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Perf Tech III (Exam 3) > Topic 11: Autotransfusion > Flashcards

Topic 11: Autotransfusion Flashcards

1
Q

Autotransfusion-?

A

person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood.

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2
Q

There are two main kinds of autotransfusion

A

: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)

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3
Q

Cell saver

A

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.
Bc the blood is recirculated, there is no limit to the amount of blood that can be given back to the patient

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4
Q

Types of intraoperative cell savers

A
  • Discontinous

* Continous (i.e. CATS)

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5
Q

Haemonetics

A

Cell Saver 5

Elite

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6
Q

Medtronic

A

Autolog

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7
Q

Sorin

A

Xtra

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8
Q

Cobe

A

BRAT

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9
Q

Dideco

A

Compact Advanced Cell Saver

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10
Q

Fresenius (Terumo)

A
  • CATS system

* Continuous auto transfusion system

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11
Q

Setup of the Disposables: cell savers

A
  • Aspiration set
  • Heparinized Saline
  • Collection Reservoir
  • Bowl
  • Wash Solution
  • Collection Bag
  • Blood Filter, Lipid filter, Leukocyte reduction filter
  • Transfer packs
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12
Q

Aspiration Set

A
  • 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
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13
Q

•Anticoagulant

A
  • Heparinized saline (30,000 units Heparin/1000 mL saline)
  • CPD(citrate-phosphate-dextrose)
  • ACD-A (anticoagulant citrate dextrose solution-solution A)
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14
Q

Collection Reservoir

A
  • ~3000 to 4000 mL capacity

* Gross filter or 30-100 micron filter

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15
Q

•Bowl

A

•Varying sizes from 50 mL to 250 mL

Turbo bowl, Disk, Latham Bowl

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16
Q

Phases of Washing Cells

A

Fill
Wash
Empty

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17
Q

Fill Phase – Washing cells

goes to what speed? and how does it work?

A

Centrifuge/accelerates to the speed selected on the centrifuge speed control (typically 5,600 rpm).
•The pump begins rotation, transferring
Reservoir contents —-> wash bowl.
•The application of centripetal acceleration* separates the components of the fluid according to their weight (layering)
The wash bowl filling continues until the buffy coat reaches the shoulder of the wash bowl.
•Note: Centrifugal force does NOT exist

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18
Q

Fill Phase – Washing cells AUTO mode?

A

•In the “auto mode” autotransfusion devices have
automatic buffy coat sensor, which is calibrated to detect
a full bowl.
Fill phase —>Wash phase automatically

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19
Q

Wash Phase –

A

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
20
Q

During Wash Phase – manual mode note?

A

watch for clear effluent

21
Q

Empty Phase

A

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 —> air purge –> tied off
In accordance with Guidelines set by the American Association of Blood Banks (AABB) the blood should be reinfused within 4 hours from washing

22
Q

Empty Phase

A

•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 —> air purge –> tied off

23
Q

The reinfusion bag ____ used for direct pressure infusion to patient

A

should not be

The reinfusion bag may contain air
Therefore, a separate blood bag attached to the reinfusion bag is used.
disconnect —> air purge –> tied off

24
Q

In accordance with Guidelines set by the American Association of Blood Banks (AABB) the blood should be reinfused within _____ from washing

A

4 hours from washing

25
Q

Labeling Specimens (anesthesia and transport) - what aspects need labeling?

A
  • Patients Registration sticker
  • Type: i.e. WPRBC’s
  • Time collected
  • Time of expiration
  • Volume
  • Initials
26
Q

Record Keeping?

A

A signed autologus cellsaver record must be kept for every case
•All the input and output data is recorded

27
Q

•Usually a single record keeping sheet that may contain what aspects?

A
  • 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
28
Q

Indicators for cell washing? 6

A
  • 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 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)
29
Q

Advantages of Cell washing? 7

A
  • 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
30
Q

Substances washed out during cell washing? 10

A
  • Plasma
  • Platelets
  • WBC’s
  • Anticoagulant solution
  • Plasma free hemoglobin
  • Cellular stroma
  • Activated clotting factors
  • Intracellular enzymes
  • Potassium
  • Plasma bound antibiotics
31
Q

Contraindications to cell washing - 4

A
  • Presence of bacterial contamination of the surgical site
  • Malignancy of the surgical area
  • C-section (obstetrics)
  • Topical hemostatic agents
32
Q

Contamination of the surgical site

A

•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

33
Q

How to reduce bacterial contamination in cell salvage blood if you have to use it?

A

Large amounts of a 0.9% NS will reduce the bacterial contamination of the blood, it will not be totally eliminated

34
Q

In cell washed cells - Malignancy (cancer whats the deal)

what must you use?

A

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.
**The use of leukocyte reduction filters is recommended

35
Q

Obstetrics (C-section) and cell washing?

A

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

36
Q

Cell washing during C-section with Jehovahs witness

A

•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.

37
Q

Topical Hemostatic Agents and cell washing

A

•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

38
Q

Topical Hemostatic Agent types?

A

Avitene, Helistat, Hemopad, Instat, or collagen type products

39
Q

Contraindications a perfusionist (like your future self ) is most likely to encounter– 7

A
  • Wound infections
  • Pleural effusion
  • Betadine
  • Warm solutions
  • Sterile water
  • Malignancy
  • Topical hemostatic agents
40
Q

disadvantage of cell washing that is evident when very large blood losses occur?

A

Depletion of plasma and platelets
Removes plasma/platelets to eliminate activated clotting factors and activated platelets (causes coagulopathy if reinfused)

41
Q

Disadvantages of Cell Washing - 3

A

• Depletion of plasma and platelets
•Typically, patient may require FFP/platelets when:
estimated blood loss > half of the pt’s blood volume.
•Must test to determine the need for blood products

42
Q

Special Considerations-Orthopedic of cell washing??
Drugs?
what is the deal with cement?

A

•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.

43
Q

Special Considerations-Orthopedic of cell washing??

what is the deal with cement?

A

•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

44
Q

Special Considerations -Emergency

A

•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

45
Q 
In order to become a Certified Perioperative Blood
Management Technologist (CPBMT)
A
  • 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
46
Q

IBBM-CPBMT Certification

A

•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

Perf Tech III (Exam 3) (4 decks)

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