Anyone have any good ideas about how to deal with the section in red that would work at a smaller facility?

We don't have the centrifuge needed to perform volume reduction on platelet units. We don't have the capability to relabel units if we split them except with rolls of labels - no Digitrax, no ISBT128 registration. Our BB LIS is not set up for splitting units. No tube welder. We would have a very small number of patients that would fall into this category each year, so the whole process would be performed very infrequently at most. Competencies would be a nightmare even if only 2 or 3 of us were designated to perform this task.

Historically if we've gotten a request for split red cells units, we've recommended that a volume equivalent to a split unit be infused slowly, then discontinue the infusion. If more red cells are required another unit is set up and a small volume is infused from it. It is wasteful, but it is an extremely infrequent event.  I've received maybe two requests over many years to volume reduce platelets for a neonate, but we have no way to do that.

 

I think what you are doing is acceptable.  I am in the same boat.  I had a procedure for splitting units but can no longer comply w the labeling regulations.  I've never had an order and would recommend transfusing rbcs the same way you do.

Our blood center could provide units with one or more bags attached.  (We did not perform many neonatal transfusions and ordered these for the neonates).  The empty bags had labels and our computer was set up for the aliquots.  We were fortunate that this only took a few hours.   If an urgent need, your process sounds acceptable. 

Ditto.  We haven't 'split' a unit for a non-neonate for over 20 years!

I agree with the above ... we'll just state what we do if we ever do get an MD who requests a split unit.  I'd only add that the usual approach is for the MD to instruct the infusionist to 'Transfuse over 4 hrs.'  vs the usual transfusion rate of 1.5 - 2 hrs.

Eventually, hopefully, the CAP Checklist Team get the message that splitting the unit is not the only answer and shouldn't be unless it's done often enough to maintain competency, etc.

I added a statement about either not transfusing or splitting units for patients that are at risk for circulatory overload and that it was the provider's responsibility to identify patients who are at risk .  We use Epic and after the last JC inspection, transfusion rates were amended to specify urgent, normal or slow rates at the time the transfusion order is entered.