Bassett Medical Center Transfusion Services

Bassett Medical Center Transfusion Services SIGNING OUT (ISSUE) and STORAGE OF RED CELL Products in the OR Signing out/issuing of red cell products for patient s in the Operating Room (OR) is performed by the Blood Bank (BB) Technologist at the time of surgery. It will be the responsibility of the OR Circulating RN to notify the Blood Bank by phone at least 15 minutes prior to the scheduled case using first and last name and MRN. This will allow time for packing, issuing and transport of red cell products to the OR by a validated OR assistant (ORA) or if staffing does not permit, the Blood Bank Technologist. It will be standard practice, unless OR staffing does not permit, for the ORA to be dispatched to the Blood Bank for up to four (4) units of crossmatch compatible red cell products, in the temperature regulated Hemo-Cool, Jr. II following the procedure below. All units stored in the Hemo-Cool, Jr. II will have a Hemo Temp II Indicator on the back of the blood bag to ensure that unit storage has been maintained at a temperature of 1 o C-6 o C upon return to the Blood Bank. For all procedures: Coolers will be issued to the OR for a maximum of 3 hours at which time the cooler must be returned to the Blood Bank to determine temperature of the cooler and the blood bag(s) inside. A Delivery Request Form must accompany the cooler if the cooler is to be reissued to the OR.. Blood Bank Technologist will be responsible for: 1. The HemoCool, Jr.ll coolers are routinely kept in a ready to use status in the Blood Bank. However, if not already plugged in, at least one hour prior to the scheduled surgery, the Hemo-Cool, Jr. II must be plugged in making certain the power adapter (black box) is placed into the metal vented protection bracket on the end of the cooler. If the thermal plate is not already inside the Hemo-Cool Jr., it can be found stored in the Helmer #5 refrigerator, on the bottom shelf. Remove the plate from the refrigerator and place in the Hemo- Cool Jr. with the vertical portion against the cold sink in the cooler. Note: The temperature switch must be in the low position to achieve a fast cool down rate. 2. Place the number of HemoTemp II Indicators, flower side down, that are needed into the HemoTemp Activator for a minimum of one minute up to a maximum of three days, being sure to include one indicator for each unit being stored and one for a mock product. Note: Prior to placing indicators in the heat block activator, place the current date on the back of the indicator. 3. After incubation, remove the indicators from the Activator. The irreversible flower will be a black color. Once the flower on the indicator turns a blue color (30-45 seconds), remove the back of the indicator strip. 4. Remove the units that are to be issued from Helmer #4 as well as the mock product from Helmer #2. Immediately press the indicator strip onto the bottom back of the red cell product and mock product. Note: The indicator strip must be directly on the product bag and not on the unit number stickers found on the back or on the front label of the unit bag. 5. To insure proper adhesion of the indicator strip once it has been applied, place the blood bag with the face of the strip down on a flat surface and rotate the bag. For proper activation and usage: Indicator must be heated and placed on the designated product that is at a temperature of 1 o C -4 o C. If the color is green or tan, the indicator has not been properly activated. This could be a result of the blood being warmer than 4 o C when the strip was applied. Remove the indicator and repeat steps 3-5. 6. Place red cell products and mock product back into Helmer #4. 1

7. Secure the Traceable Alarm Thermometer probe (bottle) in its designated location (on the bottom of the cooler). Note: The bottled glycol solution containing the green temperature-buffered sensor must be touching the bottom of the thermolyser plate inside the cooler. The display portion of the Traceable Alarm Thermometer is placed outside of the cooler) 8. A Patient Identification Card must be properly filled out indicating the patient s first and last name, MRN and unit numbers in the bottom section of the Patient Identification Card. Green card cardiac cases Orange card non-cardiac cases 9. Refer to the procedure on Signing out of Blood and Blood Components, Volume III being sure to include the patient identification card when checking patient information in the Laboratory Information System. 10. Transfusion slips are preprinted with a box containing information for recording HemoTemp ll information. Note: During Downtime procedures, transfusion slips are available above the sign-out station for manual entry of patient and unit information. Each slip used during downtime has a label attached to each ply containing the Hemotemp II information for documentation of temperature and blue flower being present at the time of transfusion. On the back side of this slip is information in the event of a transfusion reaction. 11. At the time of issue, for the mock product and each unit, document the temperature range color of the flower, and cooler identification (C, D, E, Y, or Z) on the Patient Identification Card (see example below). Indicate the color of the flower with the first letter of the color. For example, B for blue. Note: For product to be acceptable for issue, the HemoTemp Indicator should read 1 o C -3 o C or 4 o C -6 o C and the flower should be blue B. 12. Record the temperature of the cooler s digital display, the minimum temperature and the maximum temperature on the Patient Identification Card along with the date, time and initials of the technologist packing the cooler (Temp Upon Issue). Note: Temperature of the cooler must be in the range of 1 o C-6 o C on the digital, minimum and maximum temperature readings in order to use for storage. The acceptability of the blood product to issue is based upon the following criteria: Reversible Numbers Temperature Range Irreversible Flower Acceptability Visible 1 o -3 o C or 4 o -6 o C Blue OK Visible 7 o C-9 o C Blue Not OK Visible 1 o -3 o C or 4 o -6 o C or 7 o -9 o C Green or Tan Not OK Invisible No visible range Green or Tan Not OK Invisible No visible range Blue Not OK 13. Immediately place the blood bags inside the cooler chamber in a vertical position, facing toward the front of the cooler. Unit bags must be sitting on the cold plate in an upright position to maintain appropriate storage temperature. The maximum number of units to be transported/stored in the cooler is four (4) units. 14. The mock product is then placed vertically against the cold sink, perpendicular to the units. The mock product serves to moderate the unit temperature in the cooler. 15. Secure the cooler cover. 16. For all cases using the orange and green Patient Identification Card, note the time the cooler must be returned in the appropriate location on the card. Secure the card to the cooler. Note: Time of return is determined by adding three hours to the time of issue. 17. For cardiac case (green card) coolers only, the Time Tracker must be started and sent with the cooler. Quick Start of Time Tracker: Press the MENU key. Use the arrow keys to select AUTO. Press the ENTER key to select. Press START 2

