Embracing technology? Using change management strategies to improve the use of continuous lateral rotation therapy.

The purpose of this quality improvement initiative was to improve the utilization of continuous lateral rotation therapy (CLRT) in a nine-bed community hospital ICU within the context of a nurse-driven protocol. Nursing focus groups, analyzed using a strength, weakness, opportunity, threat (SWOT) approach, resulted in the implementation of four interventions over seven weeks. Change management strategies guided all aspects of the project. Results showed a modest increase in the utilization of CLRT. This initiative demonstrates that change management strategies may assist with the incorporation of technology into nursing practice by increasing empowerment and creating an attachment to and responsibility for outcomes.

Prediction of red cell and blood volumes distribution by various nomograms: do current nomograms overestimate?

BACKGROUND: Currently used formulas for estimation of a person's red cell volume (RCV) by weight and height are decades old and were based on the use of 51Cr isotopes and on a sample population, which may not be reflective of today's population. In this study, the accuracy and precision of the use of 99mTc RCV measurements in volunteers more typical of today's population were evaluated. STUDY DESIGN AND METHODS: The subjects were volunteers who met the requirements for a standard blood donation. RESULTS: The mean +/- standard deviation (SD) 99mTc RCV for 127 males (mean weight, 83.2 kg; height, 180 cm) was 2062 +/- 339 mL, and for 101 females (mean weight, 69.5 kg; height, 166 cm) it was 1320 +/- 201 mL. These results were highly correlated with RCV results with the standard extrapolation 51Cr method with stored red blood cells (RBCs) and highly consistent (within +/-10%) by repeated measurements with the same 22 donors over a 3.5-year period. The RCV results correlated with estimates from the current formulas, but were on average 11 to 14 percent lower. CONCLUSION: The studies demonstrated that 99mTc is a reproducible and precise method for determination of a person's RCV and that current formulas may significantly overestimate the RCV of today's population. This is likely the result of a shift in population characteristics over the past four decades as reflected by an increased mean body mass index (from 25 to 28 kg/m2), which has not resulted in a proportionally increased RCV.

Reevaluation of the resting time period when preparing whole blood-derived platelet concentrates with the platelet-rich plasma method.

BACKGROUND: The resting of platelet (PLT) pellets during the preparation of whole blood-derived PLT concentrates (PCs) is considered an essential step. A reevaluation of the rest period was conducted because preparation and storage conditions have been modified during the past 20 years. STUDY DESIGN AND METHODS: A two-site in vitro study (Study 1) was conducted with rest times of 0 to 5 minutes, 1 hour, and 4 hours (n = 31-33 per rest period). Leukoreduced PCs were stored for 5 days. A second study (Study 2) measuring in vivo viability was conducted at a third site (14 paired studies). PCs were prepared from 2 units of whole blood on the same day to simultaneously compare viability following storage and radioisotopic labeling. RESULTS: In Study 1, comparable in vitro parameters and swirling were observed with the three rest periods. The mean (+/-1 SD) values after storage for the extent of shape change and hypotonic stress parameters were 0 to 5 minutes, 16.7 +/- 7.2 and 66.0 +/- 15.7%; 1 hour, 19.1 +/- 6.9 and 69.3 +/- 17.9%; and 4 hours, 17.6 +/- 5.5 and 64.1 +/- 11.3%. In Study 2, the in vivo recovery was 49.9 +/- 15.3 and 50.9 +/- 20.2% with 0- to 5-minute and 1-hour rest periods, respectively. The corresponding survival time was 111.2 +/- 50.7 and 114.9 +/- 43.8 hours. CONCLUSION: These studies indicate comparable in vitro and in vivo viability properties with 0- to 5-minute and 1-hour rest periods and at 4 hours (in vitro only).

Autologous transfusion recovery of WBC-reduced high-concentration platelet concentrates.

