Transport Of Blood Products Research Articles

Knowledge, attitude and practice survey of bacterial contamination of blood for transfusion in the Democratic Republic of the Congo.

We assessed healthcare worker's knowledge-attitude-practice regarding bacterial contamination of blood products in the Democratic Republic of the Congo. In three hospitals and the National Blood Transfusion Center (NBTC), two multiple-choice surveys were completed on a tablet computer: one each, for blood bank (31 questions) and for clinical ward staff (20 questions). A score was calculated for 11 overlapping knowledge questions. Among 247 participants (blood bank No.=62, ward No.=185), median (range) knowledge score was 10 (2-19) on a maximum of 20, with blood bank staff (12/20) scoring higher than clinical ward staff (9/20) (p<0.0001). Half (50.2%) of 247 participants recalled previous training in transfusion medicine. Participants had limited understanding of and compliance with NBTC-recommended preventive measures: incorrect assumption that wearing gloves prevents bacterial contamination (83.8%) and that blood banks test donor blood for bacteria (59.9%). Half (50.0%) of blood bank staff did not acknowledge the NBTC-recommended antisepsis procedure, 62.1% did not apply the appropriate number of antisepsis steps, and 32.3% saw no harm in touching the venipuncture site after antisepsis. Presence of bacteria on healthy skin (62.3%) and blood bank fomites (examination gloves: 30.8%, soap: 62.8%) was underestimated. Although 92.4% of clinical ward staff said to easily recognize transfusion reactions, only 15.7% recognized septic reactions and post-transfusion antibiotic treatment practices were not consistent. Challenges reported by blood bank staff and particular for low-resource settings were: frequent power cuts (98.4%), transport of blood products by patient attendants (41.1%), without cooling elements (64.4%), and reuse of finished antiseptic/disinfectant containers (75.4%). The present study points to gaps in knowledge, attitudes, practices along sampling, cold chain and transfusion which can feed customized training and monitoring.

Stunned Myocardium as a Sequela of Acute Severe Anemia: An Adult Simulation Case for Anesthesiology Residents.

Anesthesiologists develop anesthetic plans according to the surgical procedure, patient's medical history, and physical exams. Patients with ischemic heart disease are predisposed to intraoperative cardiac complications from surgical blood loss. Unanticipated events can lead to intraoperative complications despite careful anesthesia planning. This anesthetic management simulation was developed for the anesthesiology residency curriculum during the first clinical anesthesia year (CA 1/PGY 2 residents). A total of 23 CA 1 residents participated. A 50-minute encounter focused on a 73-year-old male who presents for an elective total hip replacement and develops acute myocardial stunning in the setting of critical acute blood loss and a delay in the transportation of blood products. One hundred percent of the residents felt the simulation was educationally valuable in the immediate postsimulation survey (Kirkpatrick level 1). The follow-up survey showed that 100% of residents felt the simulation increased their knowledge of managing acute cardiac ischemia (Kirkpatrick level 2), and 93% felt it increased awareness and confidence in similar real-life situations that positively affected patient outcomes (Kirkpatrick level 3). Our simulation provides a psychologically safe environment for anesthesiology residents to develop management skills for acute critical anemia and cardiogenic shock and foster communication skills with a surgery team.

Airborne! UAV delivery of blood products and medical logistics for combat zones.

Innovative solutions to resupply critical medical logistics and blood products may be required in future near-peer conflicts. Unmanned aerial vehicles (UAVs) are increasingly being used in austere environments and may be a viable platform for medical resupply and the transport of blood products. A literature review on PubMed and Google Scholar up to March of 2022 yielded a total of 27 articles that were included in this narrative review. The objectives of this article are to discuss the current limitations of prehospital blood transfusion in military settings, discuss the current uses of UAVs for medical logistics, and highlight the ongoing research surrounding UAVs for blood product delivery. UAVs allow for the timely delivery of medical supplies in numerous settings and have been utilized for both military and civilian purposes. Investigations into the effects of aeromedical transportation on blood products have found minimal blood product degradation when appropriately thermoregulated and delivered in a manner that minimizes trauma. UAV delivery of blood products is now actively being explored by numerous entities around the globe. Current limitations surrounding the lack of high-quality safety data, engineering constraints over carrying capacity, storage capability, and distance traveled, as well as air space regulations persist. UAVs may offer a novel solution for the transport of medical supplies and blood products in a safe and timely manner for the forward-deployed setting. Further research on optimal UAV design, optimal delivery techniques, and blood product safety following transport should be explored prior to implementation.

