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Special Care nursery-do you have a pedi unit on site at all times?


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So my hospital hasn't transfused a pediatric patient, let alone neonate, in at least a decade.  We don't stock splitting or syringe supplies and we don't keep an irradiated fresh pedi unit either.  The rational is that the nursing staff and lab staff lack the experience to do such transfusions and by the time everyone read their procedures the baby could be lifelined to a facility with a NICU (we have a helicopter available 24/7).  Even by road during traffic the drive would only be about an hour.  Our blood supplier is about an hour away (2 if they take their time getting it ready during rush hour) so again, it is faster to transfer the baby than wait for the blood to arrive and prepare it.

We have a special care nursery but it's really not that "special", I've never actually seen a baby with worse than some mild breathing or blood sugar issues stay here.  What does everyone else without a proper NICU do for the extremely rare pediatric patient?

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I would think that the freshest irradiated or unirradiated unit you have on hand would be suitable for a baby in a true emergency.   A full unit could be issued and tranfusionist would use what they needed and discard.   This plan should be discussed with all involved before it happens to make sure everyone is OK with this.  Perhaps a procedure should be written as well.     

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If this is such a rare happening my suggestion is, if it ever does happen, simply do the best you can with what you have.  If you come up with some procedure then you will have to review and train with it on a regular basis and I would suggest that once per year is not enough.  Bottom line, you cannot prepare for every eventuality your fertile mind can come up with. The key in the rare circumstances is to not panic or get bullied into doing something you know is not correct.  You can drive yourself crazy with all the "what ifs".  I am all for preparation but it must be reasonable and realistic.  :coffeecup:

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We have a Special Care Nursery, but not a NICU and transfuse a neonate maybe 1x a year. We keep an O Neg Irradiated <7 days old with satellite bags (6) attached ( sterile coupling) by our blood supplier. The unit is replaced weekly as part of our regular inventory. If it does not get used for a neonate transfusion we just cross it over to our regular inventory and use if for an adult patient. We have a large enough oncology program that we have no problems using up an O Neg, Irradiated unit.

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Jessica A, we are much like you. Haven't transfused a newborn in 10 years or so. Our policy is to issue the freshest O negative unit on the shelf and they would let us know the volume used. By that time, the baby would be long gone from here.

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On ‎11‎/‎5‎/‎2018 at 9:20 AM, R1R2 said:

I would think that the freshest irradiated or unirradiated unit you have on hand would be suitable for a baby in a true emergency.   A full unit could be issued and tranfusionist would use what they needed and discard.   This plan should be discussed with all involved before it happens to make sure everyone is OK with this.  Perhaps a procedure should be written as well.     

This is what I would tell them to do if it came to it.  I think I'll update our procedure and start by saying "in a true emergency" we'll use our freshest O Neg and give it as uncrossmatched.  We already have the procedure written that they will take the whole unit and give what they need, discarding the rest.  We of course had a situation recently where a large maternal fetal hemorrhage nearly killed the baby and someone said "we don't do that here" (the RN I believe) when the MD asked about transfusing before lifelining.  So as part of the CAPA I'm having to look at our policies which admittedly need updating.

 

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