Releasing RBC units post surgery

[BB in VA]

Does anyone have a policy, written or unwritten, regarding the release of crossmatched units post surgery? I have been looking at a 24 hour post Hgb of >10 before releasing the units. I hate to leave units for the entire 3 days when another patient can use them. We recently had a situation where the units were released and then on the 3rd day the patient required transfusion with a Hgb <8. Different units were crossmatched and available for the patient within 15 minutes. Any thoughts?

Thanks, TB in Virginia

[Liz]

That is typical Blood Banking, and good practice and patient care.

I am not sure I see where your concern is.

[BB in VA]

Thanks Liz for your reply. The concern is not mine but of some of my co-workers who believe that units set up should remain x-matched until the sample expires. I feel as if it's my job to care for the patients as well as my inventory and blood supplier. We are currently experiencing typical summer shortages as I am sure most of us are. Thanks again.

Terry

[Steven Jeff]

Hi Terry

The modern approach to blood banking in my opinion is that blood units should be returned to stock 24 hours post op unless the Hb is less than 8g/dL possibly 9g/dL in an elderly patient. During the last 5 years in the UK the management of blood stock has changed significantly along with adherence to lower transfusion trigger levels and the avoidance of unnecessary transfusions.

Please continue to enlighten your co-workers; the return of cross matched units has no relationship to when the sample expires in this scenario.

Steve

:)

[rravkin@aol.com]

Terry,

In practice I have taken units down on post-op patients who showed no signs of active bleeding and did not have orders to transfused, according to the patient's RN, and who had a negative antibody screen. I practiced this upon need and without a formal writen policy. I think that it is just good practice and good product management.

[Bill]

Our experience with total hip patients is that the Hgb does not usually bottom until 24-36 hrs post surgery. Because of this, we usually wait until morning of 2nd day post surgery to release units back into available status.

[Liz]

Terry,

In practice I have taken units down on post-op patients who showed no signs of active bleeding and did not have orders to transfused, according to the patient's RN, and who had a negative antibody screen. I practiced this upon need and without a formal writen policy. I think that it is just good practice and good product management.

I agree that you can individualize, and decide as the need arises.

[David Saikin]

Our policy states that units may be taken down the 1st post-op day . . . I usually wait until the hematlogy results on the 2nd day (esp for hips/knees). For many of my preop pts, the xm specimen is only good for the date of surgery so, unless we get a TS order the next day, the units come down automatically.

[khalidm3]

We return the units to inventory next day to operation day unless treating physician or nurse inform blood bank to hold the units due to low Hb or some other reasons. It is mentioned in our return blood policy.

[Deny Morlino]

Nothing in policy here, but if a patients post surgical H&H seems to be holding and I have a patient that will definately use the unit, I will release for use with another patient.

[pbaker]

We have no formal policy regarding release of units prior to specimen expiration. However, I look at the crossmatched units daily and release those with a stable hemoglobin of 9 or greater regardless if the original order was a surgical or medical request. I often find units still set on patients that have discharged or have expired. Those definitely get taken down.

We use electronic crossmatches and as soon and I can educate the medical/nursing staff (and calm their fears) we will be going to crossmatch on demand as EXM was designed to be used. This will virtually eliminate the problem of units set for no reason.

[EDibble]

We have no policy per se, but assess every post op patient every morning. We do a lot of ortho procedures here, and the specimens often expire the day of or the day after surgery. As was stated earlier by Bill, the Hgb of these folks don't often bottom out for several days and we have to set them up all over again. Holding units crossmatched for three days post op on a patient with a stable H&H would really interfere with good inventory management. We have EXM, so setting up more units on someone with an indated specimen is a snap!

[Mabel Adams]

If you must replace "stolen" units, do you charge for the replacement crossmatch?

[L106]

We have no formal policy regarding release of units prior to specimen expiration. However, I look at the crossmatched units daily and release those with a stable hemoglobin of 9 or greater regardless if the original order was a surgical or medical request. I often find units still set on patients that have discharged or have expired. Those definitely get taken down.

I do the same as pbaker. If I "steal" a unit from a patient and then need to set up a replacement for him/her, I do not charge the patient.

Donna

[EDibble]

No, we do not charge the patient if they have to be set up on new units because we chose to release them.

[Liz]

I absolutely agree with Donna and Elizabeth, if the unit is needed for another patient within the famous 3 days I use it; and then should there be a need for the first patient, I prepare once again but at no charge.

[SMILLER]

In general, we also would wait till the next day to down-tag units.

Some exceptions are for our post-open-heart unit patients, where we keep them xmatched for 48 hours, and for any patient with an allo-antibody who may need blood (surgical, GI bleed, etc.) where we usually would have two crossmatched as long as they are in the hospital.

[EDibble]

I should have added that too: if the patient has antibodies we usually keep the units xmatched until the the patient is discharged or the specimen expires.

In general, we also would wait till the next day to down-tag units.

Some exceptions are for our post-open-heart unit patients, where we keep them xmatched for 48 hours, and for any patient with an allo-antibody who may need blood (surgical, GI bleed, etc.) where we usually would have two crossmatched as long as they are in the hospital.

[LaraT23]

No We just use the 72 hour rule on everyone unless the units are short dated, then we will release them if it seems some one will use them.

[mia9941]

David,

I have always been confused about how our facility derived the policy concerning how long a xm specimen is good. Can you direct me to information related to the development of this policy? Thanks.

[AMcCord]

OUr policy states that units will be released 48-72 post-crossmatch. If the patient has no antibodies, is not actively bleeding, has gone to surgery already or has no other problems and the Hgb looks OK, then we use the option to release at 48 hours. If supplies are tight and the patient's Hgb is 10-11 post-op, I might release the unit at 24 hours with notification to the patient's nurse. (We do orthopedic, gyn and general surgery here.)