11. Autotransfusion- Exam 3 Flashcards
Autotransfusion=
person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood.
What are the 2 types of auto-transfusion
- Blood can be autologously “pre-donated” by one’s self
- Blood can be collected during and after the surgery using an intraoperative blood salvage device
(such as a Cell Saver).
Cell saver=
intraoperative cell salvage machine suctions*, washes, and filters blood so it can be given back to the patient’s body instead of being thrown away
with a cell saver, what is the limit you can give back to the patient
Because the blood is recirculated, there is NO limit to the amount of blood that can be given back to the patient
Autologous Cell Washing Devices=
Haemonetics Cell Saver 5 Haemonetics Elite Medtronic Autolog Sorin Xtra Cobe BRAT Dideco Compact Advanced Cell Saver Fresenius (Terumo) CATS system
Haemonetics Cell Saver 5=
made in 1976
can do platelets
has 3 bowl sizes
can do partial bowls
Haemonetics Elite=
upgraded cell saver 5
has usb scanner and color screen
can do suction
Medtronic Autolog=
- One size bowl
- Smart “will detect hct coming in and wash it faster or slower based in the incoming hct”
- cardiotomy reservoir weighs contents
Sorin Xtra=
can connect to sorins pump and electronic system
Cobe BRAT=
simple system
2-3 bowl sizes
Dideco Compact Advanced Cell Saver=
may not see in the field
Fresenius (Terumo) CATS system=
transfusion bag will slowly fill throughout the case
what does CATS stand for
Continuous auto transfusion system
after blood has collected in the reinfusion bag, how do you give it to the patient
use a transfer pack
–DO NOT use the reinfusion bag
Setup of the Disposables includes what 8 things
- Aspiration set
- Heparinized Saline
- Collection Reservoir
- Bowl
- Wash Solution
- Collection Bag
- Transfer packs
- Blood Filter, Lipid filter, Leukocyte reduction filter
Disposables
Aspiration Set=
- Usually packaged separately from washing set
- Dual lumen tube
- Anticoagulant line with drip chamber and roller clamp control
- Suction line for salvaged blood mixed with anticoagulant
Disposables
Anticoagulant=
- Heparinized saline (30,000 units/1000 mL saline) [most common]
- CPD (citrate-phosphate-dextrose)
- ACD-A (anticoagulant citrate dextrose solution- solution A)
Disposables
Collection Reservoir=
- ~3000 to 4000 mL capacity
* Gross filter or 30-100 micron filter
Disposables
Bowl=
Varying sizes from 50 mL to 250 mL
what are the 3 types of bowls/disks
turbo bowl
disk
latham bowl
turbo bowl=
135 ml [speed can be adjusted based on vol]
disk=
allows blood to be washed and emptied at the same time- CATS uses disk
latham bowl=
- angled sides- most common
- spins at 3000-4000 rpm
- when RBC’s get to the shoulder-it stops spinning and begins to wash the cells
Phases of Washing Cells
Fill
Wash
Empty
Fill phase=
- Centrifuge/accelerates to the speed selected on the centrifuge speed control (typically 5,600 rpm).
- The pump begins rotation, transferring
- Reservoir contents –> wash bowl.
4, The application of centripetal acceleration* separates the components of the fluid according to their weight (layering)
does Centrifugal force exist
Centrifugal force does NOT exist
–uses tangental force
Fill Phase: The wash bowl filling continues until what?
continues until the buffy coat reaches the shoulder of the wash bowl
Fill Phase in auto mode=
In the “auto mode” autotransfusion devices have automatic buffy coat sensor, which is calibrated to detect a full bowl.
Fill phase–> Wash phase automatically
Fill Phase in manuel mode=
if you dont stop it when the RBCs get to the shoulder then they will continue and overflow into the waste bin
Wash phase=
- Pump starts (clamps adjust): wash solution -> wash bowl
- Washing continues until the reinfuse/empty button is depressed (or the program ends and the predetermined amount of wash solution has been used)
- Effluent moves wash bowl –> waste bag
during the wash phase, if in manuel mode, what do you watch for
watch for clear effluent
Empty phase=
- The centrifuge stops, then transfers
- wash bowl –> reinfusion bag.
- The cycle ends and a new cycle can begin
after the empty phase, the reinfusion bag should NOT be used for direct pressure infusion –> patient. Why? What should be done?
- The reinfusion bag may contain air
- Therefore, a separate blood bag attached to the reinfusion bag is used.
- disconnect –> air purge –> tied off
In accordance with Guidelines set by the American Association of Blood Banks (AABB) the blood should be reinfused within ___hours from washing
4 hours
–but the manuel of clinical perfusion says 6
Labeling Specimens (anesthesia and transport) should include what 6 things
- Patients Registration sticker
- Type: i.e. WPRBC’s
- Time collected
- Time of expiration
- Volume
- Initials
what must be kept/done for every case
A signed autologus cellsaver record must be kept for every case
•All the input and output data is recorded
autologus cellsaver record should contain what 5 things
- Volume collected for reinfusion
- Hematocrit of reinfusion volume (WPRBC’S)-QC*
- Type & volume of wash solution used
- Heparinized saline/CPD concentration & amount used
- Date/time/patient information
what are 6 indicators for use of autotransfusion
- Intended for use in situations to control blood loss
- Recovery of blood lost during surgery
- Rare blood groups without blood available
- Risk of infectious disease transmission
- Autotransfusion is common intraop/postop.
