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 Practicalities – Blood Reinfusion Information and Best Practice Unloading and Discarding

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

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

Blood Collection Decision to collect blood Anticipated blood loss 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

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

Blood Collection Anticoagulants* Heparin saline ACD-A 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

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

Blood Collection During collection 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

Blood Collection Maximising blood collection 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

Blood Collection Swab washing Blood normally lost to swabs is salvaged 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.

Blood Collection Troubleshooting Loss of suction Clotting in reservoir 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.