BACKGROUND: This study evaluates the recovery and survival of high-concentration platelets (HCPs) compared to standard apheresis platelets (APCs) in a double-label autologous human system. METHODS: Nine HCP units paired with APC units were stored, labeled with either 51Cr and 111In, and returned, and recovery and survival were determined. Standard in vitro platelet biochemical and functional parameters were monitored over the storage period and evaluated in a secondary analysis. RESULTS: Three each HCP units containing more than 2.2 x 10(11), 1.5 x 10(11) to 2.1 x 10(11), and 0.8 x 10(11) to 1.1 x 10(11) platelets in 59.4 +/- 2.5 mL were stored for 1, 2, or 5 days, respectively, and simultaneously with matched APC units (3.8 x 10(11) platelets, 282 mL). Recoveries were 72.3 +/- 8.6, 60.8 +/- 14.6, and 52.5 +/- 6.7 percent for HCPs, respectively; and 59.4 +/- 6.4 percent for APCs (p=0.37). HCP survivals were 202.0 +/- 14.9, 204.9 +/- 10.2, and 162.6 +/- 17.0 hours; APC survivals were 155.4 +/- 20.3 hours (p=0.001). Secondary analysis with P-selectin added as a predictor in the model resulted in significant difference in recoveries for Day 1 HCPs versus Day 5 APCs (p=0.024) with no difference shown for HCPs on Days 2 or 5 versus APCs. No significant difference was found in survival (p=0.16). CONCLUSION: HCPs may be stored 24 hours for high yield, 48 hours for intermediate yield, and up to 5 days for yields less than 1.6 x 10(11) platelets per bag with equivalent to superior recovery and survival of platelets in the autologous transfusion model compared to APCs.

Seven-day storage of single-donor platelets: recovery and survival in an autologous transfusion study.

BACKGROUND: Bacterial screening may effectively reduce the morbidity and mortality risk associated with extended storage of platelets. Platelet viability then becomes the primary determinant of acceptable storage time. This study evaluates the effectiveness of platelets stored in plasma for 7 days. STUDY DESIGN AND METHODS: WBC-reduced, single-donor platelets (n = 24) were collected and stored by standard methods at two sites. Standard in vitro platelet biochemical and functional parameters were monitored over the storage period. On Days 5 and 7 of storage, platelets were alternately labeled with 51Cr and (111)In and returned to the subject, and recovery and survival were determined. RESULTS: Component pH(22 degrees C) was maintained in the range 6.2 to 7.61 through 7 days and did not detrimentally affect either in vitro or in vivo outcomes. In vitro platelet characteristics were adequately maintained over 7 days. Day 5 platelets had better recovery (63.0 +/- 4.36 vs. 53.9 +/- 4.36%, p < 0.0001) and survival (161 +/- 8.1 vs. 133 +/- 8.1 hr, p = 0.006) than Day 7 platelets adjusting for radioisotope, center, and donor effects. CONCLUSION: Although declines in recovery and survival were noted, these are less than used previously to gain licensure of 7-day storage and are unlikely to be clinically significant. Extension of storage to 7 days could be implemented with bacterial screening methods to select out contaminated components without a significant effect on the platelet efficacy compared to 5-day components.

Extended storage of AS-1 and AS-3 leukoreduced red blood cells for 15 days after deglycerolization and resuspension in AS-3 using an automated closed system.

BACKGROUND: The utilization of cryopreserved red blood cell (RBC) units had been limited by a maximum postdeglycerolization storage of 24 hours at 1 to 6 degrees C until the recent development of a closed system for the glycerolization and deglycerolization process. STUDY DESIGN AND METHODS: Sixty leukoreduced additive solution (AS), AS-1 (n = 30) and AS-3 (n = 30) RBC units from 500-mL whole blood (WB) collections were stored for 6 days, glycerolized, frozen at -70 +/- 5 degrees C for at least 14 days, thawed, deglycerolized, and stored for 15 days at 1 to 6 degrees C. Glycerolization and deglycerolization were performed with the ACP 215. In-vitro variables were tested before glycerolization, on Day 0, and Day 15 after deglycerolization storage. Forty donors were assessed for double-label 24-hour percent recovery, and T1/2 survival time was measured for 20 donors. RESULTS: Postdeglycerolization mean +/- standard deviation in-vitro RBC mass recoveries were 93 +/- 5 percent for AS-1 and 95 +/- 4 percent for AS-3. Mean hemoglobin +/- standard deviation after deglycerolization was 50.5 +/- 5.5g for AS-1 and 50.1 +/- 3.5g for AS-3. Mean hemolysis (Day 15) was 0.36 +/- 0.11 percent for AS-1 and 0.38 +/- 0.13 percent for AS-3. Double-label 24-hour in-vivo recoveries were 82.5 +/- 7.8 percent for AS-1 and 81.4 +/- 7.1 percent for AS-3. The 51Cr T1/2 value was 41.8 +/- 3.97 for AS-1 and 40.6 +/- 7.11 for AS-3. Other in-vitro variables were as expected. CONCLUSION: Leukoreduced AS-1 and AS-3 RBCs after frozen storage at -70 +/- 5 degrees C can be stored for up to 14 days when processing is performed with the ACP 215 system with resuspension of deglycerolized RBCs in AS-3.