bed side blood group verification

[umeshkumar]

I heard of a bedside blood grouping kit meant for checking the reciepients blood group just prior to starting transfusion. The name of the product is "Serafol" manufactured by SIFIN labs, gmbH. Is this an FDA approved kit. Can it be used for this purpose. Does AABB standards recommend this?

Thanx

[BldBnker4]

I heard of a bedside blood grouping kit meant for checking the reciepients blood group just prior to starting transfusion. The name of the product is "Serafol" manufactured by SIFIN labs, gmbH. Is this an FDA approved kit. Can it be used for this purpose. Does AABB standards recommend this?

Thanx

We perform a bedside confirmatory type with each "start" of a transfusion at my facility. We have special Blood Bank staff called "Blood Bank Assistants" that take the blood to the floor and start the transfusion with the patient's nurse. We do not use a special kit. We merely take a small tray of supplies and perform a slide type on either a fingerstick specimen or a specimen drawn from the patient's line. This is performed BEFORE the start of the blood or blood product. We perform this bedside type each transfusion unless there is product hanging with which we can compare blood types and patient information. As a result, we do not have ABO hemolytic transfusion reactions. This bedside type is even performed in surgery using a small amount of blood from the line tip. This is acceptable with all regulating agencies, including FDA as we are FDA inspected). The last AABB inspection we had was so impressed that I was told that they would try to make it a recommendation.

[R1R2]

We perform a bedside confirmatory type with each "start" of a transfusion at my facility. We have special Blood Bank staff called "Blood Bank Assistants" that take the blood to the floor and start the transfusion with the patient's nurse. We do not use a special kit. We merely take a small tray of supplies and perform a slide type on either a fingerstick specimen or a specimen drawn from the patient's line. This is performed BEFORE the start of the blood or blood product. We perform this bedside type each transfusion unless there is product hanging with which we can compare blood types and patient information. As a result, we do not have ABO hemolytic transfusion reactions. This bedside type is even performed in surgery using a small amount of blood from the line tip. This is acceptable with all regulating agencies, including FDA as we are FDA inspected). The last AABB inspection we had was so impressed that I was told that they would try to make it a recommendation.

How do you record the results of this bedside test?

[umeshkumar]

Thanks for that information. Are these blood bank assistants, trained nurses or trained blood bank technicians? Do you have them in all the shifts?

We perform a bedside confirmatory type with each "start" of a transfusion at my facility. We have special Blood Bank staff called "Blood Bank Assistants" that take the blood to the floor and start the transfusion with the patient's nurse. We do not use a special kit. We merely take a small tray of supplies and perform a slide type on either a fingerstick specimen or a specimen drawn from the patient's line. This is performed BEFORE the start of the blood or blood product. We perform this bedside type each transfusion unless there is product hanging with which we can compare blood types and patient information. As a result, we do not have ABO hemolytic transfusion reactions. This bedside type is even performed in surgery using a small amount of blood from the line tip. This is acceptable with all regulating agencies, including FDA as we are FDA inspected). The last AABB inspection we had was so impressed that I was told that they would try to make it a recommendation.

[Liz]

Pls do tell us the number, the shifts and job description of Blood Bank Assistants. Interesting.

Thank you

[jayinsat]

We perform a bedside confirmatory type with each "start" of a transfusion at my facility. We have special Blood Bank staff called "Blood Bank Assistants" that take the blood to the floor and start the transfusion with the patient's nurse. We do not use a special kit. We merely take a small tray of supplies and perform a slide type on either a fingerstick specimen or a specimen drawn from the patient's line. This is performed BEFORE the start of the blood or blood product. We perform this bedside type each transfusion unless there is product hanging with which we can compare blood types and patient information. As a result, we do not have ABO hemolytic transfusion reactions. This bedside type is even performed in surgery using a small amount of blood from the line tip. This is acceptable with all regulating agencies, including FDA as we are FDA inspected). The last AABB inspection we had was so impressed that I was told that they would try to make it a recommendation.

Wow! Honestly, I feel this is overkill. As a patient (presumably, without a line) I would NOT want my finger stuck 4 times if I were getting 4 units of blood and the nurse was too slow to hang the subsequent units before the prior was taken down. This is especially irritating when you consider all the other times the patient is stuck for other lab tests. I could see doing this before the 1st unit is hung and that be the only time for that admission, but every time? Too much!

I would much rather use a band system or something to prevent abo htr's than this. I have worked in the blood bank for 25 years and have never experienced an abo htr either. Not one hospital has ever gone that far. The cost of the extra staff, in my opinion, outweighs the benefit. I'm not sure what size hospital you're in but in a major medical center, this will never work.

