Form B4.602B
INSTRUCTIONS FOR THE GRAVITY METHOD COLLECTION
OF UMBILICAL CORD BLOOD (CB)
The in utero gravity CB collection procedure will take place at the site of delivery.
Best collections are those initiated immediately after delivery-or at least within 10 minutes of the birth of the infant.
Requirements for CB Collection35 weeks or greater gestation
Singleton birth
Vaginal birth
CB Collection KIT Contents:
Check that CB Collection Kit Envelope contains all of the following materials:
Note: Please DO NOT PLACE any Patient identifiers on outside of envelope and seal to ensure patient confidentiality.
Donor Eligibility, Informed Consent and CB Transport – Provided by UCCBB
Form Name & Number / # pages / COMMENTForm C2.103: Maternal FDA Medical History Questionnaire. / 4 / Before placing UCCBB CB bar code labels on the paperwork, you may be able to screen CB donors, by first checking that the maternal history does not restrict donor eligibility
Form B4.602: Instructions for CB Collection / 3 / Check that you have a complete CB Collection kit
Form C2.102: UCCBB/ Poudre Valley Hospital Informed Consent to Collect CB. / 8 / Page 8 –Request for State testing # to be sent to NICU.
Form C2.104: UCCBB HIV testing Consent and Information / 1 / Two sided. Extra copy for patient on back of education sheet.
Form C2.101: University of Colorado Cord Blood Bank (UCCBB) Labor and Delivery (L&D) Information. / 1 / Please be sure to complete ALL sections.
Cord Donor Education / 1 / Front and copy of HIV info on back- for patient to keep
Form B7.201: Collection and Shipping log / 1 / PVH- Dirty Supply Room. Apply UCCBB Bar code label and PVH Maternal Label.Record Minimum and Maximum
Temperature before taking to PVH Clinical labs- BY 6AM.
PVH Supplied Forms
PVH Maternal Admission Assessment / 4 / Add to Collection Kit Envelope
PVH Newborn Profile / 1 / May Fax to UCCBB with page 8 of UCCBB Consent Fax #: 303-724-1849
UCB Collection Kit Materials List-
Check that CB Collection Kit Jar contains all of the following materials:
Item Description / Number of each item / COMMENTCB Collection Bag. Sterile 250 ml bag with 35 ml CPD with 16G x1 ½ inch Sterile needle. / 1 / Observe Baxter Single Blood Pack for sterility (Clear CPD), integrity (No cracks or punctures) and check expiration date. Record on C2.101.
(Note: Peel pouch items and the cord blood collection bag are sterile.)
Green Tie Tag with “Labeled by: “ sticker / 1
Tie tag strip / 1
Betadine Swabs (Packet of 3) / 1 / A single swipe up with each - at collection
Blue-clamps / 2 / Use one to Strip CB from line & a second to secure seal.
7ml EDTA-Purple top BD Vacutainer blood collection tubes / 3 / Maternal blood. Must have at least 5 ml per tube.
7ml Serum-Red top BD Vacutainer blood collection tubes / 1 / Maternal blood. Must have at least 5 ml per tube. Note: If unable to fill all tubes, completely fill at least one RT and two purple.
Biohazard zip-lock bag / 1 / For CB collection bag.
Secondary Plastic container (Jar) with lid / 1 / Note: Attach Bar code label to Jar- Not lid
Bar-Coded UCCBB CB ID Labels / 19 / Note: All Labels must be accounted for- Please place any remaining labels from CB Kit- into envelope.
Gravity Collection Procedure
Note that if at any point in the procedure, the placenta spontaneously drops- STOP Cord Collection. Document reason for “consented, not collected” on form B7.201 Collection and Shipping Log.
Immediately following the delivery of the infant,
1. Clamp the cord approximately 2 and 6 inches from the child and cut the cord between the clamps.
2. Once the child is stable and handed out, clean the umbilical vein near the end of the cord proximal to the clamp, with the betadine swabs. A single swipe upwards with each of the three swabs.
3. Visualize the umbilical vein and cannulate with the 16-gauge needle connected to the blood collection bag.
4. It is often helpful to wrap sterile gauze around the insertion site, as the site can leak.
5. During collection, agitate the collection bag every few minutes to ensure adequate mixing of blood and anticoagulant.
6. Periodically check the bag and tubing to see if blood is still flowing.
7. When the flow has stopped, clamp the line with a hemostat or Kelly clamp 2 – 4 inches below the needle.
8. Remove the needle from the vein and cut off the needle above the Kelly clamp.
9. Using the first blue clamp provided, strip the tubing blood into the bag and leave the blue clamp 4 inches from the bag.
10. Place the second blue clamp just above the first clamp.
11. Tie the line once or twice with over hand knots to further insure the line is secure.
12. Place the collection label and the bar code label on the collection bag and ensure the bar coded identification label matches the ones on the consent forms.
13. Place cord blood collection bag in a biohazard double zip lock bag for transport.
14. Complete maternal and CB collection/delivery information on the Labor and
Delivery (L&D) Form (Form# C2.101)
15. Forward page 8 of Consent form (C2.102) to the NICU for child’s addressograph/ PKU blot card number.
16. Ensure the maternal blood samples are drawn along with PVH samples.
17. Place maternal blood samples in a separate biohazard zip lock bag and into the same transport jar as the CB Bag.
18. Place the transport containers into Transport Cart in the Soiled Utility Room.
19. Complete CB Transport Log (Form B7.201):
a. Place the “PV Log” barcode in column 1 and a Maternal ID Label in column 4.
b. Write in the Collection Date/Time, Collection Kit Lot # (on the maternal blood tube bag), the reason why collection was not completed (if applicable), and collection staff names. Keep shipper contents at room temperature. DO NOT ADD ICE.
20. Each day at 6:00AM, be sure to deliver the cords to the Lab for shipment:
a. Ensure there is a collection jar and documentation pack for each cord.
b. Record the Minimum, Maximum and Current temperature on the form.
c. Take the cords to the lab and bring back an equal number of new collection kits.
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