units spiked not transfused returned to the blood bank

[dld]

I have worked in the blood bank for 15 years, and we have always had a policy that if a unit was returned to the blood bank spiked, not transfused, within 30 minutes, we could reissue to that patient within a 24 hour period. My problem is, I cannot find anything in the AABB technical manual, or anywhere else for that matter, that supports our practice. I'm questioning whether we should be doing this...especially since I am now in charge of the blood bank. Does anyone have a policy allowing or not allowing this practice? Thanks

[Dansket]

I have worked in the blood bank for 15 years, and we have always had a policy that if a unit was returned to the blood bank spiked, not transfused, within 30 minutes, we could reissue to that patient within a 24 hour period. My problem is, I cannot find anything in the AABB technical manual, or anywhere else for that matter, that supports our practice. I'm questioning whether we should be doing this...especially since I am now in charge of the blood bank. Does anyone have a policy allowing or not allowing this practice? Thanks

That practice is arbitrary, not evidence-based and cannot be justified with current standards/regulations. The best way to address this issue is to create processes the insure that Nursing does not pick up blood before they have documented patient consent, measured pretransfusion vitals, know that the patient is not scheduled for a procedure, have a patent iv, etc, that is they are truly ready to start the transfusion.

[R1R2]

I agree with Dansket

[dld]

For the most part the RNs are pretty good about having everything in place before they start the transfusion, but it does happen on occasion. My gut is telling me to discontinue this practice and here is why: Unit was returned spiked not transfused to the blood bank within 30 min. We were in the process of reissuing the unit to the patient about 12 hours later when the nurse noticed there was not a cap on the other end of the tubing -- huge infection risk!! I just do not think it is worth putting the patient at risk -- I'd rather toss out that $350 unit of blood. I'm still curious to hear what others do...thanks!

[R1R2]

We do not accept a unit back if it was spiked. I encourage the RN to try to complete the transfusion within 4 hours of entry or discard the unit. I will update the BB records if unit was not transfused and discarded in the patient care area.

[SMILLER]

We would do the same as R1R2. Whatever you do, make sure you are following your own written policies and procedures.

Scott

[aafrin]

We only re-issue blood units returned to blood bank within 30 minutes if they were not spiked/punctured. Once bag is punctured then it has to be transfused within 4 hours or discarded. We do not accept spiked/punctured bags back into the blood bank even for storage as sterility has been compromised and patient may get a reaction.

[goodchild]

AABB Standards directly conflict this practice:

5.24 Blood, blood components, tissue or derivatives that have been returned to the blood bank or transfusion service shall be accepted into inventory for reissue only if the following conditions have been met:

1) The container closure has not been disturbed.

I don't know if you're CAP or JCAHO or whichever but CAP says something similar albeit a little more vague, it discusses verifying the integrity of the container.

[DFields]

AGREE! Never accept back a spiked blood component. The ward has up to 4 hours to administer the product once it is spiked.

[David Saikin]

We follow the AABB standard: if the ports are compromised (spiked), we will not accept back into BB. Must be infused within 4 hrs of initial release.

[MAGNUM]

We do not accept any spiked units back into the blood bank, for whatever reason, they spike it they bought it. It is too bad that we cannot dock the offending person the cost of the unit.

[John C. Staley]

We follow the AABB standard: if the ports are compromised (spiked), we will not accept back into BB. Must be infused within 4 hrs of initial release.

Once again, David and I are in total agreement. Careful David, you don't want to make a habit of this.

[Dr. Pepper]

We also follow the AABB standard and do not accept spiked units back. I do try to find out what happened and make it an "opportunity for improvement" for nursing. It's almost always that they don't have consent or the patient has spiked a temp, so I suggest to check the vitals and consent before they send for the blood (also the commonest reasons blood stays out too long) and certainly before they spike it.

[Mabel Adams]

Once spiked it is an open system and an open system at RT has a 4 hr expiration. I am with the others in agreeing with R1R2.

[BBCLS]

We do not accept a unit back if it was spiked. I encourage the RN to try to complete the transfusion within 4 hours of entry or discard the unit. I will update the BB records if unit was not transfused and discarded in the patient care area.

We do the same.

[tkakin]

We do not accept a unit back if it was spiked. I encourage the RN to try to complete the transfusion within 4 hours of entry or discard the unit. I will update the BB records if unit was not transfused and discarded in the patient care area.

ditto

[jayinsat]

Doggonit! I haven't had this problem in quite a while. I read this thread yesterday and guess what? Came in this morning to a wasted unit because the nurse lost I.V. access and couldn't get it restarted. Thanks for the jinx!

[dld]

kinda funny how that happens, isn't it? It was a blessing this came up in our blood bank last week, it gave me an opportunity to review our policy/practice and I immediately sent out word to the bb staff to no longer accept spiked units back to the blood bank for reissue...and wouldn't you know, CAP shows up for our inspection the next day...WHEW!

[donnawac]

We do not allow it. Once the unit leaves the blood bank window--if it comes back it is destroyed. The only units that we allow back are the ones that were issued to the surgery refrigerators that have temperature monitors (Safe T Vue) on them. If they have not turned completely red we accept them back.

[JulieSt]

I agree with the others - we discard any unit which is returned spiked! I then send the transfusion practitioner to find out why they spiked it and didn't use it!

[Urvashi]

We do not accept the spiked units or left at R.T. > 30 minutes. At our facility,to control the wastage, the RN must file an on line incident report with the reason for wastage and return the unit for proper disposal. We discard the unit in blood bank and update the computer.

[EDibble]

Jumping on the bandwagon with everyone else. BTW, we also have a pick up slip with check offs for "Patient consent" etc, so it prompts the nurses to double check this before they come down to pick up the unit.

[teskridge]

I work at 3 different institutions. 2 of them don't allow reissue of a red cell unit that has been outside of the blood bank longer than 30 minutes. The 3rd facility will reissue a red cell unit as long as it does not hang over 4 hours...but it can not be released and placed back into inventory and the bag can not be entered..so if it's been spiked it would get discarded.

[tbostock]

Jumping on the bandwagon with everyone else. BTW, we also have a pick up slip with check offs for "Patient consent" etc, so it prompts the nurses to double check this before they come down to pick up the unit.

So do we, so they all check it. Then when we do an audit later to look for signed consent, we are anywhere from 80-90% compliant. {{{heavy sigh}}}

[LCoronado]

We also follow the AABB standard and do not accept spiked units back. I do try to find out what happened and make it an "opportunity for improvement" for nursing. It's almost always that they don't have consent or the patient has spiked a temp, so I suggest to check the vitals and consent before they send for the blood (also the commonest reasons blood stays out too long) and certainly before they spike it.

Same here. It is written into the nursing policy for transfusion that vital signs will be measured within 30 minutes of picking up blood, to avoid "surprises" after the blood is up on the floors.