Just my opinion.

Edited September 11, 2012 by jayinsat

[BldBnker4]

Pls do tell us the number, the shifts and job description of Blood Bank Assistants. Interesting.

Thank you

They are trained technicans that have phlebotomy experience. We have them on all shifts (4 on days, 2 on evenings, and 1 on MN's). They do not fingerstick on each unit transfused. Once the bedside type is performed and product is hanging, the hanging product bag is used to compare blood types and other identifying information on the "to follow" units. Most of our patients have lines and the sample is drawn from the line. Much less fingersticks than you might think. This process has saved our butts more than once. Literally. We are only as good as the sample we receive. Mislabeled samples can cause HTR's! The cost is minimal considering the risks vs. benefits. These assistants also help in the Blood Bank when they are not on the floor. They answer the phone, perform clerical duties, help with inventory of supplies and blood products. A tech issues the blood to the assistant and we have control over the blood until it is started. If there is an issue, the blood is returned in a timely manner. We never leave blood on the floor unstarted. This helps with time limits on the blood being out of the bank and the two-person of patient identification is also a safety mechanism. The nurses love it because they don't have to leave their patient/floor to physically come to the Blood Bank. We deliver!

[BldBnker4]

P.S. We are a pretty large facility. We are licensed as a 600 bed hospital. This system has been in place for over 40 years! It seems to be working for us!

[Liz]

That is very interesting, i had not heard of BB assistants before. Something I shall seriously look into as we grow into a 600 bed hospital very soon. Yes I can see how it would avoid mistakes and leaving blood on the station esp if one has a teaching medical center as well. Good idea. 40 years!

Here I must ask if 4 on days, 2 on evenings, and 1 on MN's are enough? How many transfusions a month do you have? You do have a BMT unit, etc...

What goes on in the OR, ER, and closed units, ICU, PICU etc..?

[AMcCord]

Are your test samples for Blood Bank drawn by lab staff or by nurses/physicians?

[BldBnker4]

That is very interesting, i had not heard of BB assistants before. Something I shall seriously look into as we grow into a 600 bed hospital very soon. Yes I can see how it would avoid mistakes and leaving blood on the station esp if one has a teaching medical center as well. Good idea. 40 years!

Here I must ask if 4 on days, 2 on evenings, and 1 on MN's are enough? How many transfusions a month do you have? You do have a BMT unit, etc...

What goes on in the OR, ER, and closed units, ICU, PICU etc..?

We transfused 1037 PC's last month along with about 250 other prodcuts. The staffing is adequate. Of course, there are times when they may have to take more than one patient's blood at a time, but they are very efficient and try to combine trips if possible. We are not a level 1 trauma center and no longer do peds (there is a large pediatric facility nearby). We have 2 ICU's and a cardiovascular recovery area. The samples are collected by nurses (if the patient has a line), the Assistant (if it is a fingerstick) and the physician (if it is in the ER sometimes or OR). The documentation of the bedside type is noted on the transfusion slip.

[AMcCord]

Are your test samples for Blood Bank drawn by lab staff or by nurses/physicians?

Sorry, I should have asked.........Are your pre-transfusion samples for Blood Bank drawn by lab staff (BB assistants?) or by nurses/physicians?

- - - Updated - - -

[BldBnker4]

Sorry, I should have asked.........Are your pre-transfusion samples for Blood Bank drawn by lab staff (BB assistants?) or by nurses/physicians?

- - - Updated - - -

Pre-transfusion samples are collected by nursing staff and phlebotomists.

[ANORRIS]

Pre-transfusion samples are collected by nursing staff and phlebotomists.

Are these assistants CLA's?

[John C. Staley]

I'm curious. How many times in the 40 years this practice has been in place has an ABO incompatible transfusion been prevented?

[BldBnker4]

I'm curious. How many times in the 40 years this practice has been in place has an ABO incompatible transfusion been prevented?

Don't know how many in all of the 40 years that we have prevented an HTR (haven't been here all those years!), but I can say for the last 20 years or so.....I can think of 5 or 6 times we discovered that the patient in the bed was a different type than the blood set up. Mislabled samples are usually the culprit.

[John C. Staley]

So...... what happens when you specifically set up type O blood on a type B patient because you are either out of type B or you have some older type O you need to utilize? The blood types don't match. Who get to decided at the beside if the transfusion will proceed or not?

[jayinsat]

Don't know how many in all of the 40 years that we have prevented an HTR (haven't been here all those years!), but I can say for the last 20 years or so.....I can think of 5 or 6 times we discovered that the patient in the bed was a different type than the blood set up. Mislabled samples are usually the culprit.

