test 2 Flashcards
Autotransfusion
- person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood
two main kinds of autotransfusion:
- Blood can be autologously “pre-donated”
* Alternatively, it can be collected during and after the surgery using an intraoperative blood salvage device
Acute Normovolemic Hemodilution (ANH)
- Whole blood drained via gravity into a blood collection bag containing anticoagulant
* Central line
* Venous line - Room temperature with agitation
- Good for 8 hours
- Properly labeled: name, MRN, date, time withdrawn
Cell saver
- intraoperative cell salvage machine that suctions, washes, and filters blood so it can be given back to the patient 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
Haemonetics
• Cell Saver 5
- have different bowl sizes
• Elite
Medtronic
• Autolog
- use less saline solution
Sorin
• Xtra
Cobe (Sorin)
• BRAT2
Dideco
• Compact Advanced Cell Saver
Fresenius (Terumo)
• C.A.T.S
- Continuous Autotransfusion System
Discontinuous cell salvage
- happen in 3 different phases
1) fill
2) wash
3) empty
Continuous cell salvage
- 3 phases happen all at once
1) fill
2) wash
3) empty
Aspiration Set
- Disposable
- Usually packaged separately from washing set
- Double line tube
* Anticoagulant line with drip chamber and roller clamp control
* Suction line for salvaged blood mixed with anticoagulant
Anticoagulant
- Disposable
- Heparinized saline (30,000 units Heparin/1 L saline)
- CPD (citrate-phosphate-dextrose)
- ACD-A (anticoagulant citrate dextrose solution- solution A)
Collection Reservoir
- Disposable
- ~3000 to 4000 mL capacity
- Gross filter or 30-100 micron filter
Bowl
• Disposable
• Varying sizes from 50 mL to 250 mL
-based on blood loss expected and size of patient
Wash Solution
- Disposable
* Normal saline
Disk
- used in continuous cell salvage
Latham bowl
- angled sides
Baylor bowl
- straight sides
C.A.T.S. process
1) first separation phase
- initial separation stage
- most of the unwanted constituents are separated out
- complete removal of non-emulsified fat
2) washing phase
- RBC resuspended with saline
- further removal of blood plasma
3) second separation phase
- final separation stage
- RBC packed to a hematocrit of 60-65%
- used saline removed
- monitors PRC filling level
Wash Phase
• When the bowl is filled:
- The pump starts (clamps adjust)
- wash solution -> wash bowl
• Washing continues until the re-infuse/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.
- disconnect -> purge air -> tie off
blood reinfusion must begin within how many hours from
collection
6 hrs
Ways of using Partially Filled Bowl
• “Concentrate”
• Send washed PRBC from reinfusion bag back to bowl
• Allows for a full bowl of RBC when no more blood is expected
from patient reservoir
• “Return”
• Sends contents of bowl back to patient reservoir
Labeling Specimens
anesthesia and transport
- Patients Registration sticker
- Type: i.e. WPRBC’s
- Time collected
- Time of expiration
- Volume
- Initials
Record Keeping
- A signed autologous cell salvage record must be kept for every case
- All the input and output data is recorded
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
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
- Eliminates need for compatibility testing
- Reduces risk of TRALI (transfusion related acute lung injury)
- Acceptable for most religious groups
- Cost-effective
PRBC vs cell salvaged blood
Packed red cells have a higher: 1) total volume 2) HCT 3) RBC volume 4) potassium 5) plasma free Hgb Cell salvage blood have a higher 1) remaining volume 2) pH 3) 2,3 DPG
Substances washed out
- Plasma
- Platelets
- WBC’s
- Fat
- Anticoagulant solution
- Plasma free hemoglobin
- Cellular stroma
- Activated clotting factors
- Intracellular enzymes
- Potassium
- Plasma bound antibiotics
Relative Contraindications
- Presence of bacterial contamination of the surgical site
- Malignancy of the surgical area
- 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 re-infused 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
Possible exceptions to this malignancy
• Removal of an encapsulated tumor is possible
• If an inadequate supply of blood exists
**The use of leukocyte reduction filters is recommended
Obstetrics
• do not want to suck up Amniotic fluid because it can cause inflammatory rxns that can cause an embolism
- washing cycle clears the amniotic fluid
• Can be used In a Jehovah’s witness patient to remove amniotic fluid and then suctioning the blood that is being lost
Topical Hemostatic Agents
- Do not get into cell saver because of clot formation
• 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
Special Considerations- Sickle Cell Anemia
- Debated issue
- Blood may sickle and further reduce oxygen-carrying capacity
- No trials, only case reports
Special Considerations Pheochromocytoma
- Adrenalectomy
- Blood may contain catecholamines that may cause severe hypertension when re-infused
- Cell salvage does not wash out catecholamines
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
- use small bowl and 1.5x wash
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
- NOT YOUR CALL
Contraindications a Perfusionist is most likely to encounter
- Wound infections
- Pleural effusion (fluid behind lungs)
- Betadine
- Warm solutions
- Sterile water and other irrigation solutions
- Malignancy
- Topical hemostatic agents
- Thrombin
Jehovah’s Witness Patients
• Refuse transfusion of whole blood and it’s products
• Red cells
• Platelets
• White cells
• Plasma
• Many will accept
• Albumin
• Cryoprecipitate
• Clotting factor concentrates
• Immunoglobulins
- circuit needs to be one continuous circuitDisadvantages
• Depletion of plasma and platelets
- Removes plasma/platelets to eliminate activated clotting factors and activated platelets (causes coagulopathy if re-infused)
- 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
IBBM-CPBMT Certification
• Currently, the International Board of Blood Management is the governing body for certification in autotransfusion (CPBMT)
IBBM’s mission
• 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/y
