Form B4.602C
Histocompatibility
Rocky Mountain Pancreatic Islet Lab
University of Colorado Cord Blood Bank
Immunotoxicology
Flow Cytometry
Initial Cord Blood Collection Training:
CRITERION CHECKLIST
Collection Hospital__________________
CB Collector Print Name (Last)
(First)
CRITICAL ELEMENTS
MET
1. Identify patients who are candidates for Cord Blood Collection:
a. 35 weeks or greater gestation
b. Singleton birth
c. Vaginal birth
2. Review UCCBB Consent/ Medical History/Labor & Delivery
forms in CB collection kit packet (Forms C2.102, C2.101 &
C2.104) and how to attach bar code/Hospital addressograph
labels.
3. Obtain copy of Maternal Collection Hospital Admission
Assessment Form and include with the consent form.
4. Review in-utero collection kit contents (See Form B4.602BInstructions for CB Collection-for a complete listing of Kit
contents.) and how to attach Bar code labels.
5. Discuss CB banking collection process and obtaining maternal
patient consent (no surrogate mothers), also maternal blood
tubes, and paperwork labeling requirements.
6. Arrange for collection of maternal cord blood labs with routine
collection Hospital blood draw labs.
7. Correctly label and send collection hospital maternal blood
labs. Keep UCCBB maternal blood labs in CB Collection kit
8. Check cord blood collection bag for expiration date, integrity,
35ml CPD and 16Gx 1 ½ Sterile needle. Place cord blood
collection label and bar code label on collection bag.
9. Set collection bag on delivery table along with betadine swabs,
alcohol pads, clamps and other collection equipment.
10. See Instructions for Gravity collection of CB (B4.602B). Hold
needle in cord while collecting for three to four minutes (you
may place clamp to hold needle). During collection, agitate
every few minutes to ensure adequate mixing of anticoagulant.
Invert the bag back and forth for a period of 1-2 minutes when
complete. Initial the Green Tie Tag.
11. Accept cord blood collection bag with double clamped tubing
from HCP. Cut off the needle above the clamp and carefully tie
a knot at the distal end of the tubing.
12. Strip the blood from the tubing into the bag, agitate and let the
tubing refill.
MET
CRITICAL ELEMENTS
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NOT MET
NOT MET
Collections Criterion Checklist
Form B4.602C
13. Strip the blood into the bag a second time and tie a second knot
about 6 – 10” from the bag.
14. Place CB Collection bag into biohazard bag and seal.
15. Complete Maternal and Cord Blood collection/and delivery
information on the Labor and Delivery Summary (Form
C2.101).
16. Forward Page 8 of the Consent Form to SCN for baby’s address
label and blot card number. Obtain a copy of the completed
baby collection hospital Newborn Profile and fax it and page 8
to UCCBB (303-724-1849). The original page 8 is sent to the State
Health Department where newborn screening is performed.
17. Complete log (form B7.201) for all consented patients. If
consented, but no collection obtained, make notation on the log
and return CB Collection kit associated with bar coded forms to
UCCBB.
18. Check for correct labeling and completeness: cord blood
collection bag, maternal blood tubes, consents, collection
hospital maternal assessment, Labor and Delivery form and CB
Log.
19. Place cord blood collection bag(in biohazard bag), and maternal
blood into Transport Container. Be sure to include consents,
maternal assessment and Labor&Delivery forms in the original
envelope.
20. Place transport container and envelope into the insulated
wheeled cart for transport to collection hospital Clinical labs.
21. NLT 0600 each day, record the storage temperature on the Log
Form and transport the cords, documentation envelopes and
Log Form to the collection hospital Laboratory Sendouts
Section..
22. Return the cart to the Birthing Center. The Laboratory will pack
the cords and fax a copy of the Log to the UCCBB
O Passed Training/Competency
Validated by:
O Needs remedial Training
Date:
I _______________________agree that I have met the above criteria for collection of Cord blood .
(Signature)
COMMENTS:___________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
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