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Intraoperative Cell Salvage

UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK. Intraoperative Cell Salvage. Basic Blood Facts Blood Conservation Haemovigilance Principles of Intraoperative Cell Salvage Indications and Contraindications Practicalities – Blood Collection Practicalities – Blood Processing

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Intraoperative Cell Salvage

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  1. UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Intraoperative Cell Salvage • Basic Blood Facts • Blood Conservation • Haemovigilance • Principles of Intraoperative Cell Salvage • Indications and Contraindications • Practicalities – Blood Collection • Practicalities – Blood Processing • Practicalities – Blood Reinfusion • Information and Best Practice • Unloading and Discarding

  2. UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Learning Outcomes • To identify the equipment used for blood collection and describe the function of each component • To name the two main types of anticoagulant used in ICS, describe their functions and mechanism of action • To describe methods of maximizing blood collection • To identify potential problems areas during blood collection

  3. UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Collection • Aspiration of blood from surgical field • Anticoagulation • Filtering • Storage prior to processing

  4. UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Collection • Decision to collect blood • Anticipated blood loss • Patient risk factors for bleeding • Low Preoperative Haemoglobin • Patient objections to receiving allogeneic (donor) blood

  5. UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Collection • Collect only setup Where adequate blood loss for processing cannot be predicated

  6. UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Collection • Anticoagulants* • Heparin saline • 25-30, 000 IU heparin/1000mls IV normal saline (0.9% NaCl) • Ratio 1:5 e.g. 20ml to 100ml blood • Antithrombin III Ineffective if the patient suffers an antithrombin III deficiency • ACD-A • Pre-prepared • Ratio 1:7 e.g. 15ml to 100ml blood • Binds Calcium Calcium containing fluids may block the action of ACD-A e.g. Hartmann’s Solution *Recommended minimum flow rate – 1 drip per second

  7. UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Collection • Wide bore suction tip • e.g. Yankauer • Low vacuum level • to minimise RBC Haemolysis

  8. UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Collection • During collection • Regulate vacuum • Regulate anticoagulant flow (↑ with ↑ blood loss) • Monitor volume of blood loss Only IV grade fluids should be aspirated into the system

  9. UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Collection • Maximising blood collection • Maintain a low vacuum level • Suction technique (aspirate from pools of blood) • Wide bore suction tip • Swab washing

  10. UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Collection • Swab washing • Blood normally lost to swabs is salvaged • Sterile bowl • 1000mls IV normal Saline (0.9%NaCl) • Swabs placed in bowl for ~ 5 mins then gently squeezed out • Swab wash aspirated in to ICS machine and processed Ensure the swab wash bowl is maintained within the sterile field. Ensure no substances not intended for IV use enter the swab wash bowl e.g. Betadine soaked swabs.

  11. UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Collection • Troubleshooting • Loss of suction • Clotting in reservoir • Contamination with non-IV substances* *The decision to use blood that is potentially contaminated with bacteria, amniotic fluid or malignant cells should be made by the clinicians caring for the patients, taking into account the latest evidence and considering the risks and benefits for the individual patient.

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