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AMER

30 minutes for return blood and blood products

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I just looked up the actual validation study writeup.

We prepared plasma from Autologous units (because they would have been discarded anyway) and folded them over a thermometer (between the two 'sides', not in the crease).

Then we placed them in 37oC waterbath until they reached approx. 37oC (current temp of waterbath).

Then we placed them in the refrigerator in a holder (to simulate how they'd be situated if stored in the refrigerator).

We recorded the temperature every 10min. until they reached 6oC (remember these are folded).

Summary: range was 70-120 minutes (note volume is not consistent so this probably affected the cooling rate) for units to reach below 10oC (sorry, I mis-stated that in my earlier post).

Therefore, we felt it conservative to consider Thawed Plasma 'Issued Prior to Cooling' for up to 60 min past thaw time (even if it's been placed in the refrigerator prior to issue). It's also an easy time frame for the techs to remember.

"A unit of Thawed Plasma will be considered 'Issued Prior to Cooling' for up to 60 minutes past thaw time. After that, it will be considered 'cool' and must remain stored at 1-6oC or maintained under 10oC during transportation."

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Does this thermometer take outer bag temp? Because when I validated sad t vues the savy bur10 did not change temp until 20 min.

Yes, the infrared takes the outer surface of the bag and not the core blood. To do a proper validation one should validate per saf t vue validation with a calibrated temp probe going into a bag(s) to see how long the center takes to come to 10 degrees.

my next thought is just discard. In my hospital they can't even get to the floors and back in 10 minutes.

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Drop the 30min rule and go simply by temperature guidelines (current best practice)

the maximum minimum temperature for each blood bag or just the general temperature at the time the blood bags arrived? -just to make sure-

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Mable,

Could we speak regarding the 0.95 emissivity issue? We are getting ready to implement the infra red thermometer and I woull really like more info about what you do with this value. I did read up on emissivity and now my head hurts. You could page me to your number and I will call you if that works. 570-973-0125

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Time limits such as 30 min or 15 min must be validated if you state them in your procedure per CAP and AABB so the best process in my opinion is to set temperature guidelines and then you do not need to validate. However, if you use 1-10 for thawed FFP that has not been refrigerated for very long, it will never pass - might want to revisit that guideline for those units that have just come out of the thawer.

We do not use 30 minutes (or any time frame) for acceptability of return. It has to meet all of our criteria for temps (2-10 for rbcs and thawed FFP, 20-24 for platelets and cryo), and visual inspection criteria (bag not entered, segments still attached, passes visual inspection for appearance and color, label intact, etc). If it doesn't meet all of the above, they are discarded. FFP always fails because it does not usually leave here as cold as the RBCs do.

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Both AABB and CAP until now we are thinking how to resolve this problem they gave us one month to solve this problem.when they read the procedures they found the 30 min . for RETURN Blodd and Blood Products.

I was wondering how they feel about blood products that are sent in a validated cooler to say OR or ER. Would you have to take the temp of the products if you are recording the temp of the cooler on return?

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As an assessor I would want the temperature of the product documented more than the cooler temperature.

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I would suggest some sort of temperature indicator placed on each unit to determine if the unit was removed from the cooler and then returned to it.

JB

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Time limits such as 30 min or 15 min must be validated if you state them in your procedure per CAP and AABB so the best process in my opinion is to set temperature guidelines and then you do not need to validate. However, if you use 1-10 for thawed FFP that has not been refrigerated for very long, it will never pass - might want to revisit that guideline for those units that have just come out of the thawer.

We thaw on demand now that we have a microwave thawer, so we hardly ever get FFP returned. We considered having a different criteria for FFP but even when we take it back, we hardly ever get a chance to use it on a different patient, so it gets discarded anyway. So this made it "cleaner" to have the same criteria for RBCs and FFP.

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After this thread I am changing my procedure, no more returns on routine issues. Issuing with a Sav T Vue would suffice, however we return so rarely it is not worth the extra work and cost.

For units issued to surgery or massive or emergency transfusion, these units are already issued in a validated COOLER, good for 8 hours and all are issued with Sav T Vues. I validated both RBC and FFP. FFP turns red sooner... but the policy states anything returned after 8 hours or with a red sav t vue (unacceptable temp) these units will be discarded. Plts and Cryo issued in this situation are issued with a paper form which insists on storage temp of acceptable range must be documented for approval for return. Surgery takes their room temperatures with calibrated thermometers every day. However since we instituted this we have had no returns. They are just not asking for them unless they plan to infuse. So much the better.

Kym

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How can we approve if we issued or dispense Blood or any Blood Products and returned with in 30 minutes is acceptable practise?????

Urgent please:confused::confused:

Amer:confused:

Has anyone purchased the Thermoco blood banking thermometer to comply with this rule and if so how do you like it?

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It is relatively inexpensive and if you are able to return just a couple of units back into inventory per year it pays for itself. It is easy to validate, use and recalibrate.

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How can we approve if we issued or dispense Blood or any Blood Products and returned with in 30 minutes is acceptable practise?????

Urgent please:confused::confused:

Amer:confused:

TRM.42470

Has anyone purchased the Thermoco blood banking thermometer to comply with this rule and if so how do you like it? We too are looking to comply with this rule.icon7.png

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Hi everyone,

My first POST..

I am still not sure what is the best way of monitoring unit of blood after leaving the BB. In our facility we have a temp indicator.

Also, please advise what you tell the nurses the "reason" why we do not accept those units back to BB after half hour, but is allowed to hang almost 4 hours during transfusion. Thanks..

jem

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Welcome Josephine!

When nursing poses the question you described, explain that the unit is returned with the temperature below 10.0 C so it can be stored for future issue with reasonable assurance bacteria have not grown in the unit. The 4 hour window is for the same assurance, but applies during transfusion (blood will not be reissued).

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Another way to explain to RN's:

Bateria proliferate best at warmer temperatures. With certain bacteria, counts can double every 30 minutes. Because a unit may be issued and returned several times before a patient actually gets the unit, we limit the return times so that they are not likely up to >4 hours, which is the benchmark for acceptable time outside of refrigeration.

[Of course, the 30 min rule is going away. It is now a timeframe which you have validated.]

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