Emergency release of plasma products???

[MeganPLT]

We are currently having some "issues" with not thawing and giving our plasma components out quick enough in an emergency / MTP type situation...I was wondering if anyone else is having "issues" like ours and may have suggestions/ideas to cut down on time?

Here is a typical senario:

We use the Helmer DH4 (or thermogenesis 10 for when a great deal of product needs thawing) water bath and it takes apprx 14-16minutes to thaw the plasma components, after the units are thawed (lets say we did 4 units of FFP) we then print out new ISBT labels that have the converted "thawed FFP" label with a new expiration date of 24hours. We then go into our computer system (Sunquest) and allocate/convert the units and get printed patient compatiblity labels to attach to the unit and the request form. The relabeling/allocating part takes about 5 extra minutes. So usually we can get these product out of BB in 20minutes. The issues come in when the OR/emergency situation is so great that they basically want the units as soon as they come out of the thawers...so I guess my first question is: does anyone have an emergency release form/procedure for cases where there is no time to print patient labels on plasma products so you just literally write the unit number down and do the computer work later and release the thawed product directly? or, My second question: is a 20minute TAT too long for plasma components to be ready by a blood bank?

[adiescast]

When we went to a massive transfusion protocol, we stipulated that we could not meet the need unless we were permitted to stock pre-thawed plasma with a 5 day outdate. We keep 6 Os, 6 As, 6 Bs, and 3 ABs thawed at all times. The only time we get in trouble is the rare AB trauma case or when they refuse to get a type for us (which has happened once in the 3 years since we started this). If the patient is type O, you have plenty of plasma because they can use all of the types. If they are not, you start thawing as soon as the first batch goes out the door. We always start with the 3 ABs (it is written into the protocol) in the first cooler. that gives us at least two coolers worth of plasma for any patient (other than the two exceptions listed above), which is usually plenty of time to get the next batch thawed. We use 5 day thawed plasma for all patients requiring plasma.

We also usually print out the ISBT thawed plasma labels while the plasma is thawing (we don't have the integrated server yet). You can do the thaw process in Sunquest while the plasma is thawing and then all you have to do when it is done is the label check after you apply the labels. You can even allocate and print tags while it is thawing if you do the component prep function while you wait.

Twenty minutes is not a bad turn around time for frozen products. You can speed it up a bit by manually manipulating the products during the thawing process. (stop the thawer, smoosh the plasma, start the thawer again)

[Mabel Adams]

Yes, if you break the big ice chunks up into half or quarters after 5-10 minutes they do thaw faster.

Adiescast, how big a hospital do you serve and how much FFP do you waste? I keep trying to figure out how to have pre-thawed plasma in our remote 260 bed level II trauma center hospital. I fear the only way I could do it is to keep type A instead of AB thawed. I suppose it wouldn't do much harm to even an AB or B adult patient with a couple of units--about the same amount of plasma as is in 2 apheresis plts--but I sort of hate to go there. The computer wouldn't like it. Then I could try to use it up on routine FFP patients and thaw some more to hold for emergencies. Otherwise we would use up or waste too much AB FFP, I think.

[David Saikin]

You do not have to relabel thawed FFP UNLESS you are going to convert it to 5d thawed plasma . . . Rewrite the exp date directly on the product . . . you could also do all your computer work while the product is thawing (if it breaks you can "e-discard" it after the fact) and have the product ready to go as soon as it leaves the bath.

[MeganPLT]

Thank you for your advice, adiescast and David, I think we could speed up things by doing the computer work while it's thawing (I guess we haven't in the past because we wanted to make sure it didn't break, but like you said we can always discard it later, duh!) and we have discussed just writing the exp date on the thawed unit in times of emergency so I think that's a good thing to make standard in emergency cases! (Although there are times that while the plasma components are thawing, we are working on the plts or red cells so there isn't time to even get to the FFP until it's finished thawing, depending on staffing but that's another issue)

BI don't think we are big enough or have enough cases to justify having many units of FFP pre-thawed, we'd probably end up wasting more than we used for MTPs (we are not a trauma 1 hospital). We have discussed keeping a couple of liquid plasma units on hand but I'm not sure how useful those would be in an emergent situation...anyone keep those on hand and find them useful for emergent situations? How do the Docs feel about using them?

