Nancy L.

We use the Mini-Vidas for dDimer as well as for some other assays. It is very easy to use. Run time is 20 minutes. We don't run very many of them so only being able to do a few at a time is not an issue. Providers are happy with it. Calibration is simple. QC failures are rare. The only negative for us is the expense. We run other things on our vidas as well. I would not get a vidas just to do ddimers.

A good friend of mine who lives in a distant state is a chronically anemic MS patient. She is quadriplegic so is not physically active. She became extremely weak and confused and was taken to the hospital where she was found to have a HGB of 1.6 gm/dl. They panicked and quickly gave her 6 units of packed cells. Surprise, surprise........she had a heart attack. She recovered and is doing well. What were they thinking slamming in so much blood so quickly. Her poor system hadn't had that much blood in circulation for months. Talk about overload!

We do the same as AFiddler. For our UA w Culture if Indicated, a culture is reflexed by the system if there are positive dipstick results of leukocyte esterase, blood, nitrates or proteins and microscopic findings of >5 wbc's per hpf or WBC clumps. The culture will not reflex if there are >2+ squamous epithelial cells. In that case, a comment is resulted that the specimen is not appropriate for culture as >2+ squamous epithelial cells is indicative of contamination. A new clean catch or cath specimen is requested if a culture is desired.

When there is more than one specimen container per accession number, cerner systems assigns a letter suffix to differentiate. For example, the green top tube would be Acc#A, red top Acc#B, and lavender Acc#C. In this way all containers of the same accession number can be placed in their own storage location. Letters assigned to containers can be seen in container details. We are in the process of switching to Cerner from Meditech (global organizational decision) and are also setting up specimen storage tracking. We look forward to not wasting ridiculous amounts of time searching through racks to find a specimen for add on orders et cetera. One key piece though...just like any other organizational system, it must be used in order to work. If someone removes specimen from rack without following through with tracking in computer it could get very aggravating. Good luck!

We are in the beginning stages of shopping for new chemistry and immunochemistry analyzers. We are looking for an integrated chemistry/immunochemistry system. Abbott gave us a nice demo of their Architect system. Would anyone be willing to share their experiences/insights regarding the Architect? What do you like and dislike about it and why? I'd be happy to have other tech's thoughts instead of just the sales person's. :cool: Thanks!

Has anyone heard of using a DAT to screen for FMH? We have used the Rosette tests in the past. One of our students tells me of another facility that does a DAT. They examine the DAT under the microscope and if they see any agglutination at all, they send the specimen out for quantitation. I have some misgivings about this and am wondering what others think of this idea.

I concur Terri! This year we moved into a new lab (after being displaced to a temporary location for several months) and our entire organization (hospital, lab, blood bank, and 14 clinics) are going to a new computer system. We are in the midst of the build right now. We are due for our next CAP inspection right at go live time. Seat belts definitely needed! We have postponed a proposed change in blood bank methodology (from manual gel to automated or possibly solid phase). Never a dull moment! Happy New Year!! I'm looking forward to the New Year when one of my favorite traditions is to throw away all my to do lists at home (wish I could do the same at work) and declare myself to be all caught up on all my duties! True, some things will need to be readdressed but really, there are many things that just don't need done and I happily let them go! It's nice to be all caught up on everything, even if it's only for a couple of days!

My immediate knee-jerk response is: No, Of Course Not! However, I seem to remember in the back of my mind, the rare possibility that the mother's AB type could be due to a rare cis-AB where the A and B antigens are both on the same allele allowing for the passing on of the O antigen on the other allele. I'm typing this after a very long day with no reference books at hand and may be imagining things. I look forward to hearing from the real experts.

