ADDENDA June 10, 2003

8. A colleague in Alaska suggests that those who store blood in OR refrigerators may want to review JCAHO's Sentinel Event Alert #10 entitled 'Blood Transfusion Errors: Preventing Future Occurrences' (August, 1999). One of the root causes identified for twelve cases related to transfusion error, resulting in ten fatalities, was "equipment-related factors such as blood for multiple operating room patients being stored together in the same refrigerator."

ADDENDA June 11, 2003

9. Several colleagues have inquired about specifics regarding the portable blood storage refrigerators mentioned by one or more blood bankers responding to the discussion about storing blood in refrigerators outside the blood bank. One colleague has responded saying that they are using a Jewett model CT1-1B-03 compact Blood Bank Refrigerator purchased from the local Jewett supplier, Norwest Medical Associates, Inc. The refrigerator must include casters and the correct temperature monitoring units.

(Editor's query: If there are other devices or vendors providing such devices, colleagues are encouraged to share that information.)

ADDENDA Apr 8, 2005

10. A transfusion medicine physician in Oregon is intrigued by a new generation of blood storage refrigerators that use computerized controls to manage remote dispensing of blood products and which could potentially function like a "blood vending machine". He wonders if a properly controlled "blood vending machine" might address many of the concerns that surround the uncontrolled use of OR blood refrigerators. The inquiring Oregonian wonders if any colleagues have acquired experience with a "blood vending machine" type of device, and if so what has that experience been?

ADDENDA Apr 11, 2005

11. A colleague in Bethesda, Maryland has provided a picture and specifications (PDF file) for a 'blood vending machine' like that mentioned by the transfusion medicine physician from Oregon in posting #10.

ADDENDA May 24, 2005

12. The blood bank manager at a hospital in Oxford, United Kingdom reports that her institution recently implemented a blood storage refrigerator system (by Olympus) that uses computerized controls to manage remote dispensing of blood products, and that they are using this system for release of blood for patients in the Operating Rooms and Recovery Rooms. They have been using the refrigerator system routinely for several months and staff acceptance of the system has been excellent. The system tells the user which blood units to select, checks that the user has selected the correct one, and prints out a 'compatibility' label for the blood bag and confirms the correct label is attached to the correct blood bag. It then updates the lab computer system with the allocated blood unit and patient information. She reports that the system has proven safe, and that her hospital plans to soon take delivery of an enhanced blood refrigerator for so that the system will only release the exact blood units required. The refrigerator pictured (see attached) operates in the following fashion; if a patient is group A Rh positive, only a group A positive drawer of the refrigerator will open. If there is crossmatched blood available, only the drawer containing the crossmatched unit will open.

ADDENDA Aug. 19, 2005

13. A colleague in the heartland of America reports that her hospital uses a blood transport carrier (by American Thermal Wizards-Red Shield Carriers) designed to "hold" blood at acceptable temperatures for up to 24 hours, and which employs an on-board digital validator recording temperatures to document each minute of use. In her facility they use this device to hold 1-4 units of red cells (or a two unit model which is good for pediatric settings and helicopter runs). Upon return of the transport carrier from the OR to the blood bank, a graph can be generated that displays time vs temperature. They can place QA comments directly on the graph, if necessary, for compliance support.

ADDENDA Aug. 25, 2005

14. A colleague at one of the hospitals in a network of approximately 190 hospitals and 91 outpatient surgery centers in the United States, England and Switzerland reports that her facility used to have a blood storage refrigerator in their operating room. However, in June of 2004 they switched from using a blood storage refrigerator in the OR to using validated insulated cardboard boxes that were issued by the blood bank for storage of blood in the OR suite for a particular patient. They place a datalogger with a thermistor on the units of blood, which allows for recording the temperature of the blood, even if it is taken out of the box. She has graciously offered to discuss their system with any colleagues who wish to contact her directly via email at Maria.Amador@hcahealthcare.com.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator