Autotransfusion Flashcards
Autotransfusion
person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood.
There are two main kinds of autotransfusion:
Blood can be autologously “pre-donated” (termed so despite
“donation” not typically referring to giving to one’s self)
Alternatively, it can be collected during and after the surgery using an intraoperative blood salvage device
(such as a Cell Saver).
Cell saver
ntraoperative cell salvage machine suctions*, washes, and filters blood so it can be given back to the patient’s body instead of being thrown away.
Because the blood is recirculated, there is no limit to the amount of blood that can be given back to the patient.
Aspiration Set
Usuallypackagedseparatelyfromwashingset
• Duallumentube • Anticoagulant line with drip chamber and roller clamp control • Suction line for salvaged blood mixed with anticoagulant
Anticoagulant
Heparinizedsaline(30,000unitsHeparin/1000mLsaline) • CPD(citrate-phosphate-dextrose) • ACD-A(anticoagulantcitratedextrosesolution-solutionA)
Collection Reservoir
~3000to4000mLcapacity • Gross filter or 30-100 micron filter
Bowl
Varyingsizesfrom50mLto250mL
Fill phase
Centrifuge/accelerates to the speed selected on the
centrifuge speed control (typically 5,600 rpm). • The pump begins rotation, transferring
Reservoir contentswash bowl. • The application of centripetal acceleration* separates the
components of the fluid according to their weight (layering)
• Note: Centrifugal force does NOT exist
The wash bowl filling continues until
he buffy coat
reaches the shoulder of the wash bowl.
In the “auto mode” autotransfusion devices have
automatic buffy coat sensor, which is calibrated to detect a full bowl.
Fill phaseWash phase automatically
(really cool concept – BUT you will be running them in the manual mode at MWU)
Wash phase
When the bowl is filled: The 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
Manual mode note : watch for clear effluent
Empty phase
The centrifuge stops, then transfers wash bowl reinfusion bag.
• The cycle ends and a new cycle can begin • The reinfusion bag should not be used for direct pressure
infusion patient • The reinfusion bag may contain air
Therefore, a separate blood bag attached to the reinfusion bag is used. disconnectair purgetied off
In accordance with Guidelines set by the American Association of Blood Banks (AABB) the blood should be reinfused within 4 hours from washing.
Labeling Specimens
anesthesia and transport
- Patients Registration sticker • Type: i.e. WPRBC’s • Time collected • Time of expiration
- Volume • Initials
Record Keeping
A signed autologus cellsaver record must be kept for every case
• All the input and output data is recorded
• Usually a single sheet that may contain: • 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
Indications
• 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 intraoperatively/postoperatively. • Recovery of blood in the extracorporeal circuit at the end of
surgery or from aspirated drainage.
Post protamine
CPB circuit salvage ICU Pre-washing PRBC’s for pediatrics
Advantages
- 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
Substances washed out
• Plasma • Platelets • WBC’s • Anticoagulant solution • Plasma free hemoglobin • Cellular stroma • Activated clotting factors • Intracellular enzymes • Potassium • Plasma bound antibiotics
CONTRAINDICATIONS
Presence of bacterial contamination of the surgical site • Malignancy of the surgical area • C-section (obstetrics) • Topical hemostatic agents
Contamination of the surgical site
• Any abdominal procedure poses the risk of contamination
• 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 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 reduce the bacterial contamination of the blood, it will not be totally eliminated
Malignancy
• The possibility exists of reinfusion of cancer cells from the surgical site
There are possible exceptions to this contraindication: • Removal of an encapsulated tumor is possible.
Blood may be aspirated from the surgical site, processed and reinfused with the surgeon’s consent.
• If an inadequate supply of blood exists WPRBC’s may be used to support the patient with the surgeon’s
consent.
Obstetrics
Not normally used in Caesarean sections
possibility of an amniotic fluid embolism exists.
• 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, for example, the cell saver can be used with strict guidelines of irrigating profusely to remove amniotic fluid and then suctioning the blood that is being lost.
Topical Hemostatic Agents
Avitene, Helistat, Hemopad, Instat, or collagen type products
• Waste or wall suction source must be used. • Autotransfusion can be resumed once these products are
flushed from the surgical site.
• If Gelfoam, Surgicel, Thrombogen or Thrombostat are used, autotransfusion possibly can continue
direct suctioning of these products should be avoided
Contraindications a perfusionist
(like your future self)
is most likely to encounter
- Wound infections • Pleural effusion • Betadine • Warm solutions • Sterile water
- Malignancy • Topical hemostatic agents
Disadvantages
Depletion of plasma and platelets Removes plasma/platelets to eliminate activated clotting factors and
activated platelets (causes coagulopathy if reinfused) This disadvantage is evident when very large blood losses occur
• Typically, patient may require FFP/platelets when:
estimated blood loss > half of the patient’s blood volume. • Must test to determine the need for blood products
Special Considerations -
Orthopedic
Antibiotics which are plasma bound can be removed, topical antibiotics which are not plasma bound may not be washed out
may actually become concentrated to the point of being nephrotoxic.
• Cement is often used or encountered during primary or revision total joint replacement surgery. Cement in the liquid or soft state should not be introduced into the autotransfusion 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.
Special Considerations -
Emergency
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.
IBBM-CPBMT Certification
Currently, the International Board of Blood Management is the governing body for certification in
autotransfusion (CPBMT). The IBBM’s mission is to 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)
• 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.
Questions?
