bmarotto

Does anyone know a source for phase change coolant blocks that can used in place of the blue ice blocks?

Thanks for all the replies. We just ordered a Thermosafe model 930 to try out. We also ordered an EvaKool IceMate Wheelie Model IM050-W. We will validate each of them and take it from there. We are hoping the IceMate works out so we can use them for the liver transplants when they want 10 red cells and 10 plasma at a time. We have two sizes now, four large that can hold the 10 + 10 and twenty smaller ones that can hold five units. They are getting old so we would like to start replacing them as the hinges and latch mechanisms fail. Here is the link to the IceMate: http://www.cooler-store.com/evakool_icemate_wheelie_polyethylene_ice_box_im050_w_26375_prd1.htm If we can't find something that holds 10 + 10 the OR is going to start asking for a refrigerator again. I don't want to go there!

Ah, yes...just a little something to make the BB feel better.

I am looking for large transport coolers to send blood to the operating room for liver transplants and massive transfusions. I can not find the large ISC containers..are they no longer being made? Does anyone know of a good substitue?

Hi John! I hope to get my staff to realize that batching is NOT a bad thing, wasting reagents is. We get a lot of routine type & screens on patients coming in for pre-op testing. We can set them aside so all three shifts will have samples to add to that single "must have it now" order.

Great point, David. It sounds like the referring hospital did not have a BB computer system at the time and the tech just went with the type of the sample instead of checking the file. I wonder what was done about the MD who drew the blood. It has always bothered me when there is a different level of accountability depending on your position.

We are working to streamline our workflow and bring in automation this year. We would like to start "batching" routine transfusion orders. What are others using for turnaround times for routine inpatient transfusion orders?

We inspect upon receipt, at issue, and before placing a unit that is returned unused back in inventory. We do not routinely check every unit daily. Our inventory is too large at it just makes no sense to me.

We do the same but billing has received some payment refusals saying 86885 and 86850 (antibody screen) are mutually exclusive. I have explained to the best of my ability, including showing charge sheets from our reference lab with charges for 86850 along with multiple 86885 (selected cell) charges. Has anyone else had this problem? Billing said they need to add a modifier.

Welcome Nova Hippy. Our outpatients are discharged a short time after the transfusion is ended but they are given an information sheet with signs and symptoms of a reaction and instructions on how to proceed should they experience a reaction.

Having residents rotate through Blood Bank does have positive results. This past summer, we were informed that two residents (future anesthesiologists) wanted to do a two week elective in Blood Bank. We were notified on June 24th that they would start on July 1st! We scrambled to accommodate them but it was well worth the effort. They learned a lot and recommended the rotation to other residents. They have said nothing but good things about the Blood Bank. Maybe it is my imagination, but we do not seem to be getting as many strange orders (or bad attitude) from residents this year!

Thanks Denny. The reason I ask is becasue a waste management consultant said items not "saturated with blood" could go in regular trash. Some nursing units take this to include empty blood bags. Call me old fashioned but I rather have them go in Biohazard trash. We send a two part tie tag..one copy is charted and the other remains on the unit at all times. If it ends up in regular trash, we have a privacy problem. I am not concerned about Biohazard trash which is incinerated. All the lab specimens go in Biohazard trash and we certainly do not remove the patient ID labels from them before disposal!

The folks from our not yet live HIS system thought they could use their new medication administration system for transfusions. They were totally unaware of 510k. It turned out that they could not "read" codabar labels and since our blood center still uses codabar we dodged that bullet.

Two questions about how your hospital handles the disposal of blood bags/sets post transfusion: 1. How are blood bags and administration sets disposed of...regular or biohazard trash? 2. Are the patient identifiers (label or tie tag) removed before disposal? Thanks. Bev

I heard once Ortho's exclusivity agreement for U.S. distribution expires, BioRad will be offering gel reagents in the U.S. I do not recall exactly when it expires, but I believe it is sometime in the next two years.

Magnum...what lot # are you having trouble with cell#1? We had the same problem with several patients yesterday using screening cell lot#34156 but it went away when we repeated with a new lot#. And yes, we have had trouble with the check cells. Immucor sent a letter about reports of weak check cell reactivity a few weeks ago. We have also had problems with weak reactions with anti-D dating back to April. We are in the process of switching our cells to BioRad and may make a total switch if these issues do not resolve.

Is anyone using a contracted apheresis service to collect stem cells? If so, is the service FACT accredited? Our hospital outsourced therapeutic apheresis and stem cell collections to our contracted dialysis service. They are primarily a dialysis provider. I think we were their first stem cell site. I am concerned over how FACT will view this. The Blood Bank does assume responsibility for labeling the apheresis product.