A bi-objective integrated mathematical model for blood supply chain: Case of Turkish red crescent

&lt;p style='text-indent:20px;'&gt;Various criteria feature in blood supply chain (BSC) designs, where cost-based and time-based are the most commonly found in the literature. In the current study, total annual cost is used together with a new time-based objective. The total time spent in the transportation of blood products is considered as time lost, and weight is given to that time according to the product amount and then normalized with respect to shelf life. In using cost and time objectives, we developed a bi-objective mixed-integer mathematical programming model for the BSC of Turkish Red Crescent (TRC, the singular authority controlling BSC throughout Turkey), including collection, production, and distribution echelons, and also considering bag-type decisions for whole-blood collection. The objective of the study was to propose a BSC design model and solution approach. With all real-life TRC instances resolved optimally, a linear programming relaxation-based heuristic was developed for large-scale problem sizes. Real-life data were obtained from the TRC and the remainder from open-to-public sources. The study's main finding is that cost and time objectives alone produce significantly different designs, whilst using them together to form efficient-frontier solutions for decision-makers adds practical value.&lt;/p&gt;

Meeting demand-Obstetric hemorrhage and blood availability in Malawi, a qualitative study.

Postpartum haemorrhage (PPH) is the leading cause of maternal mortality in Malawi. Despite the presence of a centralized institution supplying blood and blood products for hospitals across the country, a lack of timely blood transfusion has been identified as a critical barrier to successful PPH management. This study aims to understand the factors that affect the blood delivery pipeline and adequate access to blood products for postpartum haemorrhage patients. Qualitative data were collected through in-depth interviews with key stakeholders across the blood delivery pipeline. Interviews were conducted from July 2020 to January 2021 at Queen Elizabeth Central Hospital and Mulanje District Hospital, a referral and district hospital respectively, as well as the Malawi Blood Transfusion Service. Line by line, open coding was used to perform a thematic analysis of the data using Nvivo and Atlas.ti software. Five key themes were identified: 1) Lack of blood availability due to an inadequate donor pool, 2) Transportation of blood products and PPH patients is impeded by distance to target sites and competing interests for blood delivery vehicles, 3) The Malawi Blood Transfusion Service has difficulty meeting demand for blood products due to inadequate funding and difficulty retaining blood donors, 4) Current PPH management protocols and practices lead to delays due to inconsistent guidelines on delivery and analysis of patient samples, and 5) Communication between health cadres is inconsistent and affected by a lack of adequate resources. Barriers to timely blood transfusion for PPH patients exist across the blood delivery pipeline. While an investment of infrastructure would alleviate many obstacles, several solutions identified in this study can be implemented without additional resources, such as establishing joint department meetings to improve communication between health cadres. Ultimately, given a resource limited setting, it may be worth considering de-centralizing the blood supply.

"Initial trial on the transport of blood products using an unmanned aerial vehicle (UAV) in Japan in preparation for a disaster"

Objective: We determined to examine the effects of transport by unmanned aerial vehicle (UAV) on quality of red blood cell solution. Materials and methods: Two bags of RBC solution (RBC#1 and #2; 1 bag: 280 mL) were supplied from Japan Red Cross Society. RBC solution was separated into two bags (1 bag: 140 mL). UAV group implies the RBC solution in an ATR (FUJIFILM Toyama Chemical Co. Ltd., Tokyo) transported by UAV. Control group implies the RBC solution in another ATR, not flown. In sampling from RBC solution at day 11 (four days before transport), day 16 (day after transport), lactate dehydrogenase (LD), potassium, blood sugar, lactic acid, and pH were measured. Results:We compared the biochemistry between UAV and the control group and observed no significant differences. Although the lactate dehydrogenase (LD) level in the UAV group slightly increased, the LD level post-filtration was very similar between the UAV and control groups. Conclusion:In conclusion, we could fly and transport the ATR containing an RBC solution using a UAV, and the transport by UAV did not significantly affect the quality of the RBC solution

Physiologically-guided Balanced Resuscitation: An Evidence-based Approach for Acute Fluid Management in Paediatric Major Trauma

