jshepherd

Hey everyone, We have a Refusal of Blood Products policy and form for a patient to sign if they so choose. We are revamping both of these, to ensure they are clear, concise and understandable. I have been asked to see if anyone uses some sort of decision aid for patients to make this choice. What I'm thinking that means is: something that will help educate the patient about blood products to help them decide what kinds they are willing to accept or not. We already have an informed consent process in place for blood consents, but we all know that all doctors do not speak as clearly and correctly as all other doctors! We're wanting to standardize this information so that we are sure patients are making an informed decision to refuse. Does anyone have a great one-pager, or a video, they use maybe? Thanks!

Agree with Sonya, our fridges store reagent and blood products, so our range is 2.5-5.5 as well. I recall that autologous units that were "biohazard" because the donor was Hep C pos or something like that should be sequestered to their own area, and besides the BB knowledge of segregating certain things, I don't believe there is any rule about what can and cannot be in the same fridge. If you're talking about utilizing a fridge in or near the OR to store blood products for these transplants, then you just need to be sure the fridge is rated for storing blood products. Any old Frigidaire may not hold temps accurately throughout the whole fridge, which is what our OR attempted to get! We bought them an actual BB fridge (Helmer undercounter), and kept it specifically for blood only.

Our medical director always insists on 100 samples. This is WAY overkill for things that are not done frequently, like eluates, but for a TYSC or ABID on the Echos it's a statistical sample size for our volumes. We did 100 TYSCs on each Lumena, and 100 antibody panels on each Lumena (we have 2 Lumenas, and upgraded from 2 Echos). We were done in about 3 days for each instrument, running 4 at a time. Not too bad.

We use Charter Medical 150ml syringes and 150ml transfer bags, and they do not stipulate an expiration either. Regarding the 4 hour time, we have always followed the rule that the unit must be issued from the blood bank before expiration time. In the age of Epic for nursing documentation, the nursing staff must start the documentation (scanning the 4 barcodes on the unit) before the expiration time as well. The fact that it is infusing past the expiration time is fine, as long as it's infused within 4 hours of being spiked by the nursing staff.

Stephanie - that is genius! We have always called it therapeutic phlebotomy here though, and there would be a LOT of undoing things, including Epic documentation fields, that seem very complicated in the scheme of it. Thanks for the outside the box thinking though!

Working at what used to be the county hospital, but is now a hospital authority for the city, not affiliated with a hospital system, there is NO possibility of a sign on bonus. Many other locations nearby, all system hospitals, are offering sign on bonuses. That said, we are doing well in the BB here, I have been mostly fully staffed throughout COVID. Core lab on the other hand....has had some issues, and candidates are VERY few and far between. COVID brought us our first traveling MLSs in many years, and a lot of traveling phlebs.

We also use liquid plasma for our trauma patients. Prevents us from keeping thawed 5 day on hand and having to waste it, since for a large level 1 center, we really don't transfuse plasma that much! We provide type A liquid plasma, though we do keep some AB on hand as well. It is not irradiated, just as the O neg or O pos units we give traumas are not irradiated. This is based on the theory that those patients who are massively bleeding will not notice a WBC or two the same way they don't notice a mismatch in blood type (thinking of B and AB patients here). I understand that plasma that is never frozen could have WBCs in it, hence why it may be good to irradiate it, but when giving to trauma patients to help staunch massive bleeding it seems overkill, especially with Dr. Blumberg's point about WBC antigens being present in irradiated products. We also have a whole blood program for our traumas, providing O pos low titer LR (with a platelet sparing filter) as the first units in an MTP, when we have it in stock of course!

Thanks David! It does fall under the QSA regs for BB in the JC standards, so the policy is "owned" by me, and I "oversee" it. Though you are correct, the procedures are not being performed by lab staff, but by nursing staff only. This is done in many places in the hospital, including outpatient clinics, again by nursing staff only. I'm pretty sure this falls under nursing competency, but venipuncture is venipuncture is it not? I have never had anyone complain about nursing comps for t-phleb specifically, its so crazy to me!

Hey everyone! We have just a visit from JC, who cited us because our nursing staff who perform therapeutic phlebotomy are not competencied in this procedure. Per the state's guidelines, nurses must be competencied in venipuncture, and they are, but there is not specific call-out for T-phleb. Does anyone else have a competency program for therapeutic phlebotomy?? I have never heard of such a thing in my 6 years at this facility where the nurses do this. Also, just venting here- this is totally a nursing issue, not a laboratory one! Thanks!

We have the ArkBio microwave. I thought it came from Florida....but I could be wrong.

We have a patient with a known anti-C, with extra reactions in solid phase testing, but very clearly just the C in tube with LISS. Now the patient is showing a positive DAT, both IgG (2+) and C3 (1+). My question is: is there an indication for performing an eluate? The patient should be delivering today, and the C titer is 4, and has been throughout the pregnancy. She has not been transfused, but I'm wondering if somehow there was a fetal maternal transfusion that could have caused the positive DAT, and if that has been reported as being significant in the past?