Welcome Wendy!! I have found this site to be very informative and fun at the same time! Glad to have you.

rravkin, Thank you for your suggestions. We are, in fact, in the process of doing pretty much as you suggest. I am developing a flow chart procedure and have set up scenarios for techs to "dry practice" to give me feedback for the flowchart. I have also made up "Emergency Release Packets" that contain all the tags, uncrossmatched blood stickers, forms, etc. that would be needed in a massive transfusion or emergency release situation. As much information as possible will be filled out ahead of time. Our current (soon to be previous) procedure is quite thorough and complete and way too cumbersome to be a quick reference. I am trying to make it as easy and as efficient as possible since we all know that these things always happen when the least experienced part time tech is covering blood bank! Once I have the flowchart procedure and packets complete, we will have drills to get everyone comfortable and follow that up with q 6 mos competencies. We meet all requirements now but my goal is to ensure timely competence and efficiency - not just compliance. Thanks everyone for your comments!

We inspect at the time of receipt (documented in computer), daily (log book), and at time of issue (documented in computer).

We do very similar to what Malcolm suggests. Nursing personnel or transport can come pick up the blood product. It is checked out by a blood bank tech and the transporter. The patient's complete name, wristband number, blood type, donor identification number, unit blood type, unit expiration date are all double checked by both people comparing the information in the computer, the unit, crossmatch card attached to the unit, and the blood product requisition form that must be brought by the transporter. Only those who have received competency training (which must be repeated annually) are allowed to pick up the blood. Once the transporter has the blood, they must take it directly to the nursing unit and hand it to an RN.

I very seldom post a reply on any of the bloodbanktalk threads but I very often read through them. I feel that I have way more to learn than to offer. This thread is a great example of that. Thank you, Malcolm, for a simple yet thorough explanation! I am a generalist (have been for 30 years). A few years ago I added lead tech in blood bank to my generalist duties. This forum has been a great in helping me to learn more. Thanks everyone!

We have found that one has to be sure to finalize the filing of the issue of a unit of blood before the screen closes. We had a tech complete the check out process including all double checks with the messenger picking up the unit, resulted everything in meditech but got interupted and didn't actually file the result. The screen closed itself out and it wasn't discovered until the next day when it appeared that there was a unit missing from inventory. We were able to recover the information and reenter it but definitely not an optimum or desirable situation. Another reason to close or lock your session before you walk away - it makes sure you complete what you were doing. To be fair to the tech - it was our night tech. She is the only one in the lab which means she has to answer the phones, draw the blood and do all the lab work in addition to maintenance, QC, and other duties. Our night techs are great jugglers and manage to keep a lot of balls in the air. I know I'm too old to do that anymore!

While we are aware we can keep meditech open using analyzer batch screens, it is our policy to lock the session anytime we walk away from the terminal. It is too easy to get multiple screens open under several tech's accounts and end up resulting something under someone else's name. I only want work I've done released under my name NOT work that someone else has done that I will be held responsible for. It's not that difficult to reenter my password when I return to the terminal. I believe the safety feature is worth the minor annoyance. I have no problem with keeping the batch open while I am close to the terminal if I am the only one using it.

We are a looking at developing a Massive Transfusion Protocol. We are a busy but small (110 bed) hospital. Most of the information I have on MTP's come from larger hospitals and level I trauma centers. Does anyone have any experience with MTP in a smaller setting? Some of the issues we face with trying to implement an RBC:FFP:Platelet ratio are as follows: We do not convert to "thawed plasma". Therefore we do not thaw plasma ahead of time as any FFP thawed and not used within 24 hours is wasted. We do not stock platelets. It takes about 2 hours to get them here from our supplier. We do not stock cryo. We have very few massive transfusions. Probably a couple per year. I look forward to any advice or insights you can share. Thanks!

It didn't sound like a jumbled garble of mess to me. Perhaps because we have the very same policy!

I would do the same as L106. In addition, if units were issued after expiration of the crossmatch, this would constitute a deviation from SOP and an incident report would be filled out and reviewed by the pathologist/medical director.

