The 30 minute rule

[MERRYPATH]

I think that the 30 minute rule may be out of date for 2015...at least it seems to have been in 2013. I want to not toss units based on old practices. http://www.ncbi.nlm.nih.gov/pubmed/22845177

Edited August 10, 2015 by MERRYPATH

[QCDan]

I would take the temperature of units returned and not go via a 30 minute rule unless you have performed a validation study confirming that units remain at 10C or less during that time period.

STAY AWAY from the 30 minute myth.

[David Saikin]

I use 15 minutes . . . I think the "old" rule dealt with studies using blood in glass bottles (but don't quote me on that).  Tried looking up the etiology of 30 minutes - to no avail.  AABB TM states that if you use a time limit it must be validated.

[Dr. Pepper]

Agree with David. The 30 minute rule was for glass bottles or fat units of whole blood. If you try it yourself with an outdated or mock unit of packed cells you get 15-17 minutes at best. The myth was perpetuated by AABB for years by a sentence in the Tech Manual that went something like "Many facilities use a 30 minute limit ........." Hasn't been in there for a while. We just take the temp of the unit when it returns.

Edited August 11, 2015 by Dr. Pepper

[SMILLER]

_{We reject returned units (if not kept and/or monitored appropriately) if not returned within 30 minutes OR if they fail inspection.  Inspection includes that they are at an acceptable temp when returned to BB.  So even if a unit returns to the BB whose temp is within 1-10C, we will discard it if more than 30 minutes  have passed.}

 

_Scott

[BankerGirl]

_{We reject returned units (if not kept and/or monitored appropriately) if not returned within 30 minutes OR if they fail inspection.  Inspection includes that they are at an acceptable temp when returned to BB.  So even if a unit returns to the BB whose temp is within 1-10C, we will discard it if more than 30 minutes  have passed.}

 

_Scott

I have basically the same statement in my blood return policy and during my last inspection, the inspector couldn't get past the "30 minutes" and told me it wasn't acceptable.  Ours states if returned within 30 mins we will take temp and evaluate, but if outside of 30 minutes, automatic quarantine.  I had to explain it to him three times.  Then the lightbulb went on and he said OK.

[Cliff]

Tried looking up the etiology of 30 minutes - to no avail.

 

Look through an old AABB Accreditation Information Manual, that's where I last saw it.  That was at least 10 years ago.

 

We did an extensive validation throughout our institution mimicking what happens to a unit of blood when it leaves here.  We took a unit of blood and split it in two, then place a TempTale temperature monitor in the middle and thoroughly rubber banded the unit back together.  We placed it in a fridge overnight.  Then when a product was being issued we took our fake unit out and had it travel the same route that the unit did.  Sat on the same counters, went to the same patient care area, sat on the counter there.  Then after the nurse took the real unit we took our fake unit back to the blood bank and let it sit on the counter until a total of 40 minutes elapsed.  We did this 10 times to each of the main areas we issued in our organization.  It took weeks to do.

 

We were able to "prove" that 30 minutes is an acceptable time for a unit to be out of our blood bank.  Sadly no one has ever asked to see this validation.

[John C. Staley]

Wow Cliff I am amazed and surprised.  Amazed that anyone was willing to undertake such an exhaustive test!  Surprised that 30 minutes was, in fact, acceptable in your facility.  While we did not do anything near as thorough as you did, we did check the temp of every unit returned and never did a unit out more than 15 minutes come back at 10oC or under. 

[goodchild]

Sadly no one has ever asked to see this validation.

 

Publish it !

[MERRYPATH]

I was thinking more about the need for modern RBCs to be at risk if only out 30 minutes...or less. I wonder if the risk is so much less today that the 30 minute rule is only serving to waste a precious commodity. I agree that if the requirement is to keep the units under 10 degrees 30 minutes is the limit but if the actual danger zone is an entirely different temp range then the practice of the 30 minute rule is as obsolete as other practices we squirmed when we gave up...not looking micro is still hard for me. I think the 30 minute rule at least needs to be proven as necessary considering todays cleaner units. I think that using old practices as iron clad leads to stinkin' thinkin' as we know that there are contaminants that thrive at refrigerator temps as well as tropical temps.

[Auntie-D]

I think that using old practices as iron clad leads to stinkin' thinkin' as we know that there are contaminants that thrive at refrigerator temps as well as tropical temps.

 

It's not just to stop bacterial proliferation though - we also refrigeration to stop degeneration of the RBCs resulting in an increase in potassium and a loss of antigens. This is far more of an issue than bacterial contamination.

[Dr. Pepper]

There are always things that make you scratch your head a bit, that you dare not go above 6o for a second during storage, but that 10o is fine during shipping. Or that you cannot send RhIG through the pneumatic tube because it might be subjected to undue turbulance, but the shipper can kick the hell out of it and throw it in the back of a truck with bad shocks to jiggle along a bumpy road on its way to you.