- Recovery of blood in the ECC at the end of surgery or from aspirated drainage.
what are 7 advantages of autotransfusion
High levels of 2,3-DPG Normothermic pH relatively normal Lower risk of infectious diseases Functionally superior cells Lower potassium (compared to stored blood) Quickly available
what 10 things do they wash out
- Plasma
- Platelets
- WBC’s
- Potassium
- Anticoagulant solution
- Plasma free hemoglobin
- Cellular stroma
- Activated clotting factors
- Intracellular enzymes
- Plasma bound antibiotics
what are 4 contraindications
- Presence of bacterial contamination of the surgical site
- Malignancy of the surgical area
- C-section (obstetrics)
- Topical hemostatic agents
what procedures pose a risk of contamination
Any abdominal procedure
-bowel/GI contents/pancreatic fluids
what procedures pose a risk of contamination
Any abdominal procedure
-bowel/GI contents/pancreatic fluids
what happens if there is a question of possible contamination
the blood may be held until the surgeon determines whether or not bowel contents are in the surgical field. (standby w/ reservoir*)
if the blood is contaminated, what happens
the entire contents should be discarded.
–If the patient’s life depends upon this – it may be reinfused with the surgeon’s consent
Large amounts of a 0.9% NS will do what
REDUCE the bacterial contamination of the blood, BUT it will not be totally eliminated
The possibility exists of reinfusion of what from the surgical site
cancer cells from the surgical site
what are possible exceptions to the malignancy contraindication
- Removal of an encapsulated tumor is possible
- If an inadequate supply of blood exists
why is Removal of an encapsulated tumor an exception to the malignancy contraindication
Blood may be aspirated from the surgical site, processed and reinfused with the surgeon’s consent
why is an inadequate supply of blood existing an exception to the malignancy contraindication
WPRBC’s may be used to support the patient with the surgeon’s consent
if malignant cells are of concern, what should be used
The use of leukocyte reduction filters is recommended
why is autotransfusion Not normally used in Caesarean sections
possibility of an amniotic fluid embolism exists
-do not want amniotic fluid to enter the mothers blood stream
Emerging literature about amniotic fluid suggests what
Emerging literature suggests that amniotic fluid is being cleared during the wash cycle
–It is possible that the utilization of autotransfusion in obstetrics may increase as more research is completed
In a Jehovah’s witness patient the cell saver can be used with ____ guidelines of irrigating profusely to remove ______ fluid and then _____ the blood that is being lost
strict
amniotic
suctioning
Topical Hemostatic Agents include what 5 products
Avitene Helistat Hemopad Instat Collagen type products
if topical hemostatic agents are used, when can Autotransfusion resume?
once these products are flushed from the surgical site
–Waste or wall suction source must be used
autotransfusion possibly can continue if what topical agents are used
Gelfoam
Surgicel
Thrombogen
Thrombostat
what should be avoided of topical agents are used
direct suctioning
what should be avoided of topical agents are used
direct suctioning
Contraindications a perfusionist (like your future self) is most likely to encounter (7)
- Wound infections
- Pleural effusion
- Betadine
- Warm solutions
- Sterile water
- Malignancy
- Topical hemostatic agents
what is the main disadvantage to autotransfusion
Depletion of plasma and platelets
–Removes plasma/platelets to eliminate activated clotting factors and activated platelets (causes coagulopathy if reinfused)
when will the main disadvantage of Depletion of plasma and platelets become most evident
evident when very large blood losses occur
when do you give FFP/platelets
estimated blood loss > half of the patient’s blood volume.
•Must test to determine the need for blood products
what do you need to keep in mind with Jehovah Witness Patients
keep a closed circuit
Antibiotics which are plasma bound can be ____, buy topical antibiotics which are not plasma bound may _____ washed out–may actually become concentrated to the point of being _____
removed
not be
nephrotoxic.
Cement is often used or encountered during primary or revision total joint replacement surgery. Cement in the liquid or soft state should ____ introduced into the autotransfusion system
not be
why should cement not be introduced to the autotransusion system
The use of ultrasonic equipment during revision of total joints changes the cement to a liquid or soft state precluding autotransfusion during the use of such equipment
when can autotranfusion be used despite contraindications being present
In life saving situations with the consent of the surgeon, autotransfusion can be utilized in the presence of the previous stated contraindications i.e. sepsis, bowel contamination and malignancy
–NOT our call
what is the governing body for certification in autotransfusion (CPBMT).
International Board of Blood Management
what is the IBBM’s mission
promote education and sound scientific principles to advance the safe and competent practice of perioperative blood management
In order to become a Certified Perioperative Blood Management Technologist (CPBMT), what are the 3 requirements
- Have a minimum of a high school diploma/ equivalent
- Be practicing in the field of blood management for a minimum of one (1) year
- Complete fifty (50) autotransfusion procedures/yr
