Umbilical Cord BloodUmbilical Cord BloodCollection TrainingCollection Training

www.cordbloodbankarkansas.org

Umbilical Cord Blood CollectionUmbilical Cord Blood Collection

A special thank you from Cord Blood Bank of Arkansas!With the dedication of healthcare professionals,

many can be given another chance at life.

The Cord Blood Bank of Arkansas4301 W. Markham St., #503Little Rock, AR 72205-7199

1-855-854-2222 (CBBA)501-686-6271 (office)501-766-4611 (cell)

501-296-1127

www.cordbloodbankarkansas.org

(SM) All rights reserved. Property of CBBA. Proprietary material. Not be reproduced or redistributed in any fashion without the express written consent of CBBA.

Table of ContentsTable of Contents

I. Background of Cord Blood pg.1

II. The Process pg. 7

III. Umbilical Cord Collection pg. 17

IV. Maternal Blood Draw pg. 47

V. Packaging pg. 52

Chapter IChapter I

Background of Cord BloodBackground of Cord Blood

What is Cord Blood?What is Cord Blood?

• “Cord Blood” is the blood found in the umbilical cord and is rich in life saving stem cells.

• Historically, the umbilical cord was considered “medical waste” and was discarded after delivery.

Why is Cord Blood So Special?Why is Cord Blood So Special?• 10 years ago, the number of

known treatable diseases, using cord blood, was 4!

• Currently, Cord Blood is used to treat over 75 different Cancers and Disorders

– Including: Leukemia, Lymphoma, Metabolic/Storage Diseases, Immunodeficiencies, Genetic Disorders, Neurological Disorders….

Cord Blood TimelineCord Blood Timeline• 1988: 1st Related Cord Blood Transplant

• 1991: 1st Unrelated Cord Blood Transplant

• 1993: 1st Umbilical Cord Blood Bank

• 1995: Cryobanks International is established as a cord blood bank

• 2007: Arkansas State Legislators approved the Newborn Umbilical Cord Initiative Act #695 which established the Cord Blood Bank of Arkansas

• 2011: The Cord Blood Bank of Arkansas opens in collaboration with Lifeforce Cryobanks.

Test Your Knowledge!Test Your Knowledge!True or FalseTrue or False

1. Cord Blood is found inside the Umbilical CordTRUETRUE

2. Cord Blood is NOT currently being used to treat diseases

FALSE:FALSE: Cord Blood is used to treat over 75 diseases and Cord Blood is used to treat over 75 diseases and

disordersdisorders3. There has NOT been a successful Cord Blood

Transplant to dateFALSEFALSE

To date more than 10,000 transplants have To date more than 10,000 transplants have been performed!been performed!

Chapter II

The ProcessThe Process

The Process OverviewThe Process Overview1. Form Completion

2. Collection Kit Sent To Mother

3. Mom brings kit to the hospital when in labor

4. Cord Blood is Collected

5. Cord Blood is picked up by the courier

6. Cord Blood must be processed within 48 hours of cord blood collection!

Step 1: Consent Form CompletionStep 1: Consent Form Completion

Mothers can access enrollment forms in two ways:1. By calling CBBA, and requesting forms to be mailed

2. By visiting www.cordbloodbankarkansas.org and downloading the forms directly from our website (available 8/01/2011

Enrollment forms must be completed and signed by the Mother and Physician for the unit to be processed

Step 2: Review Collection Kit Step 2: Review Collection Kit MaterialsMaterials

Foil Pouch

95k Transport Biohazard Bag

Collection bag

Maternal Tubes and Sleeve

Clamp

Gel Pak

Green Label

Alcohol and Iodine Pads/swabs

Step 3: Cord Blood CollectionStep 3: Cord Blood Collection

• The cord blood collection is performed after the birth of the baby.

• The collection may be performed by the attending physician, nurse or midwife.

• The process is painless and easy to collect!

It takes a few minutes that It takes a few minutes that could save another’s life!could save another’s life!

