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Return and Reissue of components

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I would appreciate if anyone would be willing to share with me their current sop for return and reissue of blood components?

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On ‎2‎/‎4‎/‎2017 at 5:06 PM, Dansket said:

Thanks for sharing this flowsheet. At the left hand bottom there is a box to document the elapsed time. What are your requirements for returning products? 30 minutes rule? If so, has your site 'validated' this rule?

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32 minutes ago, 3cardmoe said:

Thanks for sharing this flowsheet. At the left hand bottom there is a box to document the elapsed time. What are your requirements for returning products? 30 minutes rule? If so, has your site 'validated' this rule?

This flowchart represents our requirements for handling blood components returned unused by Nursing. 

There are three (3) basic elements: 1) Appearance, 2)Temperature, and 3) Time out of storage.  If the visual inspection of the component does not reveal any unusual observation(s) and the component is within acceptable temperature limits and the component has not be out of storage for more than 30 minutes then the blood component may be reissued for transfusion.

1.  Blood component is discarded if the container is spiked or outlet port(s) opened (regardless of temperature or time out of storage).

2.  Blood component is discarded if the container contents are abnormal in color or appearance (regardless of temperature or time out of storage).

3.  Blood component is discarded if the temperature of the blood component has exceed acceptable limits (regardless of appearance or time out of storage).

4.  Blood component is discarded if more than 30 minutes has elapsed since removal from storage (regardless of appearance, temperature or time out of storage). We do not issue in coolers.

If any of the four (4) numbered statements above is/are true, component may not be reissued for transfusion and is immediately discarded into the biohazard trash. No exceptions.

The BBK CLS who receives a returned unit is required to complete this form and use a colored highlighter to trace his/her pathway from the starting point to a termination point.  The completed form is reviewed by the supervisor and filed.

My understanding of the "30-minute" rule is that the temperature of component is ignored if the component has been out of storage for less than 30 minutes.  We do not ignore temperature.  There was an article in the AABB News several years ago that debunked the "30-minute" rule.

We borrowed our 30 minute time limit out of storage from the old rule, but did not validate.  We assume that a blood component returned unused with a normal appearance, within temperature and within 30 minutes of issue may be reasonably returned to storage for reissue.

This process is intended to limit the number of decisions required to be made by a generalist.

 

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On ‎4‎/‎2‎/‎2017 at 3:45 PM, Dansket said:

This process is intended to limit the number of decisions required to be made by a generalist.

I love your flowsheets designed to make things easier for generalists. Please share more!

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DANSKET

I am confused as to why you discard the unit if it passes all other inspections but was out greater than 30 minutes?

Are you saying that a Platelet or Cryoprecipitate that has a storage temp 20-24C comes back at 35 minutes with a temp of 24 will be discarded?

Ditto with plasma that was issued immediately after thawing so accept range is 1-37C but if it came back at 35 minutes and it's temp was 24C it would be discarded?

I understand with the RBCs because chances are that at 30 minutes the temperature would not be within acceptable range.

At our facility We dropped the 30 minute rule completely and go completely by appearance and temperature for all products regardless of whether they were issued in a cooler or not.

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I don't trust Nursing. They may have put the unit into storage on the Nursing station or mishandled the unit in attempts to warm it up or cool it down.  I draw the line at 30 minutes, no exceptions.  I don't get into "what if 31 minutes?, what if 32 minutes?, what if 33 minutes"?

According to your process, would you reissue blood returned unused and within temperature regardless of time out of storage? Are there no exceptions for time out of storage?  

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7 hours ago, jalomahe said:

At our facility We dropped the 30 minute rule completely and go completely by appearance and temperature for all products regardless of whether they were issued in a cooler or not.

We do the same. Since we QC our temperature indicators and know that red blood cells can become out of range as early at 10-15 minutes at room temperature, we will quarantine anything that is suspect (i.e. a red blood cell unit that comes back and the temperature hasn't changed over a period of time) for manager or pathologist judgement for return or discard.

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20 hours ago, Dansket said:

I don't trust Nursing. They may have put the unit into storage on the Nursing station or mishandled the unit in attempts to warm it up or cool it down.  I draw the line at 30 minutes, no exceptions.  I don't get into "what if 31 minutes?, what if 32 minutes?, what if 33 minutes"?

According to your process, would you reissue blood returned unused and within temperature regardless of time out of storage? Are there no exceptions for time out of storage?  

Nursing policy states they are to begin transfusion within 15 minutes of receipt unless the unit was issued in a cooler and if they cannot they are to immediately return the unit to the blood bank. Our nurses are very good at following this policy. That being said, there are times when the unit doesn't make it back to the blood bank in that 30 minutes but it will be back in less than 45-60. Red Cells obviously will not be within temp range so if returned they are discarded. Any other product, if it's within temperature range yes, it will return it to inventory for re-issue.

As for Red Cells if they unit can't be returned in <30 minutes and the problem is they blew the IV and they are working on starting a new line started they are told to keep the unit at room temperature and transfuse BUT they MUST complete the transfusion within 4 hours (maximum allowable transfusion time) of when the unit was released from the blood bank. 

Any time a unit of blood/component is wasted an electronic Safety Report is completed that goes to multiple people to review: patient safety, nursing location manager, transfusion safety officer, laboratory manager, etc. for follow-up.  

Edited by jalomahe

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We use Safe-T-Vue 10 in our blood products: RBCs and thawed Plasma (obviously plasma should be cold enough to attach Saf-T-Vue). Beside, visual inspection of products; we depend upon Safe-T-Vue coloration for our products return.

For platelets, we return the products upon visual inspection and room temperature return.

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8 hours ago, jalomahe said:

Nursing policy states they are to begin transfusion within 15 minutes of receipt unless the unit was issued in a cooler and if they cannot they are to immediately return the unit to the blood bank. Our nurses are very good at following this policy. That being said, there are times when the unit doesn't make it back to the blood bank in that 30 minutes but it will be back in less than 45-60. Red Cells obviously will not be within temp range so if returned they are discarded. Any other product, if it's within temperature range yes, it will return it to inventory for re-issue.

As for Red Cells if they unit can't be returned in <30 minutes and the problem is they blew the IV and they are working on starting a new line started they are told to keep the unit at room temperature and transfuse BUT they MUST complete the transfusion within 4 hours (maximum allowable transfusion time) of when the unit was released from the blood bank. 

Any time a unit of blood/component is wasted an electronic Safety Report is completed that goes to multiple people to review: patient safety, nursing location manager, transfusion safety officer, laboratory manager, etc. for follow-up.  

We have a similar policy. Blood must be returned to us within 15 minutes to be considered for reissue but has to be assessed for temp. and condition (not spiked, etc) when returned.  If the temp is too high or the unit has been spiked, it is discarded. FFP and platelets require return within 15 minutes and a decision on disposition would be made on a case by case basis. We do make an occurrence report which is reviewed by quality, nursing unit manager, myself, lab manager, etc.

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On ‎4‎/‎6‎/‎2017 at 8:57 AM, Dan87 said:

We use Safe-T-Vue 10 in our blood products: RBCs and thawed Plasma (obviously plasma should be cold enough to attach Saf-T-Vue). Beside, visual inspection of products; we depend upon Safe-T-Vue coloration for our products return.

For platelets, we return the products upon visual inspection and room temperature return.

Do you only use safe-T-vues, or do you take them temperature of the unit as well. 

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