Beside some basic medical history, our request form for for serial therapeutic phlebotomy requires the following information (this is "the plan"): 1. Indication for phlebotomy, with diagnosis code 2. Frequency of phelbotomy 3. Hold for hematocrit <____% 4. Labs to be drawn (e.g.: iron profile every 3 months) 5. Special requests We draw a standard unit of 450 + 45 mL unless otherwise specified. The order is good for up to one year or until any of the parameters change, whichever comes first.

Kate, what temperature did it reach at 18 hours?

Donna-It is complicated and I am not sure I get it either. Everything after the first paragraph (which is what I wrote) should be in red to designate the the e-mail I got from billing. What I think billing is saying, and I do not agree with, is that code 86850 (antibody screen) and 86885 (the code we use per cell tested for selected cell or partial panels) are mutually exclusive. I think they are quoting this statement from the January 2008 issue of CAP Today: The deletion of “antiserum” from 86885 and 86886 code descriptors, the addition of “reagent red cell” to 86885, and “antibody” to 86886 characterize the 2008 revisions made to these antihuman globulin (“Coombs” ) laboratory test codes. Additionally, a new parenthetical note that directs the user to code 86850 for indirect antihuman globulin testing for red blood cell antibody screening can be found below code 86886. A second parenthetical note following code 86886 instructs the user to report code 86870 for indirect antihuman globulin testing for red blood cell antibody identification using reagent red cell panels. I do not see where it says 86850 and 86885 are mutually exclusive. I interpret the final sentence as meaning we should use 86870 when doing an antibody ID using complete red cell panels. Testing patient plasma with individual cells (from one or multiple panels) using AHG method should be billed using the 86885 code per reagent cell tested. Prior to 2008, I believe CPT 86885 said per antiserum instead of per red cell tested. Anyway, our Red Cross reference lab is billing their workups the way I am billing our patients so I am not changing unless I hear otherwise from our billing department.

Funny thing...after I posted about 86885 last week I got this from our billing dept. They seem to think 86886 (antibody screen) and the 86885 are mutually exclusive. As an example, I gave them a bill we received from ARC Reference lab billing us one 86886, one 86870 (antibody ID panel) and fifty-six 86885 on the same patient draw. I have not heard back form them. Here is information from the College of American Pathologists about the changes made to codes 86850 and 86885 in 2008. These two codes are mutually exclusive which means they cannot reasonably be performed at the same anatomic site or same patient encounter. "The deletion of antiserum from 86885 and 86886 code descriptors, the addition of reagent red cell to 86885, and antibody to 86886 characterize the 2008 revisions made to these antihuman globulin (Coombs) laboratory test codes. Additionally, a new parenthetical note that directs the user to code 86850 for indirect antihuman globulin testing for red blood cell antibody screening can be found below code 86886. A second parenthetical note following code 86886 instructs the user to report code 86870 for indirect antihuman globulin testing for red blood cell antibody identification using reagent red cell panels."

We use CPT code 86885 for each reagent red cell when running additional rule in/rule/out cells after the initial panel or when doing a selected cell panel on patients with previously identified antibodies.

I would strongly suggest you get sensors that have user replaceable batteries. The ones we currently have must be returned to the vendor when the battery dies. Readings are taken fairly frequently, about every 8-9 minutes, and the batteries often die in a year or less. The vendor now has new sensors with replaceable batteries but that would mean purchasing all new sensors (over 400 for our two sites). Also, make sure you get sensors with probes that you can immerse in fluid. I insisted on that from the start but the other labs at first got sensors that they had to mount inside the fridge or freezer. It is easy for the signal to drop if the antenna is inside a well insulated fridge or freezer. I mount the sensor housing (which has the antenna) outside and run the lead with the probe inside the unit.

Our lab is getting pressured by a cardiac surgeon and anesthesia to bring in a TEG analyzer. They say it will result in a decrease use of blood components. The lab director is strongly opposed to TEG and has vetoed it for the past several years. As a result, the surgeon is now bringing it to Transfusion Committee for discussion. We have a new CEO who is pushing blood conservation so there may be support from Administration. I would like to hear from anyone who has experience with TEG, whether positive or negative. Also, did it fall under the lab as a POC device and who interpreted the graphs...anesthesia or a pathologist? Thanks in advance.

They are still made by Dravon. They are called the A-clamp. Here is the link: http://www.dravon.com/a-clamp.html