Jump to content

Emergency Neonatal Transfusion


amblanki

Recommended Posts

We are a small hospital with no NICU or pediatric floors, so obviously transfusing neonates and pediatric patients is not a frequent occurrence.  In the 11 years I have been here, we have gotten 3 panicked calls about potentially needing to transfuse neonates that ended up not needing anything before transfer.

 

Does anyone have a policy where nursing is the one to draw the unit into the syringe?  Specifically I am looking for how you handle labeling and LIS entry.

Link to comment
Share on other sites

on the very very very very rare occasion I have to transfuse a neonate prior to transport - they get the entire bag.  I will not make a procedure for something that happens once every 20 yrs.  I don't even want to think about my staff's competencies let alone the Nursing staff.  I think I've only given some thawed plasma once in the last 22 yrs here. 

Link to comment
Share on other sites

What do you do about the labeling if you send a unit with a syringe set for them to transfuse?  I was at an AABB meeting and was told that even if the syringe was not processed in the Blood Bank, the syringe still had to be ISBT labeled prior to transfusion. 

Link to comment
Share on other sites

Yes, the syringe should still be ISBT labeled.  However if you do it that infrequently, I would just have the Medical Director sign for this as an exception to policy.  That way his/her approval is documented in case something goes wrong (like at another hospital I know where the nurse tried to get the whole unit into the baby...yes, really).

Link to comment
Share on other sites

AABB sstandard 4.3.1on p9 of the current edition only speaks of labeling for storage and issue (p41).  If you give out a labeled bag I believe what Nursing does with it is beyond your control and not governed by the standards as far as Nursing labeling the syringe (though it might be prudent if they put a pt label on it).  If you are issuing the syringe from the BB then it must be labeled in accordance with the standards.

Link to comment
Share on other sites

I am now really curious how other facilities who do infrequent Neonatal Transfusions manage this.  I was at an Ohio Association of Blood Banks (OABB) meeting last October and one of the speakers was Patrick Ooley MS, MT(ASCP), CQA(ASQ)CMQ/OE Chair, AABB BBTS Program Unit.  He told the group that regardless of where the syringe is pulled off from the unit, it must be ISBT labeled.  We had always thought we were ok by sending up the unit of blood with a syringe set, that ISBT labeling was not needed because we did not pull the syringe off in Blood Bank and send it for transfusion.  Based on what Patrick said at OABB (and his credentials), we've been trying to figure out how to handle this so we are compliant.  Any ideas would be appreciated!

Link to comment
Share on other sites

I don't see anything in the standards that addresses this . . . and the FDA only cares about blood in your direct control (unless there is a fatality).  I'd call AABB and ask for the pertinent standard and then see what it says.  The rules for labeling apply only to blood centers that collect and prepare components and to hospital transfusion services that prepare . . . aliquots  . . . for pediatric use.  Current TM p158. One must be careful and knowledgeable about standards because many folks interpret them to mean what they want.  Just because someone has a title does not mean they are an authority on a particular subject.  Same holds true when you are inspected.  Many inspectors interpret the standards their own way - there are usually many ways to be compliant.  I always tell everyone to stand up for your own operation until  the regulatory authority itself NOT THE INSPECTOR/ASSESSOR makes a definitive judgement on your policy in question.

 

Call AABB and get the standard that requires labeling to be performed AFTER the blood is released/at the site of transfusion.  Who is going to train the nursing staff to label correctly.  Does not make sense to me.  As I intimated earlier, it might be prudent to put a pt label on a syringe when drawn out on the floor but it is really not your purview once the blood is released - unless you want it to be!

Link to comment
Share on other sites

We create our own baby aliquots with syringes, fully labeled, in the blood bank.  BUT we also have a policy that says when the NICU comes in breaking down the door, just give them a unit and a syringe and what they do is up to them.  We provide the syringe because it has the in-line filter.  I had never even considered the labeling of the syringe once nursing has it.  This is an interesting discussion!

Link to comment
Share on other sites

We changed our policy to aliquoting into a labeled syringe in the Blood Bank soon after I took this job 6.5 years ago because a recent inspector had said it was not acceptable for nursery to pull off a syringe and use it to transfuse the baby unlabeled.  I was not present for that inspection but I am pretty sure that it was the FDA. I agree with David's logic, but this was our experience. That said, if you are a small place that doesn't usually aliquot, I would do what needs to be done and get the medical director to sign off on it as an exception.

Link to comment
Share on other sites

Mabel - the FDA usually does not follow blood products after they leave the blood bank except to monitor transfusion events/rxs/deaths.  I've attempted to get them involved so I could coerce my Nursing staff to provide better documentation.  They would not get involved. 

 

I have also contacted AABB to see if they can direct me to the standard which states the aliquot must be labeled after the unit is released for transfusion (no aliquot from the blood bank).

Link to comment
Share on other sites

Create an account or sign in to comment

You need to be a member in order to leave a comment

Create an account

Sign up for a new account in our community. It's easy!

Register a new account

Sign in

Already have an account? Sign in here.

Sign In Now
  • Recently Browsing   0 members

    • No registered users viewing this page.
  • Advertisement

×
×
  • Create New...

Important Information

We have placed cookies on your device to help make this website better. You can adjust your cookie settings, otherwise we'll assume you're okay to continue.