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Umbilical Cord Blood Collection Training www. cordbloodbankarkansas. org Umbilical Cord Blood Collection Training www. cordbloodbankarkansas. org

Umbilical Cord Blood Collection A special thank you from Cord Blood Bank of Arkansas! Umbilical 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 Arkansas 4301 W. Markham St. , #503 Little 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 Contents I. III. IV. V. Background of Cord Blood The Process Umbilical Table of Contents I. III. IV. V. Background of Cord Blood The Process Umbilical Cord Collection Maternal Blood Draw Packaging pg. 1 pg. 7 pg. 17 pg. 47 pg. 52

Chapter I Background of Cord Blood Chapter I Background of Cord Blood

What is Cord Blood? • “Cord Blood” is the blood found in the umbilical 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? • 10 years ago, the number of known 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 Timeline • 1988: 1 st Related Cord Blood Transplant • 1991: 1 Cord Blood Timeline • 1988: 1 st Related Cord Blood Transplant • 1991: 1 st Unrelated Cord Blood Transplant • 1993: 1 st 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! True or False 1. Cord Blood is found inside the Umbilical Test Your Knowledge! True or False 1. Cord Blood is found inside the Umbilical Cord TRUE 2. Cord Blood is NOT currently being used to treat diseases FALSE: Cord Blood is used to treat over 75 diseases and disorders 3. There has NOT been a successful Cord Blood Transplant to date FALSE To date more than 10, 000 transplants have been performed!

Chapter II The Process Chapter II The Process

The Process Overview 1. 2. 3. 4. 5. 6. Form Completion Collection Kit Sent The Process Overview 1. 2. 3. 4. 5. 6. Form Completion Collection Kit Sent To Mother Mom brings kit to the hospital when in labor Cord Blood is Collected Cord Blood is picked up by the courier Cord Blood must be processed within 48 hours of cord blood collection!

Step 1: Consent Form Completion Mothers can access enrollment forms in two ways: 1. Step 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 Enrollment forms must be completed and signed by the Mother and Physician for the unit to be processed

Step 2: Review Collection Kit Materials Step 2: Review Collection Kit Materials

Foil Pouch Collection bag 95 k Transport Biohazard Bag Clamp Gel Pak Maternal Tubes Foil Pouch Collection bag 95 k Transport Biohazard Bag Clamp Gel Pak Maternal Tubes and Sleeve Green Label Alcohol and Iodine Pads/swabs

Step 3: Cord Blood Collection • The cord blood collection is performed after the Step 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 could save another’s life!

Step 4: Packaging • After the collection, the attending physician, nurse or midwife packages Step 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 Courier • After the cord blood is packaged, it is Step 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 -2222 or 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! Some hospital protocols restrict couriers to pickup at patient rooms, in this case, TIP! Some hospital protocols restrict couriers to pickup at patient rooms, in this case, cord blood may be kept at the nurses station.

Test Your Knowledge! 1. Mothers can only access enrollment forms through the mail. FALSE: Test Your Knowledge! 1. Mothers can only access enrollment forms through the mail. FALSE: Enrollment Forms Are Available at www. cordbloodbankarkansas. org 2. It is the responsibility of the mother to designate a person to notify CBBA after the cord blood is packaged. TRUE 3. CBBA will arrange a courier to pick up the cord blood. TRUE

Chapter III Umbilical Cord Blood Collection Chapter III Umbilical Cord Blood Collection

2 Types of Cord Blood Collections • Vaginal • C-Section 2 Types of Cord Blood Collections • Vaginal • C-Section

Vaginal Delivery Cord Blood is collected following delivery of the infant, after the umbilical Vaginal 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 1 Vaginal Delivery • Remove the collection bag from its foil pouch and Step 1 Vaginal Delivery • Remove the collection bag from its foil pouch and over wrap

Step 2 Vaginal Delivery • Swab a site on the lower end of the Step 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 Delivery • Insert the collection needle attached to the cord blood Step 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 Possible! This will ensure maximum volume!

TIP! The collection bag must be placed lower than the placenta to allow the 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 Delivery • Check the volume! Allow as much blood as possible Step 4 Vaginal Delivery • 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! Aim for over 85 cc!!!

 • A minimum collection volume of 85 cc is needed for the cord • A minimum collection volume of 85 cc is needed for the cord blood to be considered usable. • It is desirable to have a collection volume more than 100 cc (above the top of the white label. )

TIP! When the cord blood collection slows or stops, milk the cord upward (toward TIP! When the cord blood collection slows or stops, milk the cord upward (toward the placenta), for approximately 6 to 10 inches, reclamp 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 Step 5 Vaginal Delivery Including the weight of the collection bag and clamp, a 85 cc collection would weigh at least 160 grams. If less than 85 cc 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 Step 6 Vaginal Delivery • Following the collection (which usually takes no longer than five minutes) clamp the tubing a few inches from the end and cut it distal to the clamp, leaving the sharp (needle) on your tray. • Tie a knot at the end of the tubing. This further insures the bag doesn’t leak during transport. • 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 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 > Weight of the unit • Confirm the patient’s name written on the cord blood label.

Step 8 Vaginal Delivery • Affix the YELLOW identification label directly to the collection Step 8 Vaginal Delivery • Affix the YELLOW identification label directly to the collection bag. • A Hospital ID may also be used. IMPORTANT ! Cord Blood units that are unlabeled cannot be used for transplant !