In regards to the pretransfusion vital signs - specifically temperature - do any of you have a policy that states that a transfusion should not be initiated if patient's initial temperature is greater than a specific temperature? If so, what is your cut off temperature above which you would not transfuse and why? The only thing we've found regarding this is a paragraph from the 16th edition of the technical manual stating: Baseline Vital Signs: “…If the patient has an elevated temperature before transfusion, it may be difficult to ascertain if a transfusion reaction presenting with an election of temperature has occurred during the blood administration. In addition, a patient with an elevated temperature may destroy cellular components at an increased rate. In patients with an elevated temperature, an antipyretic should be administered and given time to have an effect, as long as the transfusion can be postponed.†Looking forward to hearing your input! Nancy

We did try to accomplish this in Meditech and in our current version (5.54) it is not possible. Meditech will search only for ABO compatible and appropriately antigen screened units but does not include the markers in this search. Meditech will not allow an ABO incompatible unit to be crossmatched and will give a warning box to disallow units that have not been appropriately antigen screened. We were unable to activate warning boxes for the markers. We will soon be updating to 5.64. I'm not sure if that will be different in this regard or not. Meditech has been a mixed bag. We've been wanting to move to electronic barriers for transfusion purposes which our current version of Meditech does not support. Our institution is looking at changing to a completely different vendor system wide. I'm not looking forward to the logistics of getting through that project! It may be worth it in the long run though.

We keep ours in the box. Kind of a pain to return them to the box after each use but I have to admit that our issues with nonspecific weak reactions (of which we had very many) have been all but eliminated.

We bult product groups, then listed individual products under defined groups. For instance: Product group PC includes PCLR (several product codes under this), PCLR2 (product codes related to the second bag of a dual collection), etc. Any of the products under PC satisfies the order for any other. This alleviates the need to know exactly which product we may need to transfuse when the crossmatch is ordered. After all, the unit clerks, secretaries, etc who put the order in the computer have no idea what our inventory is and whether or not a patient would get bag one of a dual collection or bag 2 of a dual collection. With this set up, it is not a problem. Two bags with the same number is not a problem as they have different product codes and are recognized as separate by the system. You'll need to think also about how you have your billing set up. In our case, the billing is tied to the individual product, not the product group. It took some time to set up (as I'm sure many can attest to) but once the initial set up was done, everything has gone very smoothly.

We also had a doctor (ER physician) who had an A pos patient with a positive antibody screen. He was insistent that he needed blood right away and we offered to have him sign for emergency release. He declined and requested that we just send him O negative blood. I guess they think they "negative" means negative for everything! In a non-blood banking example, we received a call from the registration clerk at the after hours ER desk stating that a patient was dropping off a stool specimen for culture and C. diff at the request of her doc. We asked that they please register the patient and forward the specimen to us along with the orders. They insisted that the patient didn't need to be registered since we were only receiving the specimen and not the patient. "It's not a patient, it's just a specimen. There's no reason to register the patient." I could almost understand this from some people but you'd think that a registration clerk (who also works in billing) would know better!

Wow, I'm sorry that you have this nightmare to deal with. Scary. It certainly sounds to me like your policy should be sufficient. Unfortunately, no process is 100% human error proof. A policy/procedure must be followed for it to be effective. Would it be possible to institute a self audit tracking the relabeling process. This would provide an opportunity to 1)reiterate the importance of proper relabeling and label checking throughout the testing process and 2)provide documentation of retraining and compliance on the part of the techs. This may be enough to satisfy the FDA that you are taking steps to make sure that your policy is and will be followed. It's unfortunate that neither of the techs paid enough attention to catch the error. While it is totally unacceptable and must be avoided at all costs, it is also easy to understand being distracted. We work in an environment where we are consistently needing to deal simultaneously with multiple complicated issues coming at us from all directions. I'm sure the techs involved are as distraught as anyone. Good luck! Nancy

We edit the information date in the computer to reflect 24 hours after thawing (we do not convert to thawed plasma). The tag that prints out and is placed on the unit then has the revised expiration date. We also place a sticker with the revised expiration date over the expiration date on the bag. This way the date on the unit matches the date on the paperwork.