1.7 Cell Salvage

Question 1

Aim Intraop Cell Salvage (ICS)

Answer 1

Risk RCC Tfusion

more commonplace hospitals

Question 2

Indications ICS

Answer 2

1. Major heaemorrhage predicted
   >1L or >20% BV
2. Patients w/ increase risk bleeding
   - clotting
   - sepsis
3. Preop anaemia
4. Unusual blood types / antibodies
5. Patient refuse allogenic donation
   - consent as may also refuse BT

Question 3

Mechanisms ICS

Answer 3

1. Surgeon
dual lumen suction catheter
blood collected site
anticoaged as aspirate
deliver collection reservoir by vacuum

2. Clot + debris removed
   40um li line leucodepltion filter
   to centrifuge chamber
3. Centifgation
   blood sperated packed RCC
   -remain centifuge

Waste prod - wcc plt lasma
forced out into waste line

4. Pack RCC washed sterile isotonic saline pumped in collection bag
5. Collected RCC re transfused or stored
6. Blood soaked swan
   may be washed
   mix into reseveor

Question 4

OBS patient ICS

Answer 4

1. More popular
   massive haemorrhage risk - implanted placenta
2. Fears of risk of AFE
   reinfusion foetal sub - no evidence + no repts literature
3. Recommended by NICE
4. Risk Rh incompatibility
   Rh -ve mum received contam Rh +ve foetal
   Anti D

Double suction set up
One for sytemic blood and ICS
other for amniotic fluid

Question 5

Malingancy and ICS

Answer 5

Not recommended manufacturer
risk reinfusing malignant cell
mets

no evidence of malignant recurrence d/t ics in literature

Recommend use urological malignance (rad prostate)
-nice
minmise suction around tumour site
leucodepetion filter

Question 6

Bowel contam ICS

Answer 6

ICS rel contraindicated
unless massive haemorrhage

shown post op wound infection unaltered ICS used

Common sense
- remove bowel contam prior to ICS
BSAbx
increase volume wash