Step 9 Vaginal Delivery Ø Weigh the collection bag containing the cord blood. Write Step 9 Vaginal Delivery Ø Weigh the collection bag containing the cord blood. Write the weight in grams on the yellow cord blood label. Ø Have the weight information readily available for the designated person, notifying CBBA of the delivery and collection.

Step 10 Vaginal Delivery Fill out the BLUE Delivery Information Sheet, Form C. 2 Step 10 Vaginal Delivery Fill out the BLUE 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 Step 11 Vaginal Delivery Keep cord blood at room temperature to ensure viability. REFRIGERATE WILL damage the cells! Do not refrigerate!

Option 1 C-Section Delivery Step 1: The collection may be performed before or after Option 1 C-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, Step 2: C-Section Delivery Swab a site on the umbilical cord with the povidone-iodine, followed by the alcohol pad.

Tip! Remember to clamp the cord as close to the baby as possible to 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 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 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 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 2 C-Section Delivery Step 1: As mentioned earlier, the collection may be performed Option 2 C-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 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 povidoneiodine, Step 3: C-Section Delivery Swab a site on the umbilical cord with the povidoneiodine, followed by the alcohol pad.

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

Step 4: C-Section Delivery Insert the collection needle attached to the cord blood collection 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 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!

Step 6: C-Section Delivery Follow Vaginal Delivery Steps 6 -11 Volume! Complete Paperwork Do Step 6: C-Section Delivery Follow Vaginal Delivery Steps 6 -11 Volume! Complete Paperwork Do NOT Refrigerate!

Test your knowledge! 1. Collect the cord blood after the placenta has been delivered. Test your knowledge! 1. Collect the cord blood after the placenta has been delivered. FALSE You can collect the cord blood before or after delivery of the placenta! 2. Do not refrigerate the cord blood, keep at room temperature TRUE 3. Cord Blood cannot be donated to the public inventory if the unit contains less than 60 cc of cord blood. TRUE

Test your knowledge! (Con’t) 4. 5. In a C-Section delivery you can collect the Test your knowledge! (Con’t) 4. 5. In a C-Section delivery you can collect the cord blood before or after the placenta is delivered TRUE Collecting after delivery of the placenta yields a higher volume of cord blood FALSE Collecting before the delivery of the placenta is the preferred method because it yields higher volume!

Chapter V Maternal Blood Draw Chapter V Maternal Blood Draw

Step 1 Maternal Blood Is Required With Every Collection! • 5 vacutainer tubes have Step 1 Maternal Blood Is Required With Every Collection! • 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.

Step 2 Place the mother’s hospital ID labels on each tube of the maternal 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 GREEN label with the phlebotomist’s initials, date and time Step 3 Fill out the GREEN 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! True or False 1. The maternal blood draw can be done Test your knowledge! True or False 1. The maternal blood draw can be done anytime before or after delivery FALSE The maternal blood draw must be done within 48 hours of the cord blood collection, but prior to cord blood kit packaging and pick-up 2. 5 tubes are supplied for the maternal blood draw TRUE 3. Be sure to fill out the GREEN label with the phlebotomist's initials, date and time of collection TRUE

Chapter VI - Packaging Chapter VI - Packaging

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

FINAL CHECK IN ORDER TO MEET THE CRITERIA FOR A TRANSPLANTABLE UNIT PLEASE CONFIRM FINAL CHECK IN ORDER TO MEET THE CRITERIA FOR A TRANSPLANTABLE UNIT PLEASE CONFIRM THAT: üTHE BAG WEIGHT IS OPTIMUM > 160 GRAMS üTHE VIALS WITH MOTHER’S BLOOD ARE LABELED WITH THE PATIENT’S FULL NAME (OR HOSPITAL ID LABEL) üTHE GREEN “VIALS FOR MOTHER’S BLOOD” LABEL IS COMPLETED AND ATTACHED TO THE ABSORBENT TUBE SLEEVE üTHE YELLOW “HUMAN CORD BLOOD” LABEL IS COMPLETED AND ATTACHED TO THE CORD BLOOD BAG üTHE BLUE DELIVERY INFORMATION SHEET HAS BEEN COMPLETED AND ENCLOSED üTHE MATERNAL SAMPLE COLLECTION RECORD FORM 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 Fed. Ex Clinical Pak Envelope. Peel the backing from the Fed. Ex air bill provided and place it on the bottom right corner of the Fed. Ex Clinical Pak. • IMPORTANT: DO NOT SEAL the Fed. Ex Clinical Pak until you have spoken to a CBBA Representative. Please weigh the cord blood unit and have this information available when you call.

5 5

THE COMPLETED YELLOW LABEL WITH BARCODE IS ON THE CORD BLOOD BAG. THE COMPLETED YELLOW LABEL WITH BARCODE IS ON THE CORD BLOOD BAG.

Test your knowledge! True or False 1. It is necessary to do a final Test your knowledge! True or False 1. It is necessary to do a final “check” before packaging the kit. TRUE 2. Only maternal blood tubes are to be sealed in the biohazard bag FALSE The cord blood bag and maternal tubes are to be sealed 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 TRUE

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

The Cord Blood Bank of Arkansas 4301 W. Markham St. , #503 Little Rock, The Cord Blood Bank of Arkansas 4301 W. Markham St. , #503 Little Rock, AR 72205 -7199 www. cordbloodbankarkansas. org 1 -855 -854 -2222 (CBBA) 501 -766 -4611 (cell) 501 -686 -6271 (office) 501 -296 -1127