Step 4: PackagingStep 4: Packaging

• After the collection, the attending physician, nurse or midwife packages the cord blood.

* Note: See Chapter 6 for detailed instructions.

Step 5: Arranging the CourierStep 5: Arranging the Courier• After the cord blood is packaged, it is the

responsibility of the mother to designate a person to notify CBBA at 1-855-854-22221-855-854-2222 or 501-766-4611.501-766-4611.

• At this time CBBA arranges a courier to pick up the cord blood from the mothers permanent room or the nurses station.

TIP!TIP!

Some hospital protocols restrict Some hospital protocols restrict couriers to pickup at patient couriers to pickup at patient

rooms, in this case, cord blood rooms, in this case, cord blood may be kept at the nurses may be kept at the nurses

station.station.

Test Your Knowledge!Test Your Knowledge!1. Mothers can only access enrollment forms through the

mail.FALSE: FALSE:

Enrollment Forms Are Available at Enrollment Forms Are Available at www.cordbloodbankarkansas.orgwww.cordbloodbankarkansas.org

2. It is the responsibility of the mother to designate a person to notify CBBA after the cord blood is packaged.

TRUETRUE3. CBBA will arrange a courier to pick up the cord blood.

TRUETRUE

Chapter IIIChapter III

Umbilical Cord Blood CollectionUmbilical Cord Blood Collection

2 Types of Cord Blood Collections2 Types of Cord Blood Collections

• Vaginal

• C-Section

Vaginal DeliveryVaginal Delivery

Cord Blood is collected following delivery of the infant, after the umbilical cord is cut, and while awaiting (or following) delivery of the placenta

Step 1Step 1Vaginal DeliveryVaginal Delivery

• Remove the collection bag from its foil pouch and over wrap

Step 2 Vaginal DeliveryStep 2 Vaginal Delivery

• Swab a site on the lower end of the cord with the povidone-iodine provided in the kit, followed by the alcohol pad.

Step 3 Vaginal DeliveryStep 3 Vaginal Delivery

• Insert the collection needle attached to the cord blood collection bag into the cleansed area of the umbilical vein. Be sure to start low on the cord and move up. Lower the umbilical cord below the perineum.

*Note: Clamp The Cord As Close To The Baby As Note: Clamp The Cord As Close To The Baby As Possible! This will ensure maximum volume!Possible! This will ensure maximum volume!

TIP!TIP!The collection bag must be placed

lower than the placenta to allow the blood to drain by gravity into the bag. Minimize manipulation of

the umbilical cord as this will adversely affect the volume of

blood obtained

Step 4 Vaginal DeliveryStep 4 Vaginal Delivery

• Check the volume!Check the volume! Allow as much blood as possible to be collected. Sufficient volume is a crucial factor for its use as a transplant.

Volume! Volume! Volume!Aim for over 85cc!!!

• A minimum collection volume of 85cc is needed for the cord blood to be considered usable.

• It is desirable to have a collection volume more than 100cc (above the top of the white label.)

TIP!TIP!When the cord blood collection slows or stops, milk the cord upward (toward the placenta), for approximately 6 to 10 inches, re-clamp the cord, clean, then re-stick allowing the cord blood to drain into the collection bag. This can be done 2 or 3 times and results in an increased collection volume.

Step 5 Vaginal Delivery

Including the weight of the collection bag and clamp, a 85cc collection would weigh at least 155 grams. If less than 85cc of cord blood is collected, please attempt to collect more by reinserting the needle into another cleansed site of the umbilical vein. Be sure to start low on the cord and move up!

Step 6 Vaginal Delivery• Following the collection

(which usually takes no longer than five minutes) clamp the tubing a few inches from the bag and cut it distal to the clamp, leaving the sharp (needle) on your tray.

• Dispose of the needle as required by your facility. If you choose to use the needle guard provided, please use the instructions supplied with the guard.

Step 7 Vaginal Delivery• Immediately after

collection, write the following on the YELLOW cord blood identification label provided:> Mother’s first & last name> Name of the physician/collector,> Name of the collection

facility> Date and time drawn

• Confirm the patient’s name written on the cord blood label.

