We routinely issue multiple pheresis units to OR for open heart surgeries. I recently found out that the storage boxes that have been in use since before my time were never validated for this purpose, so I am looking for alternatives. We have a consignment relationship with our blood center, so I need to be able to ensure proper storage conditions to be able to send unused units back. How do you handle this in your facilities? Is there something commercially available for this purpose? I am not inclined to put platelet incubators/agitators in the OR because I'm afraid the platelets may "travel" or get lost in the black hole that seems to exist in the OR department.

We issue platelets to the OR for transfusion only. RBCs go in coolers. Other satelite transfusion areas have incubator / rotators wired to our temperature monitoring system.

The only product we issue in a cooler is RBCs and this is only in the case of traumas. Our OR has monitored refrigerators for RBCs. If they require platelets they must pick them up when they are ready to be transfused.

We have room temp gel packs we put into a transport box with the platelets for transport. This combo has been validated to keep the platelets at 20-24C for 24 hours.

Minnesota Thermal Science also has a platelet transport container, although it is really for keeping platelets at the right temp in a desert war zone. I use their RBC containers. My flight nurses put 2 units into one of the containers for long distance transport. In 120 F heat, the units won't warm even a degree within 8 hours. The containers keep blood at 1-6C for 48 hours in desert heat temps and below freezing temps for long periods of time.

BC

We use a cooler packed with room temp gel packs. Cooler was validated for 20-24 C over 6 hrs. If product is returned in the cooler we use an IR thermometer to check the temp.

We issue platelet for transfusion only. Most cases we do not issue > one plateletpheresis unit.

We issue Platelets for transfusion only. Our OR has a monitored refrigerator for RBC's.

That's nothing, Karen: My OR has a monitored refrigerator for platelets!

BC

Ahh, now I see where our OR staff received training to return platelets in the cooler.

That's nothing, Karen: My OR has a monitored refrigerator for platelets!

BC

And they do it so proudly, don't they?

BC

We don't allow anything but red cells in our OR coolers. This keeps room temp FFP from warming the cooler with red cells in it and hopefully keeps plts out of them altogether.

But of course, we are dealing with surgery here and there seems to be a common theme that they can't be bothered with extraneous rules and details.

We use a cooler packed with room temp gel packs. Cooler was validated for 20-24 C over 6 hrs. If product is returned in the cooler we use an IR thermometer to check the temp.

For those of you using platelet coolers, are you doing anything in particular with the gel packs when they come back to ensure they are the proper temp to reuse? Are they put back in a room temp bin for immediate reuse or rotated? I have qualified coolers for platelet storage, but not sure how to address the returned gel packs. Am probably overthinking this... Any suggestions are welcome.

For BIG cases (messy transplants, trauma's or cardiac cases) we will dispatch a dedicated, portable, refrigerator that has a shaker mounted on top. The refrigerator has a special temperature data logger that records the internal temp and the room temp concurrently at 5 minute intervals. The shakers were added to three of our nine portables in an effort to reduce the number of times platelets get tossed in a refrigerator (give the OR staff someplace to put the platelets...) unfortunately we still see improperly stored platelets and now the surgeons fight over who gets a portable with a rotator. The little things are over $1000 each, so they require capital funding.

I have attached a photo in case anyone is curious.

Franklyn, if I remember right they seem to keep OR suites a little on the chilly side and if they are below 20oC or, heaven forbid, above 24oC your platelets might be compromised. Are the temps monitored real time?

Yikes! Don't you think a validated cooler with gel packs would be a lot cheaper ... and smaller ... and the surgeons wouldn't have to be fighting over them.

And if your concern is the rotating part: Platelets and remain 'unrotated' for 24hrs ... you aren't leaving them up there longer than that, are you?!

Mary h's Post is very interesting! I'd like to say 'overthinking', but then ... there's a lot of overthinking out there that suddenly turned into a vip hot topic complete with inspection citations.

Having read that and having said that ... in this day and age of 'validate everything', I'm going to go validate my gel packs. They are 'constantly' at room temp (from incubator to cooler back to incubator), so I imagine they'll 'recover' to 20-25oC very quickly ... but it never hurts to have some data proof when that inspector asks.

We only gave 1 pheresis at a time and it had to be transfused right away. We found that the average temp in the OR is 62 degrees F. Even if issued in a cooler the anesthesiologists had a habit of taking them out of the cooler as a reminder to hang them (or that he had them). We received platelets back at 18 degrees C and they were discarded. Expensive lesson. They still throw fits that they can't store them in the OR (I hear).

Edited June 9, 200916 yr by Trek Tech
Wrong temp units

The OR Room temperature is not monitored in real time (by the blood bank), yet, that is a future refinement we can look at once we upgrade our centralized alarm system to v6.0

However, we rarely see the temp drift below 20 Degrees C, oddly enough, so if they actually use the rotator we have a lot less medical waste. It is still worlds better than a paper chart and permits us to remotely store platelets for big cases.

As for overkill? Absolutely not. Coolers may be cheaper but we would need a lot of them, they do not readily lend themselves to q4 hour documentation of temperature, they are easily lost or misdirected and if the lid is left open they do not alarm (and your validation is rendered moot by someone that forgets to close the lid). We originally used coolers and came up with this solution over a decade ago and there is just no comparison. It certainly costs more 'up front' but long term it is so much more cost effective and efficient that there is just no comparison. We transfuse over 60,000 products a year and provide support for some really bloody surgeries. Providing an increased level of comfort to anesthesia and the surgeons is just good customer service and our wastage numbers are incredibly low for an institution of our size and volume. For example we have transfused nearly 8,000 units of plasma so far this fiscal year with total wastage at 0.7% and apheresis wastage at 1% (we cannot return products to our vendor, so that number better be low). We just never anticipated the rotators would be so popular so we didn't budget for more than 3. We will add some additional units in the future. Remember, the rotators we purchased, in part, to give the surgical staff a clearly designated spot to put platelets and cryo other than tossing it into the refrigerator. If you save a couple of apheresis units from refrigeration, you have paid for the rotator!

My co-worker, Ricardo, and I are leading a round table discussion at ASCLS this summer to talk about the blood banks role in solid organ transplant and we will be discussion our portables as part of that.

Edited June 10, 200916 yr by Franklyn

For those of you using platelet coolers, are you doing anything in particular with the gel packs when they come back to ensure they are the proper temp to reuse? Are they put back in a room temp bin for immediate reuse or rotated? I have qualified coolers for platelet storage, but not sure how to address the returned gel packs. Am probably overthinking this... Any suggestions are welcome.

Mary-

We don't issue platelets to an OR, but we do use room temperature gel packs when we ship apheresis platelets to our hospital customers. We do the following:

1. Label the gel packs with a sticker that states ROOM TEMPERATURE ONLY

2. Store the gel packs in an old platelet environmental chamber with the shakers removed...even within our own temperature-controlled and monitored Distribution area, we know that there are certain areas that tend to get warmer or colder than we would like (i.e.right next to our external door).

3. Temp the gel packs prior to re-use so that we know that they are actually 20-24 degrees.