A colleague in Santa Barbara reports that her laboratory is consolidating their services so that the blood bank laboratory will be moved from its current 'stand alone' location to the main lab area. This change in the blood bank's location is necessary due to staffing pressures that make it impossible to continue duplicating staff and services in multiple laboratory locations within the hospital. The Department of Surgery is not enthusiastic about the change in blood bank laboratory location, because currently the blood bank is down the hall (100 feet) from the surgical suites and the surgical personnel can pick up blood 24/7 with their available staff. Their surgical schedule includes routine scheduled cases, but add-on surgeries and trauma cases are also seen. Blood use by surgery can vary from 8-25 units of blood in a 24-hour period. With the planned move of the blood bank to the main lab, the new blood bank location will be one floor below and an additional 200 feet down the hall. The after hours (2300-0600) OR staff is called in to handle add on surgeries and trauma cases, and will not be able to come and get blood as easily as they used to, due to the greater distance between the blood bank and the operating rooms. The laboratory only has two clinical lab scientists during those hours and it is difficult for them to leave the laboratory to deliver blood, when they need to be doing testing and other activities in support of the trauma patient care. The laboratory is working with other hospital departments to set up a protocol with the night nursing supervisor and the hospital transporter to deliver blood from the blood bank to the OR. However, the surgeons and the OR staff are concerned that this will not occur fast enough for their needs. The inquiring colleague was hoping that other blood banks could share their experience and their procedures to effectively deal with this type of situation.

Editor's Note: An earlier discussion on transporting blood products to patient care areas may be found on this forum.

The following responses have been received.

1. A colleague in Arizona reports that she has worked for many years in a hospital where the operating rooms were six floors away from blood bank. According to their policy, surgery staff would come to the blood bank to obtain blood products. On the night shift, when only the emergency crew was in the OR, the 'house supervisor' would come to the blood bank to pick up blood. Since the 'house supervisor' was the person who calls in the OR crew, she/he was well aware of the situation and usually had delivered the first round of blood products to the OR well before the case began. With this system in place, they rarely had a problem getting products to the OR in a timely manner. About two years ago, the blood bank was moved to a building outside the main hospital, even further from the operating rooms. Now all products are sent to the OR via a pneumatic tube system. This system also works well. The Arizona colleague comments that it is important to make sure the pneumatic tube system is up to the job and completely validated.

2. The Editor wishes to refer forum members to earlier discussions on the use of a pneumatic tube system:

• Can Pneumatic Tube Systems in a Hospital Be Used for Transporting Blood Components?
• Use of pneumatic tube system for transporting platelet components
• Increased breakage rate of leukoreduced Red Blood Cells transported in a pneumatic tube system
• How do hospital Transfusion Services validate the integrity of blood products transported in a Pneumatic Tube System?

ADDENDA June 29, 2004

3. A colleague in Southern California reports that about 7 years ago her hospital faced basically the exact situation as that described by the inquiring colleague. Their blood bank used to be on the same floor as the OR until the blood bank was moved to 'join' the main lab a floor below. She says that there were concerns initially, but it has worked out OK. The transporters (anesthesia techs) were given access through a back stairway and there have been few complaints except that the coolers with ice are heavy when full! The responding colleague is unaware of any difference in patient outcomes due to the relocation of the blood bank.

ADDENDA July 8, 2004

4. A colleague from a teaching hospital in Northern California reports that their operating suites are located one floor below the blood bank, and that they prepare coolers for surgical patients. The coolers are validated to keep up to 10 units of red cells below 10C for 8 hours. The OR Hospital Assistant comes to the blood bank to pick up blood as needed. She reports that this system seems to be working well for them.

ADDENDA Feb. 26, 2007

5. A transfusion medicine physician at an East Coast hospital reports that they have a large number of operating rooms located in two different buildings. Their main blood bank laboratory is in the basement of a third adjoining building. Satellite blood storage refrigerators are located in each cluster of operating rooms. They have 21 satellite blood storage refrigerators. Each morning, a Blood Bank staff person delivers blood for surgery to nursing personnel in the OR responsible for each cluster of operating rooms. The nursing staff place blood for each scheduled surgery in the appropriate satellite blood storage refrigerator using the OR schedule to confirm patient identifiers and room location. When blood is needed during surgery, the circulating nurse assigned to a specific operating room takes blood from the satellite blood storage refrigerator to the appropriate OR and checks patient identifiers with the anesthesiologist prior to transfusions.

Recently, during an emergency, blood from a satellite blood storage refrigerator was infused without confirming patient identifiers with a second individual. The inquiring physician suggested that the hospital establish a satellite blood bank in the OR in lieu of satellite blood storage refrigerators. The physician suggested that having a satellite blood bank would help eliminate non-compliance with patient identification procedures in an emergency. Blood would be stored in a single area under immediate blood bank control. The circulating nurse would bring patient identifying information to the satellite blood bank where a tech would verify patient identifiers before issuing blood through the computer system. Then blood would then be taken directly to the appropriate OR where the anesthesiologist would confirm identifiers with the circulating nurse prior to transfusion. Hospital administration wants to know if there is data which supports the physician's impression that fewer errors would occur with a satellite blood bank. The inquiring physician would like to know if any colleagues have experiences or references that would help.

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

W. Tait Stevens, MD
CBBS e-Network Forum Assistant Editor & Moderator