Lcsmrz

I worked midnights at a facility that had alot of of JW patients, and occasionally I issued units at 0100 to sneak in a transfusion at the patient's request while the family and friends were away. I also noted that some JW surgery patients accepted the Cell Saver, since the blood "never touched air or was disconnected from body". Just as any other religious denomination, JW's have various beliefs and strength of conviction. You have to admire the ones who give up their life for their faith, when medical science has a solution to their needs.

There is a difference between regulations and what us blood bankers want in a BB package -- standards always lag behind technology. Vendors say you can't have it all, but we all know anything is possible, and it's just a matter of cost. I want to be able to set tables that will work for any of my staff, from the full-timers to the weekend-only people. As far as I know, there is only one system that will stop an ABO-incompatible unit from being issued, but will display a warning if it detects another problem and needs an override to continue. The scenario you propose is a common one, and I'm faced with the same constraints you are with the system I have.

We are a small facility in Indiana with a one-room lab and several tiny rooms for micro, BB, Path, etc. Since we have the room, we are considering moving the Blood Bank into the Main Lab and using the old BB room for an office. The BB would be in the corner, off the main workflow, with minimal distractions. The closer proximity to the Main Lab would help our older techs from walking so much and would definitely help the sole midnight shift tech. Everywhere I worked or inspected has always had a separate room where blood banking is done, yet I am unable to find a requirement to do so. We obviously do minimal blood banking here. Did I miss something?

It would depend on the requirements of the donor room. If products are being stored there, then environment would have to meet storage temperature requirements: 20-24 C, continuous monitoring, alarm system, recording every 4 hrs, etc. If not used for storage, then you would have to meet any documented requirements in the QA Plan. Another issue would be how accurately the automated system reflects the reality of the donor room temperature. Some systems measure only incoming and outgoing air temp, while other sensors were located in an area that did not reflect the actual temperature, such as an interior wall when the storage was next to the windows. Finally, the automated system has to be validated and sensors and alarams checked periodically according to the QA Plan. I have seen several places who have successfullly used facility-wide automated monitoring systems in lieu of stand-alone monitors and recording charts.

We let our computer do the work for us. Our supplier draws all the A/D units and sends us periodic status reports until the units arrive; we keep a wall calendar as a reminder. Once received, the units are entered into the computer and segregated on the A/D shelf until the patient is admitted. Popups remind us that the units are available.

My spies tell me that the dust off group documents very well, so the information exists if you reallly, really wanted it. So the question is, how bad do you want it? We record something like "initiated in ER and transported with patient" on our copy for our records and report it to the transfusion committee. Reminds me of those situations where the forms are reconstructed afterwards from the pile of empty blood and IV bags thrown in a dedicated corner of the trauma room ... if the transfusion committee won't care, why bother?

Meditech C/S gives lots of messages when scanning things in "Enter Units". Can you tell us what messages you're getting? I'm assuming that the scanner is working OK. To check a keyboard wedge reader, I use Notepad or something similar.

I can't think of a requirement either, although your process has to make sure that units gets retyped before use. Think what would happen if your computer system went down just after the units were entered as received. We segregate our incoming units on the quarantine shelf until retyped. We attach our label to one of the slits on the side, flagging the label on the unit, rather than stick it to the unit face or back. Another site I worked at flagged it around the pigtail at the top. We had a rather unreliable computer system at one time, so we retained the use of the retype label for comfort. However, I'm dropping the customized label with our facility name, as soon as the current stock runs out. It would be controlled as any other label, but I can't think of a reason to spend the extra money for the custom printing and the minimum order.

Mabel: Thanks for the name of it. I would have opted for the other one without knowing. Larry

I'm very new to Meditech 5.5 ClientServer, but I'm ready to tweak our BB setup. Specifically, I want to print a custom label on our BB label printer (with std collection labels) by checking the box on the XM Verify screen, then print a custom transfusion form on our laser printer at the time of issue. Seems like something the package can do, as long I use the correct terminology when talking to IT and set the correct parameters in the right dictionary. If someone has done this already and knows the things to do and what to watch out for, please contact me at lsmrz@mcmh.net. Thanks!

I worked at one wonderful place that had a sticker that said "Blood types do not match. This is intentional."

I vaguely remember that a 20-wk-old fetus has less than 30 mL of blood volume, so a complete exsanguination into the maternal circulation would still not cause a positive fetal screen. We do fetal screens for events after 20 wks gestation.

I've been trying for years to get rid of RhIg and all of its headaches -- Pharmacy refuses to take it! I thought the JCAHO requirement would allow me to finally rid myself of it, but I was wrong. We don't do ABO/Rh on all OB admits, and we only see the cord bloods when testing is ordered. It's an administrative nightmare to try to track things.

Alarm checking on a daily basis sounds be a bit excessive to me, esp if it means exposing your inventory to major temperature fluctuations. Unless you have a history of problems with the device or with the remote setup, even the ability to easily electronically test something doesn't mean it must be tested. Following the manufacturer's recommendations is always a good rule. Even the Tech Manual says their recommendations don't have to be followed. With the door-ajar alarm, we usually inadvertently "test" it on most days, when somesome failed to close the door completely ...

Drawing extra tubes is routine in our ER, where evaluation and changes in condition may require additional or follow-up testing. Same could be said for codes or OB in a triage situation. Drawing extra for a routine draw is a waste, unless the physician specifically requests it. Our HemOnc patients get a "BB Hold" tube drawn with their CBC to save them another port access, should the counts come back low enough to transfuse. My problem has always been the volume of blood drawn. Why draw a 4 mL EDTA, when the analyzer uses 300 uL? Or why a 7 mL chemistry tube when the sample+deadspace is 75 uL? I don't want 100% pedi tubes, but if I had some say, I would change the type of available vacutainer tubes in stock ...

Patients eat in hospital rooms every day, which is the location of many yuckier procedures besides blood collection. It's not the same as a Med Tech with gloves on with "freedom" fries and catsup at the workbench being eaten between samples. If the donor should not be moved to the refreshment area, letting them eat and drink wherever they're at is good donor care.

As we move toward a full EMR implementation, I remember the "old days" when the lab was the only computerized dept in the hospital and a 30 min downtime was required every night, with a 2-3 hr downtime for a full tape backup every weekend. And we were happy ... Now, almost the entire hospital is on-line and almost never goes down, and even a 2-3 second delay in screen response is met with howls! We have become spoiled by the great technology we now have -- and are so dependent on it, that posts to this and other forums are flooded with requests to harness it for strategic benefit. Hardware has become so inexpensive that previous discussions of the trade-offs between software and hardware have become nonexistent. As long as IT keeps me up and secure, I can live with a few inconveniences a year. They know that up-time is how they are compensated, and I wouldn't want to return to LIS support for anything ... I take that back: we all have our price!

Billing for blood banking work is quite complex, but how far you can take this depends on your LIS and whether it allows "preliminary" results. Sometimes, the effort that it takes to enter an interpretation or unit number in addition to the manual paperwork far exceeds that of a manual billing system, not to mention the increased complexity and error possibility.

53% after additive sounds good to me! If prior to adding, it sounds a bit weak. So many variables beyond time & RPM: centrifuge, what components are made, the type of bag, how full you fill 'em, how "shaken" the units are on removal, sampling technique, etc, etc. I'm assuming that the centrifuge time & speed tested OK -- the J6 is a nice device. After weighing the full bag and with 15mins @ 4200 and no brake (max packing ability?), very gentle handling, extracting all plasma (buffy coat layer starts into the tubing), your should be able to weigh resulting rbcs & plasma to get an estimated hematocrit, then check it against your sampling (strip, mix, release, repeat twice, seal and test.) If they are within 5-10%, the sampling technique is probably accurate, and only changes to your centrifuge settings will increase the Hct toward some maximum possible value. Add additive and repeat sampling to check the final hct. I suppose you can use the predonation Hct to calculate what the unit should be, then check what you actually got. Don't forget to adjust for the bag weight and the volume of CPD. Sounds like a great project for an MT student in the BB rotation !!

We record pre, 15min, and post vitals -- I worry what can happen in between these events. The more attention a transfusing patient gets, the better, whether it's in the policy, officially documented, or not.

I've seen it a few times. Probably a situation where the DAT was just below detectable limits, and the eluate set the right conditions for detection. We do eluates with only positive DAT too -- no reason to do otherwise routinely.

AABB standards mandate proper identification of patients when samples are drawn. There is no specific requirement for use of a wristband, although many people use them. It's up to use a system that allows you to sleep at night ...

I vaguely remember -- sorry, I vaguely remember just about everything nowadays -- that the RhIg contains the immunoglobulin classes that can be transported across the placenta. We see that every once in a while, too, and assume passive antibody until we can easily test otherwise.

We used a Sorvall. Assuming you don't make Platelets or Leukocytes, there is a procedure in the back of the Tech Manual for calibrating your centrifuge. There are plenty of variables, from the type of bag you use and how much you fill it to how much you sqeeze off after a hard spin. Handling the units gently out of the centrifuge will make sure units stay packed. Also, auto units may be different from allogeneic. I've used calibrated spun hcts, but a Coulter counter should be OK at hcts of 55%. Sampling technique sounds reasonable - make sure you remix the unit after stripping and before refilling the tubing.

The <80% standard comes from non-additive units. The hct should be <80% before the additive is introduced and about 60% afterwards. Hcts will vary on the processing. Soft spins will have a lower hct than hard spins. Making Source Leuko's adds to the equation, too. To maximize your plasma yield with additive bags, keep the hct's as high as feasible.