On 2/3/2016 at 1:47 PM, bxcall1 said:

I just tell the nurses to keep it. If they can get the IV going and get the unit in within 4 hrs great. If not, return at 4hrs and we'll discard.

Yes, that is a good compromise and it is important to know whether they manage to give the unit or not, because in the States at least, you can not charge the patient for a unit they do not receive.  

 

On 12/1/2015 at 0:51 PM, NewBBSup said:

I have in my procedures that if blood is returned to the blood bank from the floor and the temp is >10 C that we quaranteen the unit. (For example, lost the IV site.) We change the unit expiration to 4 hours from the original dispense time.  If the floor request the unit back we can issue to that patient IF the transfusion can be completed within 4 hours of the original dispense time.  Does anyone else do this?  My pathologist wants to discard the unit.  My thought is that if they can transfuse within 4 hours, it's ok.  I would appreciate any feedback.

This is more like what we have also done in the past.  We do not re-enter the unit in the computer though.  We simply store it in the refrigerator with the original issue paperwork and hand it back if they come back in time to get it into the patient in the original 4 hours on the original slips.  (Spiked units stay on the floor.)  If they don't come back - we have the unit and paperwork for proper crediting, paperwork and disposal.  We have had this procedure in our manual for years and have not been sited by CAP, FDA or (now) Joint Comm.  It happens so rarely that it is hard to keep everyone "competent" on that policy, but it always requires a lot of communication with the transfusing RN because they are worried and nervous too.

We used to use the >10oC limit but we got cited for that by the FDA a few years ago.  As I stated earlier, they consider the blood on the floors 'in storage'.  So now, we have to use the 6oC limit.  Grrr.

On ‎11‎/‎30‎/‎2015 at 3:16 PM, Dansket said:

Your procedures are outdated and I agree with your pathologist.  Once an RBC unit exceeds 10C, it should be discarded per AABB, CAP, FDA.  We discard any returned units that have been spiked or if the outlet port covers have been opened, to that they may not be reissued...   

 

There have been extensive discussions on this website regarding this very issue.

 

Just adding my personal opinion here:

Although our procedures have us discard the unit in the scenario mentioned, I wish we could take back the (non-spiked) unit,  quarantine it, make sure they come back to pick up the unit with at least an hour left (of the 4 hours from issue time).

How will I know if they transfused it within 4 hours? I won't, all I can do is audit the unit as to the completion time to make sure the transfusion stop time was within the 4 hours.

If you tell the nurses they HAVE to take it back or the unit will be discarded, they will take it back to avoid the guilt of wasting it and put it wherever they will. I imagine it would just SIT on a counter until they can get the IV re-started or whatever the reason is, I'd rather store it in our refrigerator.

I understand both sides of the discussion here but we are importing blood now because of our dwindling donor pool and for us, every unit counts. I think the bottom line is the blood should be transfused within 4 hours of the issue time. The recipient should be fully prepared prior to the blood being picked up. Pre-meds, baseline vitals, consent signed .... all should be completed. The delay of transfusion for whatever reason should be very rare, if it happens too often then an investigation should be done.