Each one of those incidents would have been FDA reportable errors since the wrong blood was sent out of the department to the bedside. How did FDA respond to these errors?

Edited September 17, 2012 by jayinsat

[Mabel Adams]

I think I remember hearing that they used to do bedside retypes in some part of Europe in years past. I want to say that they had a card with dried reagent on it or some such. I thought I heard that they discontinued it. I think maybe the nurses had to do it.

Do you charge for this blood type? Are the assistants qualified under CLIA to do manual blood types? We all want to find the most effective, efficient way to prevent mistransfusions. I wish there was a good way to study and compare the efficacy of various approaches but it is difficult with such a rare event as a HTR.

[BldBnker4]

The Blood Bank Assistants are CLIA qualified. There is no charge for this bedside type. It is documented on the Transfusion Slip. We do not "switch" types at this facility (unless we experience blood shortages). Even then, it states on the slip that the patient's type and the unit type are "compatible," not the same. Like I said, we are FDA inspected, AABB inspected and CAP inspected and it has flown with all of them. On the mishaps that occurred, I can not speak to what was reported as I was not the supervisor then.

[TVC15]

The Blood Bank Assistants are CLIA qualified. There is no charge for this bedside type. It is documented on the Transfusion Slip. We do not "switch" types at this facility (unless we experience blood shortages). Even then, it states on the slip that the patient's type and the unit type are "compatible," not the same. Like I said, we are FDA inspected, AABB inspected and CAP inspected and it has flown with all of them. On the mishaps that occurred, I can not speak to what was reported as I was not the supervisor then.

There are other ways to make sure you have the correct blood type on a patient. The places that use electronic cross matching...two separate blood types are required. The 2 blood bank specimens must come from separate draws at different times by different phlebotomists. The testing in the Blood Bank for the first specimen must be tested by one CLS and the second specimen must be tested by a different technologist. Once this record is established and the blood types match no more testing of the patient’s blood type is required. This does not have to be performed on the same day. If a patient comes in for presugery labs then that can be the first BB spec. The day of surgery the second BB specimen must be drawn and tested prior to givng blood to the patient.

Hospitals can also employ the BB armband number or scan. Nurses must have the patient’s armband scan which also goes on the patients chart, BB specimen and unit tag when cross matched. The nurse can only transfuse once all scans agree. The nurses goes to the bedside with a scanner to make sure all electronic data matches before transfusing.

Edited September 25, 2012 by TVC15

[TVC15]

I think I remember hearing that they used to do bedside retypes in some part of Europe in years past. I want to say that they had a card with dried reagent on it or some such. I thought I heard that they discontinued it. I think maybe the nurses had to do it.

Do you charge for this blood type? Are the assistants qualified under CLIA to do manual blood types? We all want to find the most effective, efficient way to prevent mistransfusions. I wish there was a good way to study and compare the efficacy of various approaches but it is difficult with such a rare event as a HTR.

I never heard of this practice until I moved to CA. One hospital in San Francisco uses it. They send a CLS to the bedside to perform a finger stick. They also charge the patient for the bedside check. Once the bedside is performed then it is never performed again. Only one bedside per patient history.

[umeshkumar]

hi,

when i initially posted this discussion thread on bedside blood group verification I had also a Query on a bed side blood group testing kit that's advertised/manufactured from Germany(Serafol" manufactured by SIFIN labs, gmbH)

Does anyone have information on that?

thanks

[TVC15]

hi,

when i initially posted this discussion thread on bedside blood group verification I had also a Query on a bed side blood group testing kit that's advertised/manufactured from Germany(Serafol" manufactured by SIFIN labs, gmbH)

Does anyone have information on that?

thanks

I GOOGLED it and found this http://www.medizinische-diagnostik-dreieich.de/transfusion/BedsideKartenEN.aspx

[Malcolm Needs ☆]

I think I remember hearing that they used to do bedside retypes in some part of Europe in years past. I want to say that they had a card with dried reagent on it or some such. I thought I heard that they discontinued it. I think maybe the nurses had to do it.

This is true Mabel, although, as far as the UK is concerned, it was some time ago now.

The nurses used to do it and, as far as I am concerned, was a blank, blank nuisance, because they didn't understand the concept of different ABO and/or D types, but compatible different ABO and D types. I even had one nurse that simply refused to transfuse a group A person (who had a rare antibody) with group O, antigen negative and cross-match compatible blood because it was a different group. I went absolutely SPARE at her!