Operating Room Circulating RN will be responsible for: 1. The circulating RN will phone the Blood Bank to indicate the OR is ready to receive the HemoCool Jr.. The RN will dispatch the validated ORA to the Blood Bank to pick up the cooler by signing a Delivery Request Form indicating the cooler is needed NOW. Note: If staffing does not permit an ORA to obtain the cooler, a Blood Bank tech will transport the HemoCool Jr. to the OR suite where it will be received by designated OR personnel at the entrance of the OR suite. 2. The ORA will be responsible for immediately returning to the designated OR room with the cooler and plugging the cooler into a designated wall outlet. Note: If the cooler is left unplugged or the cover is not securely fashioned, the HemoCool Jr. will maintain a digital temperature display of 1 o C -6 o C for a maximum of 30 minutes. 3. The circulating RN will sign the Blood Product Delivery Request form as the receiving RN and document time received. 4. On the line: Received in OR: Record the following: a. Temperature on the digital display of the thermometer as well as the minimum temperature and maximum temperature. Note: If the temperature of the digital display is greater than 6 o C or less than 1 o C, the Alarm Thermometer will alert the OR personnel with a visual and audible signal even if the temperature returns to a non-alarmable range (1 o C 6 o C). The circulating RN will notify the Blood Bank by phone and the ORA will be responsible for returning the cooler with the blood products back to the Blood Bank immediately. Additional product will be issued and transported to the OR by an ORA or Blood Bank tech following the above procedure. It will be the responsibility of the Blood Bank Technologist to determine acceptability of the red cell products returned. b. Date and time. c. The RN will compare the name and MRN on the Patient s Identification Card with the patient s wristband. The RN will initial and indicate by circling under the Comment section: Ok if Patient Identification Card matches the patient s wristband. Not Ok if Patient Identification Card does not match the patient s wristband. Notify the Blood Bank and return products immediately. The Patient Identification Card must remain with the cooler at all times to ensure proper identification of the cooler and content of red cell products inside. Anesthesia(CRNA or anesthesiologist/perfusion (perfusionist) is responsible for: 1. At the time of transfusion, the unit will be removed from the properly identified storage cooler. 2. If it has been determined that the product will not be transfused, the red cell product must be immediately returned to the cooler. 3. Refer to the Blood Administration policy for additional information in transfusing blood products. At the end of a case or at three hours from time of issue, the Circulating RN will be responsible for: 1. Coordinating and ensuring the Hemo Cool Jr storage container is returned to the Blood Bank. 2. If the cooler is still needed in the room after three hours, the circulating RN will sign the Blood Product Delivery Request form requesting another cooler with designated number of units up to four. Note: The Time Tracker sent with a cardiac cooler only, is set to alarm prior to the three hour time limit. This will alarm and stay lit at the following intervals: Green section - 2 hrs and 24 minutes Yellow section - 2 hrs and 33 minutes Red section 2 hrs 51 minutes at which time the alarm will say Time s Up 3

