Combine or not?

[mcgardner]

Hello

Wondering what other hospital transfusion services do with double pack apheresis platelets.  Do they combine before sending or does nursing combine at the bedside?

Thanks

[Laurie Underwood]

We combine before issuing out from our Blood Bank.

[John C. Staley]

We always combined just prior to issue.  No sense in complicating the nurse's life any more than necessary.  

[R1R2]

Nurse combines at transfusion time.   

[LIMPER55]

we combine in lab just before transfusion.

[R1R2]

When I first started as supervisor, the BB used to combine in the lab, do all the computer steps and change expiration to 24 hours, but after wasting a returned pooled double bag apheresis platelet because of a reduced expiration, I rethought our process and switched to combining at the bedside.   When we changed our process we included a note with each double bag apheresis explaining the "new product" and how to open the clamps and combine before the start of the transfusion.   Nursing was very accepting.   A couple of good things happened in the lab - we eliminated several computer steps, i.e. tech time, eliminated unnecessary waste of products and reduced the chance of making  FDA reportable errors due to labeling and expiration date changes (history of a couple BPDRs/year from pooling apheresis platelets).

[Cliff]

We pool at issue and change the expiration to 24 hours, or the original, whichever is shorter.  For us, this has not been an issue with outdating.  We issue 30 of platelets a day.  Also, if they come back, it's usually in a cooler.  

[pbaker]

Nurses combine at bedside.

[AMcCord]

We combine before issue.

[John C. Staley]

On 2/8/2017 at 7:02 AM, Cliff said:

We pool at issue and change the expiration to 24 hours, or the original, whichever is shorter.  For us, this has not been an issue with outdating.  We issue 30 of platelets a day.  Also, if they come back, it's usually in a cooler.  

Cooler??????

[ANORRIS]

Nurse takes it as is.  Too many wasted after I pooled and shortened exp. date.

[Cliff]

15 hours ago, John C. Staley said:

Cooler??????

Yup, no matter how we label them, we get a lot of platelets back in the cooler.  Again, we issue over 30 a day so there is bound to be some wasted, but this makes staff very frustrated.

[John C. Staley]

Cliff, I was hoping that was the case but since I've been out of the loop for a couple of years things could have changed.  We used to have big discussions about coolers and FFP.  Never did come up with an acceptable answer there.  

 

[Likewine99]

Pool before issue

[Eagle Eye]

POOL AT THE THE BEDSIDE BEFORE TRANSFUSION WITH NOTE TO "POOL INTO PRIMARY BAG BEFORE TRANSFUSION"...ELIMINATING EXTRA STEPS FOR BLOOD BANK STAFF.

[AMcCord]

On 2/10/2017 at 10:50 AM, Cliff said:

Yup, no matter how we label them, we get a lot of platelets back in the cooler.  Again, we issue over 30 a day so there is bound to be some wasted, but this makes staff very frustrated.

We're getting ready to have a platelet 'transporter'. Hope they can figure out that it is NOT the same thing as the red cell cooler. At least they are different colors.

[mcgardner]

Thank you all for replying.  Just a little background:  We began with nurse pooling at bedside, but the nursing staff ended up complaining about it.  After going round and round with nursing leadership (I am sure you all know how much fun that is?), I decided to go with pooling before issue and adjusting expiration date as needed.  Nursing leaders cited high attrition among their staff, etc.   I am just glad they will stop calling my techs and asking "what do I do with this?"