the unit. Infusion must be complete within 4 hours of checkout.

This policy was put in place after discussions between nursing service policy writers, myself and the lab manager with the intent to meet Blood Bank and Joint Commission standards. We got a little pushback, at first, but after explaining the reasoning behind the whole thing AND making sure that they truly understood what we were talking about (that was a little more difficult), then they were on board with us. We had questions about the change in policy from staff at first, but once they also were educated and satisfied with our explanations, we've had no problems. AND because of these requirements, we are wasting almost no units of blood products because of warm returns. Our number of wasted checked out red cells was actually zero last year.

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I agree with FDA that temp is the critical issue, however, the AABB educational material for Nurses does state a time limit for return of 30 minutes. I asked AABB what was the basis for the time limit. I was told was it was arbitrary. I guess someone decided it takes a unit 30 minutes to reach 10 degrees. If anyone knows source, I have always been curious.

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Hello Folks,

The return limit is 30 mins here too. In fact, the BloodTrack system will not grant them access to return after 30 mins, and it would not allow it to be taken again, even if they knew how to bypass the electronic lock. So our nursing policy clearly states that there must be a patent IV line, and if the patient is pyrexic, they must ask consultant advice before they come to collect blood. The thirty minute rule is intriguing - I have a feeling that it may even go back to issue of whole blood in bottles (sorry guys, I am ancient) and rise in temp, and I agree it is because of the possibility of repeated issue if returned and increase in bacterial growth with accumulated time at room temp.

It would be a good project / paper for someone to perform some experiments on blood (different bags, different volumes, different ambient temp etc) - maybe when I retire and have the time.

Cheers

Eoin

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According to FDA the temperature of the blood is the critical piece of information - not the time it has been out of the controlled temperature - for the blood to be acceptable back into inventory. The old rule of 30 minutes no longer applies - it now depends on whether the temperature has reached 10 degrees or not. If it reaches 10 degrees, then it cannot be put back into the regular inventory but it can still be transfused within the 4hr limit beginning with the initial issue. We quarantine the unit until nursing can use it and then discard if they cannot meet the 4hr limit. To decrease temperature problems, we insist that nursing take vitals before coming to get unit.

The "30 MINUTE RULE" is urban legend! estiner is correct that the FDA is clear that it is not the time out, but the temp that is the driving force. The unit can be on the floor and transfusion completed within 4 hours. My concern is where is the unit while it is awaiting infusion? Did they leave it on the radiator? In direct sun light? In a refrigerator? EEK! If the nurse cannot hang the unit right away, it should be returned to the blood bank. I like the idea of holding the unit for 4 hours and THEN discarding it! So often the unit is returned due to loss of IV or other short term event; this would allow us to re-issue the unit to the patient and avoid discarding the product!

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Hi Sue,

I agree - temp is much better than time rules - BUT it would have to be Controlled temp - measuring it on return, whilst a good idea may fall short of the mark, but would love to see your validation for measuring temp inside the bag - do you use indicators? If not - scenario - blood is left in sunlight for 20 mins - nurse says $^"!£ slap that bag into a fridge quick while we sort out this patient's IV line - can't be sorted easily - may need a central line - blood sent back to lab later with temp nice and cool - but what has it been up to in the interim?

I still feel this is one we can sort out and would love to see lots of ideas on this.

Cheers

Eoin

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Hi Eoin,

I have HemoTemp II Stickers that we apply to the unit before issue. They not only have read windows for current temp range of unit , 1-3, 4-6, etc. but if the temp of the bag reaches 10 or higher, there is an irreverible window marker that is activated. Has worked well for us, particularly with the OR who needs blood one minute, then decides against the next.........

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