[KKidd]

I'm with David. We thaw the unit in the computer and as it takes its bath, complete the paperwork, have it ready to go on the unit as soon as it towels off. This saves some time. We also have a DH4 and it can only thaw so fast! Good luck!

:boogie::boogie::boogie:

[adiescast]

Yes, if you break the big ice chunks up into half or quarters after 5-10 minutes they do thaw faster.

Adiescast, how big a hospital do you serve and how much FFP do you waste? I keep trying to figure out how to have pre-thawed plasma in our remote 260 bed level II trauma center hospital. I fear the only way I could do it is to keep type A instead of AB thawed. I suppose it wouldn't do much harm to even an AB or B adult patient with a couple of units--about the same amount of plasma as is in 2 apheresis plts--but I sort of hate to go there. The computer wouldn't like it. Then I could try to use it up on routine FFP patients and thaw some more to hold for emergencies. Otherwise we would use up or waste too much AB FFP, I think.

We are >800 beds and level one trauma center. Our open heart cases use plasma as fast as the traumas do. We have had a slight increase in wastage and a slight increase in the use of AB plasma (because we give it to whoever needs plasma on the day it will expire or as the first run in a massive protocol). We have been doing massive transfusion protocols since July 2008 and average 3 cases a month. We wasted 1-19 plasmas a month last year (thawed and not used, doesn't include other causes of wastage).

Edited April 20, 2011 by adiescast
added wastage

[Mabel Adams]

Does anyone keep type A plasma thawed for emergencies and even use it on patients with unknown types? If so, how many A units will you give before you know the type?

[blarney]

We just started keeping one AB plasma thawed at all times, good for 5 days for our hemorrhagic stroke patients who have intrancranial bleeds. We are a stroke center of excellence in our network of hospitals and the neurosurgeons insist on getting FFP on board to these patients super fast as they will not operate on them if their INR is not below 1.3. We found that being able to release the thawed product immediately provided better patient care and allowed the surgeons to evaluate them quickly as time is of the essence with a stroke. We also use this AB plasma for MTP and/or traumas since we are a level II trauma center. We have wasted only 4 AB FFP since January, so at this time, the benefit of getting the plasma out the door to the patient immediately outweighs the cost of the wastage. An added benefit is that we can thaw the plasma, modify it to a 5 day plasma and label verify it in HCLL. We can then give it out with an emergency release if the patient ID is unknown/no specimen or we can just allocate it to the patient, tag the unit and issue it within 5 minutes of the order.

[ejsommers]

We do the same....we keep TWO AB plasmas thawed at all times for emergency release situations. Two plasma and four Rbc's are initially sent up to a trauma when we get the page. We are usually waiting there with the products in a cooler when the trauma patient hits the door.

If the plasma has not been used and it getting close to the 5 day expiration we give it to the first plasma order that comes down and re-thaw two more AB's. Occasionally we get caught with expired AB's (like we did this morning) but not very often. ANY waste is a shame but it is worth it to have the pre-thawed product on-hand and ready to fly out the door when needed.

We have emergency release paperwork for the physician to sign in the emergency situation so the product can leave the BB almost immediately after the call comes in for a trauma. The floors can typically wait the couple minutes it takes to "assign" the plasma which can usually be completed before they can get to the BB if they call ahead and let us know.

[ADawson]

Hi where can i find the regulations on relabeling plasma?

[tbostock]

We have a microwave plasma thawer that thaws the FFP in 5-7 minutes. I highly recommend getting one, especially if you are a high level Trauma Center, stroke center, cardiac surgery, etc.