Step 8 Vaginal Delivery

• Affix the YELLOWYELLOW identification label directly to the collection bag.

• A Hospital ID may also be used.

IMPORTANTIMPORTANT! Cord Blood units that are

unlabeled cannot be used for transplant !

Step 9 Vaginal DeliveryStep 9 Vaginal Delivery

Weigh the collection bag containing the cord blood. Write the weight in grams on the yellow cord blood label.

Have the weight information readily available for the designated person, notifying CBBA of the delivery and collection.

Step 10 Vaginal Delivery

Fill out the BLUEBLUE Delivery Information Sheet, Form C.2-3, provided in the kit

This form is REQUIRED!

We Cannot Process The Cord Blood

Without It!

Step 11 Vaginal Delivery

Keep cord blood at room temperature to ensure

viability.

REFRIGERATE WILL damage the cells!

Do not refrigerate!Do not refrigerate!

Do not refrigerate!Do not refrigerate!

Do not refrigerate!Do not refrigerate!

Option 1C-Section Delivery

Step 1:The collection may be performed before or after the placenta is removed from the uterus using the sterile collection bag.

Step 2: C-Section Delivery

Swab a site on the umbilical cord with the povidone-iodine, followed by the alcohol pad.

Tip!Tip!Remember to clamp the cord as close to the

baby as possible to ensure

Maximum Volume!

Step 3: C-Section Delivery

Insert the needle from the collection bag into the cleansed site of the umbilical cord. Be sure to start low on the cord an move up. The collection bag can remain outside the sterile field at a lower level to allow gravity to fill it.

Step 4: C-Section Delivery

When collection is complete and the needle is removed from the cord, allow the blood remaining in the tubing to enter the collection bag to maximize recovery.

Step 5: C-Section Delivery

Secure the needle by holding it away from yourself and cover the needle by sliding the needle guard over the needle.

Option 2C-Section Delivery

Step 1:

As mentioned earlier, the collection may be performed after the placenta is removed from the uterus. Using this method, collection of the cord blood can be performed up to 20 minutes after delivery of the placenta.

Step 2: C-Section Delivery

Place the placenta and umbilical cord in a tray.

Step 3: C-Section Delivery

Swab a site on the umbilical cord with the povidone-iodine, followed by the alcohol pad.

Remember!!! Clamp Close To The Remember!!! Clamp Close To The Baby For Maximum Volume!!!!Baby For Maximum Volume!!!!

Step 4: C-Section Delivery

Insert the collection needle attached to the cord blood collection bag into the cleansed area of the umbilical vein. Be sure to start low on the cord and move up.

Step 5: C-Section Delivery

Elevate the placenta and lower the collection bag to enable gravity to drain the blood into the collection bag.

* This method of collection may not yield as high volume, but an acceptable amount can be collected

Volume is Key!Volume is Key! Volume is Key!Volume is Key!

Step 6: C-Section Delivery

Follow Vaginal Delivery Steps 6-11

Volume! Volume! Volume!

Complete Paperwork

Do NOT Refrigerate!

Test your knowledge! 1. Collect the cord blood after the placenta has

been delivered.FALSEFALSE

You can collect the cord blood before or after You can collect the cord blood before or after delivery of the placenta!delivery of the placenta!

2. Do not refrigerate the cord blood, keep at room temperature

TRUETRUE

3. Cord Blood cannot be donated to the public inventory if the unit contains less than 60 cc of cord blood.

TRUETRUE

Test your knowledge! (Con’t)

4. In a C-Section delivery you can collect the cord blood before or after the placenta is delivered

TRUETRUE 5. Collecting after delivery of the placenta yields a higher

volume of cord bloodFALSEFALSE

Collecting before the delivery of the placenta Collecting before the delivery of the placenta is the preferred method because is the preferred method because

it yields higher volume!it yields higher volume!

