Re-collection of specimens

[ejani]

Our facility is revising our collection policy and we have a debate going on in the blood bank. The question is: If you are working on a current three day specimen and you run out of that specimen and crossmatching still needs to be performed, do you :

A. Re-collect the specimen using the current band number and no pre-transfusing testing is necessary, continue on with crossmatching.

or

B. Re-band the patient, collect a new specimen and start over with the pre-transfusing testing on the new specimen?

Any information as to what your facility does would be great! Thanks

[butlermom]

We will recollect using the current band number, insisting the red sticker, if available, be placed on the properly labeled tube. (If no more Typenex stickers, the code must be clearly written on the label.) We will perform a forward and reverse type on the specimen, but not the screen, and proceed with crossmatching.

[Mary**]

Changing to a new band number if the patient is currently receiving products will cause chaos. I agree with Butlermom.

PS Hi to a fellow Hoosier!

[Generic]

Like butlermom, we get another sample and repeat the ABO/Rh. You should definitely retype the samples at least...we recently had a patient with a warm auto come into the ER near shift change. The evening shift tech called to the ER for additional samples to finish the workup and left it for the night shift tech...the new samples came and the night shift tech was working on the elution before she remembered to retype - original sample was O+, new samples were A+. They were all correctly labeled...someone in the ER got in trouble over that one lol...

[DeeMc]

On a semi-related issue. Do you ever allow two Blood Bank bands on a patient corresponding to two separate in dated specimens?

We often have very critical patients who are continuously transfused. We can not have a period of time where no crossmatched blood is available. This period of time is short, less than 1 1/2 hours from expiration of the specimen until the testing in completed on the new specimen. We are thinking we can draw a new specimen before the old expires, place a new band while leaving the old one still attached. If blood is needed it can be transfused using the attached old band. Once the testing is completed on the new band, we can instruct the RN to remove the old band.

[Deny Morlino]

DeeMc,

I am making the assumption that your process is to reband the patient for each blood bank draw? For what it is worth, we keep the same blood bank band on the patient during the admission for as long as possible to maintain the consistancy of the blood bank ID number. Would this be a possibility at your institution? It does require the techs to know when a new specimen must have an antibody screen performed, but otherwise the consistancy is useful.

[AMcCord]

We maintain one BB band through the patient's admission whenever possible, including the critical patients, as Deny's hospital does. I think multiple bands would be confusing for us and the RNs.

[Barbarakym]

We maintain one BB band through the patient's admission whenever possible, including the critical patients, as Deny's hospital does. I think multiple bands would be confusing for us and the RNs.

We have used 1 band also. This is easier with bands with custom lettering/ numbers on them to be copied to the blood draw tubes rather than stickers. Has anyone had trouble with the stickers on the wrong tube or coming off?

Kym

[SMILLER]

Assuming the patient may need to be transfused, we always repeat the Type AND Screen when a specimen outdates (or when we run out of specimen for some reason before it outdates).

Merely repeating the ABO/Rh would not guarentee that it is from the right patient, as chances are not so bad that any two patients are either A Pos or O pos anyway. And its at least possible that a patient may have developed a detectable allo-Ab after three days, especially if they have been transfused.

Having said all that (for what it is worth), if a patient has NOT been transfused (or pregnant) within the last three months, and the initial screen was negative, we will extend the outdate on the original specimen up to 5 days as long as the patient remains BB-armbanded in the hospital. So in these cases, we just keep using the original specimen for any crossmatches.

[Mabel Adams]

I have worked where we put a new band number on for each specimen and frequently dealt fine with a patient having more than one in-date band (we had a day's overlap on "keep ahead" specimens). Now, where I work, we use the same band number for the whole admission. Both have pitfalls but both can work. We once had someone crossmatch on the prior specimen, then receive a new specimen with a new band number (patient had cut band off), not register that the units crossmatched were not going to match the band number on the patient so just filed the new specimen. Then the nurse hung the blood even though the band number didn't match because she thought it didn't matter much (because we sometimes called her to check on the band number being worn by a patient in for OP plt transfusion whom we did not need to draw). The old specimen really was still in date, but the band was gone. This might not be able to happen as easily if techs weren't used to using the same band number even with a new specimen. We also have trouble with people transcribing the band number from the wristband onto the new specimen incorrectly sometimes.

[LaraT23]

We don't reband unless the patient is on a new visit or if the band is damaged or unreadable. It has worked well for us, all redraws must have the band number on them so that we can make sure it matches the original.

[Auntie-D]

All depends on if the patient has already been given products but assuming not:

We would ask for a new sample and ABOD but no antibody screen (the screen according to UK regs is valid for 30 days in non-transfused patients). We would us a new wristband number as not doing so has caused havok here...

But saying this I had a patient last week (RTA pushbike vs car) who required 31 units of blood, 16 FFP and 8 cryo and the sample we received was only 2ml. We didn't run out. I can't see how a sample would run out before all testing was done... This patient was grouped twice, had an antibody screen and a 10 unit xm and we still had plasma left.

If a patient had antibodies I could undertand a samplke running out but it would be good practice to immdiately ask for a repeat anyway?