If it has been deemed necessary to have the cooler containing red cell products follow the patient to the ICU, the anesthesiologist/surgeon or designee will: 1. Contact the Blood Bank at 3720 to inform the Blood Bank. The Circulating RN will be responsible for: 1. Coordinating and ensuring the Hemo Cool Jr storage container is returned to the Blood Bank as well as the Time Tracker for the Cardiac Cases. 2. The Blood Product Delivery Request form is completed requesting a cooler with designated number of units up to four to be sent to ICU. The Blood Bank Technologist will be responsible for: 1. Determining product acceptability based on the criteria noted below. 2. For all cases, note the time of 0630 AM on the following day in the appropriate location on the card. Secure the card to the cooler. 3. Issue products. 4. Arrange to transport the cooler to the ICU, plugging the cooler into a designated wall outlet and communicating with the ICU RN that the cooler is in the room and needed for the patient 5. Documenting on the Patient Identification Card- on the line: Received in ICU: a. Temperature on the digital display of the thermometer as well as the minimum temperature and maximum temperature. Note: If the temperature of the digital display is greater than 6 o C or less than 1 o C, the Alarm Thermometer will alert the technologist. The tech ICU personnel with a visual and audible signal even if the temperature returns to a nonalarmable range (1 o C 6 o C). The ICU RN will notify the Blood Bank by phone and the Blood Bank will be responsible for removing the alarming cooler with a replacement cooler. b. Date and time. c. The technologist will compare the name and MRN on the card with the patient s wristband. The technologist will initial and indicate by circling under the Comment section: Ok if Patient Identification Card matches the patient s wristband. Not Ok if Patient Identification Card does not match the patient s wristband. Notify the Blood Bank and return products immediately. The Patient Identification Card must remain with the cooler at all times to ensure proper identification of the cooler and content of red cell products inside. ICU RN is responsible for: 1. At the time of transfusion, the unit will be removed from the properly identified storage cooler by the patient s RN. 2. The following information is immediately recorded on the attached transfusion slip. Temperature range of the HemoTemp Indicator strip. Blue color is noted on the transfusion slip as Yes or No. The acceptability of the blood product for transfusion is based upon the following criteria: Reversible Numbers Temperature Range Irreversible Flower Acceptability Visible 1 o -3 o C or 4 o -6 o C Blue (Yes) OK Visible 7 o C-9 o C Blue (Yes) Not OK Visible 1 o -3 o C or 4 o -6 o C or 7 o -9 o C Green or Tan (No) Not OK Invisible No visible range Green or Tan (No) Not OK Invisible No visible range Blue (Yes) Not OK Refer to the Blood Administration policy for additional information in transfusing blood products. 3. If the products are used, the Blood Bank can be notified by the ICU nurse and the HemoCool Jr will be returned to the Blood Bank to ensure the continued availability of products. 4. If the temperature of the digital display is greater than 6 o C or less than 1 o C, the Alarm Thermometer will alert the ICU nurse with a visual and audible signal even if the temperature returns to a non-alarm able range of (1 o C 6 o C). 4

The ICU nurse will notify the Blood Bank and the ICU PCA or Blood Bank Technologist will be responsible for returning the blood products to the Blood Bank immediately. Two (2)-four (4) additional units will be made available for the patient and transported to the ICU by the Blood Bank Technologist following the above procedure. Note: It will be the responsibility of the Blood Bank Technologist to determine acceptability of red cell products if the Alarm Thermometer alerts the ICU nurse of the HemoCool storage unit reaching an alarmable range of less than 1 0 C and greater than 6 0 C. 5. The HemoCool Jr. can remain in the patient s room until 0630 on the next day. Blood Bank Technologist: 1. If the cooler has followed the patient to the ICU, it will be the responsibility of the Blood Bank Technologist to pick up the cooler in the ICU at 06:30 AM unless other arrangements for pickup have been made. 2. At the time of pickup, the Blood Bank Technologist will record the temperature of the digital display, the minimum temperature and the maximum temperature, date, time and initials on the Patient Identification Card (Pickup in ICU). 3. Upon receipt in the Blood Bank, the temperature of the current digital display, the minimum temperature and the maximum temperature, date, time and initials upon receipt into the Blood Bank (Received in BB) will be recorded. 4. Visual inspection of the units will be performed. (Refer to the procedure Returning Components to the Blood Bank (Volume III Components) References: Acceptability of the red cells for reissue is based upon the maintained temperature of the cooler over 24 hours, the HemoTemp Indicator strip, and visual inspection criteria. Acceptability of Red Cells for Reissue (Note: Contingent on acceptable visual inspection of unit) Indicator Reading Digital, Minimum and Maximum Temperature Temp Flower <1 o C 1 o C - 6 o C >6 o C 1 o C - 3 o C (or) 4 o C - 6 o C Blue OK for Reissue OK for Reissue OK for Reissue 1 o C - 3 o C (or) 4 o C - 6 o C Green or Tan 7 o C - 9 o C Blue Green or Tan Not OK for Reissue Not OK for Reissue Not OK for Reissue No Visible Range Blue Record Yes or No in the Okay to Reissue? Section of the Patient Identification Card if the Alarm Thermometer is acceptable and the HemoTemp Indicator Strip is acceptable. 5. Follow-up, utilizing the RL6 Electronic Incident reporting, will occur if the cooler is returned after 30 minutes from the designated time noted on the cooler card. Technical Manual, American Association of Blood Banks, 17 th edition, 2011, 273-274.575, 948. 5