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jason009

Extending TS for surgery patients-please advise

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Hi everyone,

I have been a lurker here for a while, but joined this week!  I was wondering if I could get some advice.  We currently at our hospital draw a patient for a TS or TXM and then there results are good for 12 days as long as they are not pregnant or have not received products in the last 3 months.  We are getting pressure from the surgical doctors to extend our TS/TXM to 30 days.  I am reluctant.  We have an archaic blood bank system and do not do electronic crossmatching.  I have seen that most 30 day facilities do electronic crossmatching.  The argument that I must dispute is why can't we do 30 days if the patient is redrawn for a fresh specimen when they come in for surgery.  We would ask if they received any blood products since their last TS and if not, do a type on the new specimen and use it for any crossmatching.  I realize the more time that passes, the more risk a patient would get products and not report correctly, but apparently this isn't a strong enough reason by itself.   I would prefer to keep it the same, but we are getting a major push to change. 

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Ive seen posts here that do extend from 4 to 30 days. those that are extending their XM out do so with the patient signing a disclaimer that they are not pregnant and/or have not been previously transfused since the date they got tested. I don't know how electronic crossmatching comes in to play. We still do IS crossmatch and hoping to change soon. Whatever is chosen, make sure you have compete documentation as to why or why not the process is the way it is. We would love to extend our XMs but have alot of tourists many non English speaking and so canon rely on an-any info given to us. Good luck

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I am very interested in this topic as our surgeons have recently expressed a desire for us to extend to 45 days for elective surgery patients.   Our current extension for elective surgery samples is 7 days (no transfusions/pregnancies).  I'm interested in the logistics of saving samples and pulling samples for the addition of crossmatches.  Then having to save an additional 7 days post transfusion.   How do people handle the logistics of saving samples?  Is a sample that is 45 days old still ok refrigerated for testing?  It seems this would be easier with the electronic crossmatch. 

We are considering a routine type and screen at 45 days then having the patient return within 7 days of their surgery.  This would satisfy the second ABO/Rh sample requirement and would not alter our current process of saving samples for 14 days.  We would have advanced notice of any atypical antibodies and we would be able to confirm transfusions/pregnancies closer to the date of surgery and the current sample drawn.  Also, we utilize a blood bank recipient wristband.  I cannot see a patient keeping that band on for 45 days.  We have difficulty with our Hem/Onc patients removing their bands after just a few days.

I would appreciate input from others who have moved to these longer sample extensions.

Thanks

 

 

 

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For our pre-op patients, if they have not been pregnant or transfused in the past 3 months, we'll make the specimen good for 28 days.  We do the type and screen within 3 days of collection.  Once the patient has been transfused, we set the outdate to 3 days.

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Hello

The process could be from 7 days to, let's say, 30 days or more. The point is to document that a patient had not been transfused or pregnant within the last three months. I think the reason why most people consider 14 days is to include the 7 days after transfusion a sample needs to be saved for and then add another 7 days. Another point is storage capabilities. Do you have enough space to hold samples for 30 or 45 days? We had a process in which a presurgical sample was drawn on day X and at that time the patient would be asked those two questions. Documentation of the person asking the questions (full name or employee code), the draw date, the surgery date, the answers to those two questions, patient's demographics and a disclaimer explaining that if one of the two questions is "Yes" the sample needs to be drawn within 3 days of the procedure. In some hospitals, this paper is, in fact, an order placed in the HIS and the blood bank will document the answer to those two questions. In other hospitals, a similar version of that form is filled out the day of surgery by the pre-surgical team documenting the same two questions. This second form help hospitals that extended the Type & Screen for a longer amount of time (let's say 30 or 45 days) to document any possible hospitalizations or encounters the patient may have had in between the time the presurgical sample was drawn and the surgery date. Maybe there are some strange cases where a patient may have had a visit to a hospital and blood was given (a hospital other than the one performing the future surgery) and this second form was the only tool that could have caught that. The Type and Screen can be extended on the presurgical day if both questions are "No". Those samples will be saved in a special rack and the forms filed in a special folder. I have not seen many cases in which I have to retrieve a presurgical sample to do extra testing. For the question regarding a blood bank ID band; this band,  the presurgical sample, and the presurgical form can be sent to the blood bank on the day of draw. The blood bank will give the band to the presurgical team at some point before the surgery. Maybe the second form I mentioned earlier could be used as another verifying that a blood bank ID band is on the patient and the two questions are still "No". If for some reason a patient has a clinically significant antibody(ies) two RBC units can be set up the day the sample was tested this way there won't be an issue trying to use a sample that is 30 days old. This, however, will tie up two RBC units for that amount of time.  

