The laboratory director of a hospital in the Midwest wonders how others assure that a blood product dispensed via a pneumatic tube system is administered to the correct recipient? He asks if those using pneumatic tube systems would share their respective procedures.

As background to this question he provides the following informtion. Their hospital opened a new OR and ICU area and installed a pneumatic tube system between the OR areas (2 floors), ICU and the blood bank. The original plan was to use the pneumatic tube to transport STATs (1 or 2 units). Planned blood product needs were supposed to be transported in coolers by OR personnel just before the start of a scheduled surgery. It did not take too long for the OR and ICU to insist that all products should be transported via tube, due to staffing shortages.

The blood use volume at the hospital is 100-150 RBCs transfused per day, with more than half of the units going to the OR and ICUs. Since there is only one tube station and each pneumatic tube carrier holds only 2 RBC units, it is a time-consuming process to issue the number of units required, and even more challenging in a multi-unit emergency situation. The demand to use the tube system for routine transport has put a significant strain on blood bank human resources, especially on night and evening shifts. The lab director reports that it is not unusual for there to be 2 or 3 significant bleeding cases going on simultaneously in the OR, Emergency Department and ICU.

He realizes that hospitals using pneumatic tubes have proclaimed their success, but he cannot find any information on their processes for releasing products.

He asks the following questions of personnel at these hospitals:

• did the conversion to pneumatic tube transport require more personnel?
• do they use two blood bank individuals to verify the identification of the blood unit before sending it?
• what process takes place at the receiving end to verify the identity between patient and unit?

The Editor believes that the following earlier discussions on this forum should provide some background information:

• 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?
• What guidelines do hospital Transfusion Services use to validate blood products transported in a Pneumatic Tube System?
• Practical concerns regarding the location of a hospital blood bank away from the operating rooms

ADDENDA Sept. 12, 2006

1. A physician in Ohio reports that her current institution is building a new 'heart center' that will house all cardiac patients, cardiac ICUs and the ORs for cardiac surgery. There are no plans to place a blood bank in that new hospital, instead the blood bank will be expected to provide blood to the ORs by using a high efficiency pneumatic tube system. Routine pre-op RBC requests are carted to OR refrigerators in the early morning hours, the tube system would be used for all unanticipated blood needs and for components. With their volume, that would correspond to tubing approximately 60 to 100 products to the cardiac ORs during day shift hours, each in its own carrier. The tube system vendor promises a delivery time of 1.5 to 2 minutes on a dedicated point-to-point line that will pause returning canisters mid-flight to allow delivery canisters to have priority. The distance that the canisters will travel is about six city blocks. Although the canister travel times are quick, the inquiring physician is concerned that delivery of blood will be delayed because only one product may be delivered at a time. Other concerns include anticipated problems with documenting when and by whom the products were received, and the potential for identification errors resulting from having products for multiple patients dropping into the same tube station over a short interval of time. Her question for the e-Network Forum is whether any similarly busy institutions are using a high speed tube system as their primary means of delivering blood to the ORs; and if yes, have they found this an efficient and safe system for meeting urgent high volume surgical blood needs.

ADDENDA Sept. 18, 2006

2. A blood banker at a university medical center in the central USA reports that her hospital uses a pneumatic tube system to deliver most of the blood products that they dispense, including the blood that is used to by their trauma center and by their bone marrow transplant center. Their system allows them to send up to 4 RBC units in one carrier, via a 6 inch diameter tube. She reports that they have had very few problems and that their efficiency has improved. She reports that it takes 2-3 minutes for a blood product to reach "outlying areas", but this is still faster than anyone can walk the distance. Proper training of staff on both ends of the tube system is a key priority. Proper identification of patient at the bedside is one of the most important points to stress in training. She points out that their staff are told that when they go to fetch a blood product from the tube that "Just because a blood product drops from the tube, it does not automatically mean that the blood product is for your patient!" Care must be exercised to link each blood product to the proper recipient.

The patient care floors and the OR/ER staff seem very happy about the service provided by the blood bank when using the tube system. When a patient care area is ready to transfuse a patient, a 'slip' is sent with the patient ID, the product requested, and the tube station to which to send the blood. Two blood bank staff members double check that the correct product is sent via the tube for the intended patient at the appropriate location, per the information provided on the slip.

Audits are performed periodically to check tube transit times and to see what happens after a blood product drops from the tube at a receiving station. The nurses are trained to start the transfusion within 15 minutes of receiving the blood via the tube.

She cautions that it is very important to assure that a backup plan is in place, in the event there is a spill or the tube goes down. She acknowledges "You will be surprised at how slow things move without it."

ADDENDA Feb. 26, 2007

3. 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.

Please submit comments to the e-Network Forum.

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

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