Intraoperative Cell Salvage Basic Blood Facts Blood Conservation

Intraoperative Cell Salvage § § § § § Basic Blood Facts Blood Conservation Haemovigilance Principles of Intraoperative Cell Salvage Indications and Contraindications Practicalities – Blood Collection Practicalities – Blood Processing Practicalities – Blood Reinfusion Information & Best Practice Unloading and Discarding 31

Learning Outcomes § To identify the equipment used for blood collection and describe the function of each component § To name the two main types of anticoagulant used in ICS , describe their functions and mechanism of action § To describe methods of maximising blood collection § To identify areas for potential problems during blood collection 32

Blood Collection § Aspiration of blood from surgical field § Anticoagulation § Filtering § Storage prior to processing 33

Blood Collection § Decision to collect blood § § Anticipated blood loss Patient risk factors for bleeding Low Preoperative Haemoglobin Patient objections to receiving allogeneic (donor) blood 34

Blood Collection § Collect only setup Where adequate blood loss for processing cannot be predicated 35

Blood Collection § Anticoagulants* § Heparin saline § 30, 000 IU heparin/1000 ml IV normal saline (0. 9% Na. Cl) § Ratio 1: 5 e. g. 20 ml to 100 ml blood § Antithrombin III Ineffective if the patient suffers an antithrombin III deficiency § ACD-A § Pre-prepared § Ratio 1: 7 e. g. 15 ml to 100 ml blood § Binds Calcium containing fluids may block the action of ACD-A e. g. Hartmann’s Solution *Recommended minimum flow rate – 1 drip per second 36

Blood Collection § Wide bore suction tip § e. g. Yankauer § Low vacuum level § to minimise RBC Haemolysis 37

Blood Collection § During collection § Regulate vacuum § Regulate anticoagulant flow (↑ with ↑ blood loss) § Monitor volume of blood loss Only IV grade fluids should be aspirated into the system 38

Blood Collection § Maximising blood collection § Maintain a low vacuum level § Suction technique (aspirate from pools of blood) § Wide bore suction tip § Swab washing 39

Blood Collection § Swab washing § Blood normally lost to swabs is salvaged § Sterile bowl § 1000 mls IV normal Saline (0. 9%Na. Cl) § Swabs placed in bowl for ~ 5 mins then gently squeezed out § Swab wash aspirated in to ICS machine and processed 40

Blood Collection § Troubleshooting § Loss of suction § Clotting in reservoir § Contamination with non-IV substances* *The decision to use blood that is potentially contaminated with bacteria, amniotic fluid or malignant cells should be made by the clinicians caring for the patients, taking into account the latest evidence and considering the risks and benefits for the individual patient. 41