mjshepherd

Thank you all for your input, I will be showing this to my transfusion commitee. I still think any error in specimen labeling should be discarded. I will do my best, wish me luck.

I am interested in how other facilities handle specimen labeleing errors. Do you allow corections to mislabeled or incompletely labeled specimens? If you do how do you document the errors? I have alway been very strict on labeling errors rejecting anything recollectable submitted with incorrect or missing information. However, several nurses, including the CNO, have stated that other facilities have allowed them to relabel specimens if they "certify" the corrected information. Thoughts anyone?

We buffer all of our saline as recommended by our Immucor rep, its easier that way. One bottle of pHix per cube of saline. Never had any problems with it.

My question is not when to do a blood culture, but what plates to set up. I have heard many sugestions but can find nothing in the way of regulations. We currently just inoculate a Aero/ Anero blood culture bottle for the Bac-T, but have heard that plates should be set up as well.

The 15th edition of the AABB Technical Manual (page 549) "at < 20 weeks, the fetal blood volume is rarely more than 30 mL, small enough that a single dose of 300 ug RHIG will be sufficient for prophylaxis for any feto-maternal hemorrhage. Therefore it is not necessary to quantitate fetal red cells in the maternal circulation before 20 weeks of gestation." Also, "When the gestation age is less than <20 weeks one 300 microgram dose of Rh Immune Globulin should be sufficient to cover a fetal-maternal bleed since the expected fetal blood volume is not likely to exceed that which is covered by the standard dose." Trauma During Pregnancy, by Haywood Brown, MD and Thomas Luley, DO

AABB has the cut off as 20 weeks.

I love the new Helmer cellwasher I bought last year.

I am of the paranoid blood banker variety. I would prefer having to justify the added time and work of continuing to give antigent negitive blood if there was any question of an antibody being present, than to have to justify transfusing antigen positive blood to a RCA board if a reaction occured.

Malcom, I have no other ideas for the RH enigma than those that have been posted. However as a hobby painter with my own lovely monsters I can make a suggestion for the paint in hair delimma. Mineral oil always seems to work for me. Saturate the hair and then put a shower or bathing cap on for about an hour.

Here is a copy of the form I designed for use at our facility. We require a copy to be submitted to the blood bank before units are issued then I review them monthly for appropriatness, this makes my utilization review much more effective then randomly selecting a percentage of patients. [ATTACH]496[/ATTACH] Blood Product Order Form 3.doc

I installed and validated our Echo over two years ago and overall the Echo is a good instrument, the mechanical operation is relatively simple with quick and easy maintenance. For facilities with moderate to large volumes of routine testing it does free up a lot of bench time. The patient data organization is cumbersome for facilities that are not computerized. However, when interfaced with a Blood Bank computer system the Echo will download worklists and upload patient test results fairly seamlessly. The functionality of the analyzer is also somewhat limited to ABO, RH, Antibody Screen, IgG DAT, and Antibody ID panels. While it is capable of running other functions such as forward typing of donor units and crossmatch testing these are more complicated and time consuming than manual testing. One of the best cost effective features that I have found is that many of Immucor's tube typing reagents are used on the Echo as well, reducing the number of reagents need to maintain two methods. We did have some issues with validation. The analyzer will only detect IgG antibodies, which led to us removing the crossmatch option from our testing due to incompatible blood types being reported as compatible. This also prevents the analyzer from detecting cold reactive IgM antibodies, which could be clinically significant in surgical cases where the body temperature would be lowered. The much increased sensitivity for IgG reactivity can cause problems when starting out as you may notice and increase of positive antibody screens with no identifiable specificity when tested against ID panels. We have found through experience that many of these patients with non-specific reactivity actually develop identifiable antibodies when tested at a later date, leading us to believe that the Echo may be picking up very low titers of certain antibodies. I would recommend this analyzer for any facility with moderate to high volume of routine testing that could be batched, and had the ability to have an interfaced computer system. If you have any questions fell free to contact me directly.

I use a K3 EDTA for the Immucor ECHO, I'm not sure why but it seems to cause less artifact over the K2, although Immucor states that any EDTA is acceptable for testing.

I am so glad to know I am not the only one who is addicted to this site. They laugh at me here checking in everyday to see whats new, but this has been a great source of info and amusement.

If it is due to a broken plasma bag believe it or not I had great luck with Dawn dish soap. I drained the waterbath, and put the Dawn straight on the "crud" let it sit for 15 min. then scrubbed it with a nail brush. Let me know if this works for you.

At our facility I perforn the initial appropriatness review by randomly selecting a a percentage of total patients transfused and reviewing the chart. If I see anything that falls outside the transfusion guidelines I forward it to our pathologist for the final say. If the path feels it truely falls outside acceptable practice he drafts a letter to the physician. If a physician receives 3 letters in a 2 year period he is asked to appear before the review board.

For outpatients the phlebotomist draws the specimen and labels it with out banding system, then clips the band to the patients chart. Then when they come on the day of surgery, the nurse confirms the patient identity and then attached the band on the patients wrist. Also, it sounds like you need to get your pathologist to talk to anesthesia, there should not be exceptions made to patient safety standards just because the doctor feels inconvienced. Patient/specimen identification is number one right now on Joint Commisions hit list, we a few major citiations because admin did not want to reign in the doc's.

We have two people verify the identity of the patient at the time of draw for patients who do not have a historical type on record, they each initial on the lables confimring patient ID. Anyone can be the second person for verification, nurse tech, nurse, other phleb or tech.

I could probably go with that on platelet transfusion, however that would really scare me on FFP transfusions. There are too many areas for mistakes to be made. The first blood type could be incorrect, the physician could read the wrong blood type or write it down wrong. I would feel better if a blood type was determined at least once per admission.

I love Harmening, its the first thing I hand my students when they walk in the door.

Here is the form nursing uses at my facility. [ATTACH]428[/ATTACH] Transfusion Reaction Report Form- New Hospital.doc

I have HCLL and we use Shamrock cat# SB128-22. While the label is not an exact fit for some of the printing tasks we are able to use it for several different label types, product codes for thawed plasma and, pooled cryo donor numbers and product codes, RHG labels and reagent labeles from single printer. Also I had found a great supplier of transfusion tags that print from a standard laser printer and have a peel off section that is placed on the bag. They are from Tri-State Hospital supply cat# LSL594C. I can let you look at a PDF of a template if you would like.

Believe it or not Malcom it was a strong 2+ reaction with Monoclonal anti-E, we sent to reference for confirmation and it was confirmed after cell seperation that the patient was E negative.

Once per admission, with oncology/ infusion clinic patients using a monthly admission.

My first question with showing an E specificity with a positive E antigen type would be when was the last time they were transfused. We had a case of a new anti-E found on the night shift that confused the tech to no end because she was typing E positive. After getting a better history we found out she had gotten 4 units the prev month at another hospital and were picking up donor cell reactions.

We had our JC inspection just last month, the inspector spent quite a bit of time in the Blod bank and did not have a problem with us keeping rhogam in the blood bank.