Chapter V

Maternal Blood DrawMaternal Blood Draw

Step 1Step 1

• 5 vacutainer tubes have been supplied with the kit to draw the maternal blood for required infectious disease testing. The blood can be drawn during labor or shortly after birth; anytime within 48 hours of the cord blood collection, but must be drawn prior to cord blood kit packaging and courier pick-up.

• So long as the maternal blood is drawn within 48 hours of the cord blood collection, the maternal blood can be drawn at IV start or with other lab blood draws.

Maternal Blood Is Required With Every Collection!

Step 2

Place the mother’s hospital ID labels on each tube of the maternal blood. If hospital labels are not available, write at minimum the mother’s full first and last name on the tubes.

Step 3

Fill out the GREENGREEN label with the phlebotomist’s initials, date and time of collection, and place the completed green label on the absorbent tube-holder sleeve.

Test your knowledge!Test your knowledge!True or FalseTrue or False

1. The maternal blood draw can be done anytime before or after delivery

FALSEFALSEThe maternal blood draw must be done within 48 hours The maternal blood draw must be done within 48 hours

of the cord blood collection, but prior to cord blood of the cord blood collection, but prior to cord blood kit packaging and pick-upkit packaging and pick-up

2. 5 tubes are supplied for the maternal blood drawTRUETRUE

3. Be sure to fill out the GREEN label with the phlebotomist's initials, date and time of collection

TRUETRUE

Chapter VI - Packaging

Packaging Directions

All packaging directions pictured in the upcoming slides are located on the inside of the collection kit cover.

FINAL CHECKIN ORDER TO MEET THE CRITERIA FOR A TRANSPLANTABLE UNIT

PLEASE CONFIRM THAT:THE BAG WEIGHT IS OPTIMUM > 155 GRAMSTHE VIALS WITH MOTHER’S BLOOD ARE LABELED WITH THE PATIENT’S FULL NAME (OR HOSPITAL ID LABEL)THE GREEN “VIALS FOR MOTHER’S BLOOD” LABEL IS COMPLETED AND ATTACHED TO THE ABSORBENT TUBE SLEEVETHE YELLOW “HUMAN CORD BLOOD” LABEL IS COMPLETED AND ATTACHED TO THE CORD BLOOD BAGTHE BLUE DELIVERY INFORMATION SHEET HAS BEEN COMPLETED AND ENCLOSED

•Call CBBA at 1-855-854-2222 or 501-766-4611 within 2 hours after the delivery of the baby to arrange for cord blood pick-up. If you call after hours, leave a message and we will contact you the next morning.•Close the box by pushing the ends of the flap into the sides of the box. Ship the box into the large FedEx Clinical Pak Envelope. Peel the backing from the FedEx air bill provided and place it on the bottom right corner of the FedEx Clinical Pak.•IMPORTANT: DO NOT SEAL the FedEx Clinical Pak until you have spoken to a CBBA Representative. Weigh the cord blood unity and have this information available when you call.

5

Slide #60: on step 3, re-write to:  “place completed yellow label on cord blood bag”.  (We are not using a barcode label).

PLACE COMPLETED YELLOW LABEL ON CORD BLOOD BAG.

Test your knowledge!True or False

1. It is necessary to do a final “check” before packaging the kit.

TRUETRUE2. Only maternal blood tubes are to be sealed in the

biohazard bagFALSEFALSE

The cord blood bag and maternal tubes are to be The cord blood bag and maternal tubes are to be sealed in the biohazard bagsealed in the biohazard bag

3. If hospital does not have printed labels for maternal blood tubes, it is necessary to hand write mother’s first and last name on tubes

TRUETRUE

THANK YOU & CONGRATULATIONS!THANK YOU & CONGRATULATIONS!

YOU are helping to save lives by taking just a few minutes of your time!!

The Cord Blood Bank of ArkansasThe Cord Blood Bank of Arkansas4301 W. Markham St., #503Little Rock, AR 72205-7199

www.cordbloodbankarkansas.org

1-855-854-2222 (CBBA) 501-686-6271 (office)501-766-4611 (cell) 501-296-1127