dgibaud

They use the "GEM" in our OR's, and I'm informed that this machine gives blood gases and Hct, but NO platelet count. They have so send a sample to the main lab to get that result.

Our cardiac surgeons often ask for 20u plts (for us 4 pools, or 4 pheresis units) to be on standby. They normally transfuse in groups of 10 (2 pools). At our facility platelet transfusion for CABG is a rare occurrence, maybe 1 in 15-25 patients. They have a "point of care" instrument in the OR to help them figure out the appropriate dose, and to check on the outcome.

We have Sunquest/Misys as our LIS and it is very easy to miss an issue. It's not a matter of the techs being careless, but more a matter of poorly written software. If you are distracted at the "save" portion of the computer issue (phone call for example), the system will just "time out" and will erase the transaction from the screen. The time for this to happen may be as little as 10 minutes depending on your site parameters. This is a spot where the computer should keep the transaction on the screen until acted upon, but I doesn't work that way. We are in the process of upgrading to version 7.0 and I have NOT had a chance to see if they've improved this process.

We use Cerner to generate the armband, and we use Sunquest collection manager to scan the armband and print requisition labels at bedside. Our major problems are not hospital armband vs blood bank band, they are lab draw vs nurse draw. The lab does a pretty terrific job of patient identity through numerous hours of training. The nurses.....not so much.

Swede Does this mean you have 21 days + of stored patient specimens just in case you need to add units on the actual date of surgery?

We use Fisherbrand Biohazard specimen bags, 8x10 (01-800-08). These also have a paper pouch. They're for "light duty". Your blood product should already be in a leak-proof bag, so these are fine. In 15+ years of sending blood products via tube, we've only had one problem, and that was from a leaky pool of platelets (tech problem). We don't double bag.

According to the letter from Ortho dated 1/28/11, "the overall conclusion was that since the MTS anti-IgG gel card does not contain FDA approved labeling for detection of IgM antibodies, it is not adequate to demonstrate ABO incompatibility." Further along the letter continues: "It has been brought to our attention that some ID-MTS Gel customers have been cited as out of compliance with CLIA regulations.......even in situations when the customers have performed internal validation studies demonstrating the the MTS anti-IgG crossmatch will identify ABO incompatibilities....". If you have software in place to comply with electronic XM requirements you wouldn't necessarily need to do an IS XM, but despite internal validation studies, an over- zealous inspector may still decide to go along with the strict interpretation of the CLIA regs. We do the IS XM and wait for Ortho to do the required validation studies on a large enough cohort to make an IgG XM valid for detection of ABO incompatibilities.

There was a study published in TRANSFUSION concerning "day of use" testing w/Verax PGD test. They found 9 of 27,620 platelet doses positive "at issue" that were released by donor centers as culture negative. Some of the patients receiving the PGD positive units did have significant reactions. They extrapolated their data to suggest that, if use was required in the US, we could prevent more than 300 transfusion reactions and several fatalities per year. The article title is:Detection of bacterial contamination in prestorage culture-negative apheresis platelets on day of issue with the Pan Genera Detection test.

If you're CAP accredited, the reference is TRM.31900 Mechanical Timers. "Mechanical timers on serologic centrifuges, and the speed of the centrifuge, are checked for accuracy every 6 months." They removed the requirement for digital timers probably 4 years ago.

If you're a CAP accredited lab not only do you have to apply the 6 fundamentals of competency testing, you must apply them accross all "systems" in place. That is, you need to measure the 6 fundamentals for crossmatching, antibody screening and ID's, ABO/Rh typings, elutions, etc etc. In chemistry, you can do competency testing on all tests performed on one instrument, but you also need to have the 6 fundamentals checked for each different instrument, or system, used in the performance of a techs' normal job. Needless to say this means much more documentation to get it all done.

We use plastic for eluate prep as we encountered some problems years ago with the 12 x 75 glass tubes breaking. No problems recently but still like the safety of the plastic tubes.

Lynk We started a heart program about 2 years ago. We have one surgeon who does 90% of the cases (1-2 per day). He likes 2 units red cells in the OR, 2 units on-hold in the bank. He doesn't normally ask for platelets, but when he does we can usually get them sent with our routine courier within 2 hours. They normally don't need the platelets until they're nearing the later stages of the procedure, so this works well. About 1 or 2 cases a month turn bad and use more blood and platelets. I haven't had to change my inventory, but they DO want fresher blood for these patients.

Our hospital employs a book called Lippincott's Nursing Manual. Has a good checklist for the entire procedure.

The current CAP checklist question (TRM.42460) regarding shipping blood states "For blood/blood components shipped outside of the facility, procedures have been defined for proper packaging to prevent damage and control storage temperatures." I would assume that if you have a good procedure, and have validated "control" of your storage, you should be OK. Can you prove to your inspector that if you pack components as described by your procedure, will they stay in temp range for a reasonable period of time? That's the only regulation I could find.

We have a STAT board (looks like an airport arrival/departure screen) where all stats display. Type and Screens and XM's go from green to yellow at 45 minutes, and yellow to red at one hour. All of our surgicals are STAT, and they come in all day long. The board helps us be aware of specimens that might be lost or misplaced. We think one hour is fair for XM's without antibodies.

You might want to crossmatch with a new specimen if you're restarting the patient's correct ABO after 10+ units of O. This is more of a problem if you're using whole blood, or for smaller patients.

We are having a terrible time with physician order entry, and it sounds like what everyone here is going through. The EMR sends a "Transfuse Blood Products" order to nursing, but the XM order isn't always generated. Another twist is that the Transfuse Blood Products order may indicate "irradiated components" while the XM order just calls for regular red cells. This is Cerner EMR w/Sunquest LIS. We've been live with physician order entry for 3 months now and it doesn't seem to be getting better. The physician educators don't seem to understand the 2-step order process.

We are undergoing the same process as donellda, using Cerner for our EMR and Sunquest/Misys as our bb system. We have tons of problems when the order seen in the lab doesn't match the transfusion order only seen by nursing.

We inspect daily and document in a daily log (with other temps, alarm checks, etc) and then document at issue in LIS. Don

For those who are interested, I believe the results of the University of Michigan study can be found in Transfusion 2002;42(s)20. This should be John Judd's data.

Microbiology does the culture should it happen on day shift. On other shifts there would be a generalist covering the micro dept. Don

At my place we repeat a full panel every 7 days unless crossmatches against antigen neg blood are reactive, or it's obvious something is different from the antibody screen. However, when I've polled hospitals in my area (central Michigan) the answers go from "every 3 days" to "every 30 days". Don

Went back and checked the sample w/anti-A1 lectin. It was negative so presumably this is an A2 baby. Didn't think I'd get such weak reactivity in gel, but it's good to know if this should happen again. Don

Had a cord blood submitted today and got a mixed field rxn (2-3+) in the anti-A column. The tube confirmation was 3-4+. No other problems in the card. The baby appeared to be rh neg, with a neg DAT. The mom was A neg. This could be an example of mixed mom and baby blood. Any other thoughts? Don

We are a 250bed hospital and we used to draw almost 1000 units auto, back in the 1990's. We gave up doing that and now only receive the random auto from our supplier from a patient that just can't be convinced that there really isn't any medical advantage anymore. Don