Trauma is a major cause of death, and haemorrhage represents an important target for improving outcomes after severe injury. Volume replacement with crystalloids in resuscitation might become harmful in large amounts because of coagulopathy. A fine balance must be achieved between haemodynamic and haemostatic resuscitation. Permissive hypotension refers to permitting some degree of hypotension in such adult patients in an attempt to attain this fine balance. For patients who require a significant volume of blood product resuscitation, the term 'massive transfusion protocol' (MTP) is used. There is very little data on transfusion protocols for paediatric trauma patients, and children respond to hypovolemic shock in a different physiological manner compared to adults. Hence, concepts such as permissive hypotension may not be appropriate when treating children involved in major trauma. We recently embarked on a plan to streamline the management of blood transfusion in massive bleeding during paediatric trauma, to reduce the logistical problems associated with the transport of blood products from the blood bank to the patient. From this, we evolved a MTP for paediatric major trauma. Nonetheless, further studies will be needed to see if there is indeed improved outcome after MTP in paediatric major trauma as current evidence is extrapolated from adult studies.

Application of quality principles in clinical transfusion laboratory practice

Quality systems and principles are essential aspects of high quality clinical transfusion laboratory practice. Many frameworks provide the structure for quality systems, some of which are specific to transfusion laboratory practices such as codes of practice and others are more general including ISO9001 and ISO15189. All these systems follow the same core principles incorporating quality assurance activities, quality control and continual quality improvement processes. The application of quality principles may be divided into five categories: processes, people, material, equipment and management. Specifically these categories must encompass laboratory procedures and analysis, storage and transportation of blood products, documentation of all results, selection, validation and maintenance of equipment used in these processes; the design and provision of a suitable working environment, appropriate storage and maintenance of laboratory and other records, internal and external audits and quality control. Personnel involved at any stage of clinical transfusion laboratory practice should be aware of the importance of quality principles, quality systems and quality management and their role. The strict adherence to well designed standard operating procedures and following definitive safety guidelines further enhances quality systems. Together, application of these principles ensures that all products, processes and facilities meet the required standards and specifications. If quality principles are not applied and errors are not addressed, then the consequences can be far reaching.

Interdisciplinary Process Improvement for Enhancing Blood Transfusion Safety

We describe a multipronged, multidisciplinary effort to improve the safety of blood transfusion in our hospital. System-wide practices related to the ordering, delivery, and transfusion of blood products were addressed including: (1) appropriate selection of patients and utilization of blood, (2) accurate blood product labeling and tracking, (3) reliable transportation of blood products between the transfusion service laboratory and the bedside, (4) electronic verification of patients and products at the point of transfusion, and (5) documentation of transfusion events in the patient's medical record. By implementing new technologies and focusing LEAN process improvement techniques on the preanalytical, analytical, and postanalytical phases of the transfusion cycle, we have been able to significantly reduce the risk of transfusion error in our patient population.

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Almonte's great train disaster: Shaping nurses' roles and the civilian use of blood transfusion.

Blood transfusion was initially a small-scale, labour-intensive therapy administered by physicians. Through the first decades of the 20th century, transfusion comprised a "last resort" measure used and tested primarily in the context of war. Media accounts of the Almonte train disaster on the night of 27 December 1942 linked survival to the newly established blood bank located 42 km east in Ottawa, Ontario. This event did not constitute a "first time" occurrence or a "great discovery" in the history of blood. But it did illustrate in a very visible and public manner that blood transfusion technology was now readily available for use in general hospitals and civilian populations. Canada had an infrastructure for the collection, processing, storage, and transportation of blood products, and for the recruitment of blood donors by the mid-1940s. As the need for blood declined toward the end of World War II, transfusion became a technology in need of application. The extension of transfusion to civilian populations, however, would require a ready source of labour-increased numbers of health care workers who were available continuously with the necessary knowledge and skills to assume the responsibility. Nurses were well situated for this technological role by a convergence of scientific, economic, labour, gender, professional, and educational influences that both facilitated and constrained blood transfusion as a nursing competency. This paper examines how the expanded use of one medical technology shaped related roles for nurses. Transfusion ultimately influenced nurses' work and the composition of the workforce as the first medical act "delegated" to nurses in Ontario (1947), setting a precedent for the delegation of further technologies over the next four decades.