Sorry I went on and on. I wanted to cover all the bases.

Thank You

Frank

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We do that.  

Patients who come in through our pre-op program are good for 28 days if they are not pregnant and have not been transfused in the past 3 months.  There is a query that must be completed in our LIS to confirm the answers to those questions.

Any other patient that is not seen via pre-op is 96 hours.

Rationale: patients seen through pre-op have sat down with a nurse or physician prior to their surgery and given an accurate medical history.  Translators or family members are present as required for language or any cognitive deficit (dementia etc.).  Any other patient?  - who knows what their status is.  

This works very well for us.  

Sandra

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We do up to 30 days prior as long as patient has not been pregnant or transfused in previous 3 months. The 30 days was put into place <20 yrs ago to help our Pre-Surgical Services manage appointments for patients more easily.  We do perform EXM at our facility.

Patient comes in PSS and is asked if pregnant or transfused in past 3 months. Specimen is collected and sent to the BB with the information and the date of surgery documented by nursing on the order request.

Blood bank performs a history check on patient. In the computer (Sunquest) we go under patient's order and if no pregnancy or transfusion we change the Expiration Date of the TYSC specimen to 3 days post the scheduled surgery date. If the patient answers 'Yes' to either question then the Expiration Date remains 3 days from collection.

TYSC is performed: If the patient answered 'No' to the questions and if no antibodies (historical or currently id'd) the specimen gets placed in a rack according to the date of surgery (we have multiple surgery date racks that can normally handle 3 surgery dates per rack). If the patient has antibody(ies) an aliquot of plasma is frozen for use in xm'ing ag negative units on day of surgery. We also keep a log book with all of the patient information logged on a spreadsheet each surgery date has it's own sheet. If the patient answered 'Yes' to either of the questions then the specimen is placed in the regular racks (we keep our regular racks for 10 days).

We review surgery schedules a day ahead. If we have a patient with only one blood type on file we put them on a list that is sent to the Pre-op center and the nurses order/draw an ABORh when the patient presents on the day of surgery. The nurses also re-ask the transfused/pregnant in previous 3 month questions at that time and it is documented in the patient chart. Once the ABORh is completed and if the patient has not history of antibody(ies) the patient is eligible for EXM.

Patient's who have antibody(ies) have units IAT crossmatched on the day of surgery using the frozen plasma aliquot.

At the end of the day all of the surgery specimens are placed in the regular racks so that they are saved for 10 days post day of surgery.

Works for us :-)

 

 

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Here the type and screen/xm is okay for 28 days but the patient has to go through "preadmissions" for their pre-surgical testing and asked questions about pregnancy, prior transfusion, known antibodies. The outdate is extended 3 days passed the surgical date no matter if blood is given or not. If an antibody is found the patient is not a candidate for preadmission and has to come in within 3 days prior to the surgery.

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My facility uses a blood bank banding system.  We do not extend any surgical samples beyond the 3 days.  The deterrent for making any changes here is tracking the bands and being sure they get placed on the correct patient the day of surgery.

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So no new specimen is required when they come into the OR and need blood??? 

Do you have an extra refrigerator for all of these specimens being held that long?

What if they were transfused during the time of the T/S and their surgery and they do not inform you?

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On ‎2‎/‎9‎/‎2019 at 9:06 PM, Cliff said:

For our pre-op patients, if they have not been pregnant or transfused in the past 3 months, we'll make the specimen good for 28 days.  We do the type and screen within 3 days of collection.  Once the patient has been transfused, we set the outdate to 3 days.

Same as us Cliff, but we have a 21 day policy.

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