Yes, I got it thanks.

Paul

I'm afraid the problem you face is not the lack of good, reliable data!! But I sure hope it helps.

Good luck.

Actually the issue is back on the agenda for next week and we will see how far we can go.

Dr. I may be willing to entertain the issue as she talked to someone at the U and they have apparently been using it for about two (2) years and she considers the pathologist at the U to be more conservative than she is.

Edited February 13, 200916 yr by PaulSunV

We use 5-day plasma. We are not a trauma center, but we have the same medical director as a nearby Level 1 trauma center, and they too use 5-day plasma.

Overall our use of FFP has been cut dramatically due to technologists monitoring the indication for the transfusion in combination with education of the medical staff by our esteemed blood bank medical director who is also an expert on coaguopathies. Vitamin-K is being recommended for many cases. Our director wrote ain "inhouse" handbook of transfusion guidelines called "Good Transfusion Practice" (aka The Good Book LOL)for all blood products, and it is distributed to each new batch of residents. Generally FFP is not used at my facility unless it's clearly indicated.

Incidentally our facility had one TRALI induced sudden death following a FFP transfusion and the FDA highly scrutinized the indication for the FFP infusion of that patient.

Is there any chance your Good Book is available online or via email? It sounds like a great resource.

I would love to see your "good book" also, if you can share.

Linda Frederick

Linda: Do you have me mixed up with someone regarding the "good book" !!

drsbright

Indianapolis, Indiana

Good Transfusion Practice is a hospital print shop published booklet which is 70 pages. I'll talk to Dr. Sweeney when he returns from the Pan-Arabic Trans Med conference in Qatar to see if he doesn't mind sharing his files or perhaps I can mail a booklet.

Could you please share your massive transfusion protocol?

Thank you

Wendy

OK, I will try to attach it here. The other files are the order for the chart, the list of coolers, and a label we designed to go on the cooler. The "physician orders" mostly consist of instructions for the nurses on things we wanted them to remember.

Massive protocol.DOC

MBRP cooler list.xls

m10698 MBRP orders 070708.pdf

MBRP Cooler labels.xls

Edited February 27, 200916 yr by adiescast
Added information

We use 5 day plasma at a level I trauma center. I believe we have discussed this before and except for need of factor V and VIII specifically it has been successful for patients.

I'm still fighting the battle to bring the use of 5 day plasma to my facility to reduce the waste of a valuable resource and I need some help.

First if anyone has a journal reference or two concerning the factor levels in 5 day plasma and or the efficacy of 5 day plasma I would appreciate knowing where I could find them.

Also, I have been asked to provide a list of facilities currently utilizing 5 day plasma, especially level I and level II trauma centers.

Any help will be greatly appreciated.

Thanks

John

John, I used the article in transfusion, convinced the medical director and as of Feb 20 we are using a three day expiration date. :cool: Keep on keeping on..........how is retirement?

Retirement is GOOD!

I check in with my old staff now and then, at least when I'm feeling a little sluggish and need a blood pressure boost. Apparently the 5 day plasma issue is progressing and may even be in place some time in the future, the only problem is most of them don't think they will live long enough to actually see it.

John,

Three facilities utizing 5 day plasma are The Hospital of the University of Pa, Temple University Hospital, and Christiana Hospital in De. All are Level 1 trauma centers.

From what I understand, some time in the past year, 5 day plasma was finally accepted. Not sure if my leaving had anything to do with that!!. Anyway, I would like to see the numbers some day to see if my projected $$$$ savings were any where close. I do appreciate all the support and info I received over the years while trying to get this in place. It may not have occurred during my tenure but at least I can feel good that it actually occurred.

Now if only they would consider dropping wD testing!!!!

You may have lost a battle, but you won the war! The last group you worked for has switched to

5-day!!!!! I will look for references for you. Thanks for your patience with us for all of the years you worked for the change. Everyone (all 21 hospitals-since we have opened some more since you left) are VERY HAPPY with the change.

Hope you are doing well-we miss you. I still haven't retired because I need the health insurance to pay for IVIG every 3 weeks at the tune of $6000. 50 years in healthcare and no retiree health insurance. Go figure.

This is the first time I've ever responded, but enjoy and learn from this.

bruner (aka fg)

We are a Level 1 trauma facility in Atlanta, Georgia. We have been using 5 day plasma for several years.

New Hanover Regional Medical Center in Wilmington, NC uses 5 day plasma

John - There are a few articles that have been written but I don't have a list. We have been converting to 5 day Plasma for at least four years with no problems. For infants or known patients with a Factor deficiency, we use plasma thawed within the 24 hour time frame. Routine surgeries or other patients needing FFP, we use Thawed Plasma. It has really helped on decreasing product wastage.

We also waste a lot of unused FFP in our facility and would like to bring the 5 day plasma in house. Would anyone guide me in the process of making this happen? I would really appreciate it.

At our facility the Medical Director is very much against the use of five day plasma. I don't know why; in light of the overwhelming amount of info and practice available for it's safe and efficatious use. We can only hope that in the future his veiws will change.

Before we switched to 5 day plasma, we tested the labile clotting factors, V and VIII, daily post thaw for 5 days. Our internal studies showed that approx 75% of labile factors remain at 5 days post thaw. We determined that for most of our patient population, this was adequate. We do use fresh thawed FFP for neonates and TTP plasma exchanges.

If you need to convince med directors or clinicians, do some studies and get some data. I also generated some data on cost savings, as we would not be wasting as many 24 hr plasmas. Some science, some dollars...usually works.

We are a much smaller hospital (140 beds). I didn't have any trouble with the medical staff. ER and OR were very unhappy with the 30 minute delay due to thawing a jumbo plasma when requested. I thought I would see an immediate end to wasted plasma but this wasn't so. I started out with having 1 AB thawed. Since our supplier didn't want me to go thru all their AB plasma I wasn't using it until the 4th day it was thawed if I didn't have a stat. If course, right after we started with the thawed plasma our census dropped. So, I was still wasting plasma. It is better now, but I have to keep a close eye on it, our census and what kind of patient's are in the hosptal. I also went to 3 days on the AB thawed. I also found out that I needed to re-educate some of the techs on what blood type can use what FFP type. It was really discouraging to come to work and find out that the evening before a O pos patient wasn't given the A FFP that was going to expire the next day.

Antrita

DrSBright,

Can you give some level of sumation of this major study?

We are level 1 trauma in Atlanta and we have been using 5 day old plasma for more than 6 years. We use both FFP and FP24.

From the Technical Manual it looks like 5 day plasma has good levels of ADAMTS13 so could be used for plasmapheresis. Is anyone doing this and, if so, are there any limitations or were there issues convincing anyone?

We are suffering more wastage of thawed frozen plasma due to canceled pheresis procedures or the machine breaking down that I am looking to minimize.