What to do with cooler validation info re: storage/transport?

[Kathy]

I have just finished what I consider to be a very thorough validation of some new coolers. I packed the each cooler with 1 unit of expired blood, then removed it every 30 minutes and took the temperature with an infrared thermometer until it reached >10 degrees. I repeated the process with 2 units, taking the temperature of each unit every 30 minutes. I repeated it with 3, 4, 5, 6, 7, and 8 units of blood. Per AABB suggestion/requirement, I now know the most amount of time I can keep my blood at <6 degrees (storage), which is 30 minutes, and the most amount of time I can keep it at up to 10 degrees (transport) - 3 hours. What do I do with this information? The coolers are really only meant for transport between monitored refrigerators within the hospital, but I know there is a chance someone might want to use a cooler to have blood at the bedside for a procedure (storage). I am very confused on how to word my policy in regards to storage and transport. Do I put "blood may be stored in coolers for up to 30 minutes and transported for up to 3 hours"? That is going to confuse everyone. They can walk around the hospital with a cooler full of blood for 3 hours but they can't sit it by the bedside for 1 hour?

In case you are wondering why the short amount of time, I am using a system with refrigerated gel packs, which is sufficient for our needs since we have refrigerators in the OR and ICUs.

[JOANBALONE]

I think you might have to have 2 policies or you could pick a time/packing configuration for storage (for example, 2 units have acceptable storage temp for 3 hours) that matches the 3 hour transport time for 8 units.

Why remove blood every half hour during the 10 C validation? If it is going between refrigerators it will only be removed once.

We also had a problem keeping blood cold enough (6 C) using refrigerated gel packs. We don't use them anymore.

[Kathy]

I wanted to see how long the coolers would maintain temperature. Per AABB Technical Manual, 16th edition page 284, "It is recommended that all red cell transport containers be validated to maintain a temperature for 1 to 6 C for a specified period to ensure compliance with the transport and storage requirements for Red Blood Cells." The only way to do that is to check the temperature periodically. I didn't want to do every hour because I suspected the coolers would not hold temperature for a very long time. I did do a process validation as well.

The refrigerated gel system should work for us. If we used something with wet ice or frozen coolants, the coolants would thaw out or the ice would melt and not be available to transport the blood from the OR to the ICU. We do have Thermosafe coolers for traumas in the ER, since the ER does not have a refrigerator.

[estiner]

Our ThermoSafe coolers use 3 frozen coolants and two refrigerated cool packs. They keep the temperature under 6 degrees for up to 8 hours.

[Kathy]

I think I am confusing people. I do have 2 Thermosafe coolers. When I validated them with 3 frozen packs I found that it made the blood too cold, so I have them validated for temporary storage of blood at 1-6C for up to 7 hours with 2 frozen rigid bottle refrigerants and 2 refrigerated gel packs. We had these first and are using them for traumas in the Emergency room.

In May, we started using Safe-T-Vue 10 indicators on all blood that went to the areas with monitored refrigerators. What typically happens is that we send a bunch of blood up to the OR for surgeries. For the cardiovascular cases, that blood is then transported to the CICU refrigerator, where it is stored for a period of time and then returned to the blood bank. We were finding that too many units of blood came back with red indicators. The blood comes up to >10C in as little as 15 minutes, so the room temperature transport wasn't always working for us. Realizing that a cooler system that uses frozen packs won't work for us since the frozen packs won't stay frozen and ready for transport from the OR to the CICU, I decided to go with a refrigerated gel pack system (Transport-R Inc.) so that all of the blood and gel packs can be refrigerated when they get to the OR refrigerator and then the cooler can be repacked for transport to the CICU. The gel packs will be cold since they will have been refrigerated with the blood.

The amount of time the Transport-R coolers come up to 6C and 10C is much shorter than the Thermosafe coolers, but that is fine with me since I don't need them to keep the blood cold for a very long time...mostly just long enough to transport between various locations in the hospital.

I can put in the procedure that the Transport-R coolers are only to be used for transport, but I do have the data that indicates how long they stay at storage temperature. I am wondering how to incorporate this into the procedure, especially if the CICU wants to use the coolers to keep blood at the bedside for short procedures.