Pre-surgical specimens

[kimblain]

How long before a patients surgery do you allow them to come in and be drawn. Our current practice is 7 days prior as long as they sign a statement that they have not been pregnant or transfused within the last three months. Our pre-surgery team wants them to be able to come in up to a month before. Thoughts?

[adiescast]

We use the same 3 day time frame for these samples as any other. Sorry...no help here!

[Malcolm Needs ☆]

Many hospitals in the UK use a month and, as far as I know, few ask for a signature about transfusion or pregnancy (although they do [ or are supposed to] ask the question).

[Liz]

3 days, nothing changes.

[pluto]

Less than 7 days usually

they can come in a month before if they like but I would still want another sample less than 7 days pre op

[ANORRIS]

We allow one month. We antigen type any units needed (if the patient has an antibody) and have them ready for the date of surgery. However, if blood is needed at the time of surgery and it is beyond 72hrs since the Pre Op T/S was drawn, we require a new sample and repeat the entire work up.

[carolyn swickard]

You have to worry about specimen storage issues if you plan on reusing the original specimen. We allow 7 days and I.S. XM the original specimen the day before surgery (unless there are antibodies; those are XM'd on day of receipt). If you do like ANORRIS - no storage problems, just STAT work on day of surgery.

[Liz0316]

At our hospital, as long as the patient is a PAT candidate (no preg/trx in 3mo) the specimen can be collected 21 days prior to surgery.

[David Saikin]

We use 7 days unless preg/tx'd within the past 3 months, then 3 days.

[Likewine99]

We do 14 days. There is a blurb in the AABB Standards somewhere that applies to your question. You'll probably have to define it for your facility and put it in your SOP.

[RL0121]

7 days (no preg/ no trxn in 3 mo) but if a patient receive blood on day of surgery, then it defaults to 3 days after.

[nmartin]

We use 14 days, but realistically most patients come in within 7 days prior to surgery. We use a secondary Blood Bank armband and it will not last much longer than 7 days, especially as an outpatient.

[tbostock]

3 days for all patients.

[Ardele]

We use 3 days for all specimens. Although, we have surgeons questioning this and wondering the reason why. Plus, the old time-y techs here have heart attacks when the issue is even talked about to extend the 72-hour 'rule.'

[AMcCord]

We use a 7 day rule for anyone not transfused or pregnant in the last 90 days. We do all testing, including crossmatch when the specimen is drawn and hold any crossmatched blood until the patient shows up for surgery (this is not a problem with our blood supply). We also obtain a fresh sample when the patient is admitted if the original was drawn more than 72 hours before. Any additional crossmatches or crossmatches added to a previous T&S order would be crossmatched with the new specimen (repeat type and antibody screen would be required on the new specimen). We very rarely have to use the fresh specimen for added crossmatches.

If a T&S is ordered more than 7 days prior to surgery and the patient has not been transfused/pregnant, we go ahead and do it anyway and report it, but definitely collect a fresh specimen the day of surgery. The blood type and antibody screen is not going to change (they haven't been transfused/pregnant), so we don't see the need to repeat those. We just want to make sure we have fresh specimen for crossmatching, if needed. Again, we almost never need to use that fresh specimen.

We used to have lots of PAT orders from the Ortho and OB/GYN docs, then they suddenly decided it was much too inconvenient for their patients and now we do everything STAT 39 minutes prior to surgery. These same patients usually have an appointment with the surgeon (1/2 to 20 blocks from the hospital - it's not a large town) within that 7 day period and about 50-60% actually come to the hospital for other tests or X-rays 1-3 days preop - but too inconvenient!!!!!!! to draw Blood Bank!!!!!!!!!!!

[Dr. Pepper]

Likewise, likewine, 14 days, unless the stored sample shows signs of contamination. We ask the pregnant/transfused question, record the answer in the LIS, and use the 3 day rule if they say yes or are unsure. (We won't discuss the patients who say they haven't been transfused, then you see in your computer records that they got blood the week before.) Whatever time limit you choose, CAP wants you to specify it in P&P.

[cthherbal ☆]

We use 10 day prior to surgery for PAT patients. Sample expires 3 days from surgery. I have also worked at a hospital that used 30 days because they validated storage- that the same type and screen results were obtained day of draw as 30 days later.

[CM2]

We draw samples up to 30 days before surgery. If screen is positive or historical antibody, 3 day rule from date of sample draw. If screen is negative, patient must return on date of their procedure with the preadmission armband issued at blood draw and be asked the pregnancy/transfusion in 3 months questions. armband is stapled to form, patient signs it, we get it, and change outdate to 3 days from that return date (not to exceed the initial 30 days assigned).

[ltechlin]

If screen is negative, patient must return on date of their procedure with the preadmission armband issued at blood draw and be asked the pregnancy/transfusion in 3 months questions. armband is stapled to form, patient signs it, we get it, and change outdate to 3 days from that return date (not to exceed the initial 30 days assigned).

When does the patient get a hospital and/or blood bank armband placed on them?

[L106]

We use the same 3 day time frame for these samples as any other. Sorry...no help here!

Same here.

[Deny Morlino]

When does the patient get a hospital and/or blood bank armband placed on them?

The blood bank band is placed on the patients arm during the presurgical draw at our facility. The admission band from the hospital system is placed the morning of surgery when the patient arrives.

[LCoronado]

We currently treat everyone the same - 3 days, no exceptions. We used to have phlebotomy ask about transfusion or pregnancy within three months but there were numerous gaps in the process: the question was not asked, or the patient was not sure of his or her own history/status. However, we are transitioning to a new directorship and a new policy may be forthcoming; I am sure that if we extend the time allowed we will, this time around, ask for a signed statement of some sort.

[CM2]

Itechlin: They are given a preadmission armband at time of PAT sample draw which they have to keep (we dont require them to wear it for those 30 days =P). They return with this armband and give it to us, theoretically proving they are the same person who had the sample drawn. They get a "real" armband placed at time of admission for their surgery which they are required to wear the duration of their inpatient stay.

[ltechlin]

CM2 -

Inspectors are ok with they patient just having possession of the armband, not actually wearing it?

Edited January 12, 2012 by ltechlin
The quote option didn't work quite right.

[CM2]

Hrm.. I dont think our policy explicitly states that uncut armbands must be refused. Perhaps I should leave my answer at that =)