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

Learning Outcomes To identify the indications for ICS UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Learning Outcomes To identify the indications for ICS To identify the relative contraindications for ICS To outline when the risks/benefits of using/not using ICS change

Indications and Contraindications UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Indications and Contraindications Indications and patient selection Elective and emergency surgical procedures Clinical decision (surgeon and/or anaesthetist) Estimated blood loss >20% of patient’s estimated blood volume Patient factors Risk factors for bleeding Low preoperative Hb Rare blood group / multiple antibodies Unwilling to receive allogeneic blood on religious or other grounds

Indications and Contraindications UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Indications and Contraindications Relative Contraindications Bowel contents in the surgical field Infected surgical fields Sickle cell disease Heparin induced thrombocytopenia (if heparin is the only available anticoagulant for ICS)

Indications and Contraindications UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Indications and Contraindications Warnings Contaminating substances* e.g. Non-intravenous substances e.g. antibiotics not licensed for IV use; Iodine; topical clotting agents; orthopaedic cememt Non-intravenous bodily fluids e.g. gastric/pancreatic secretions; pleural effusions; metal fragments from implants *Action when contaminating substances present: Avoid aspirating (discontinue ICS) Irrigate with 0.9% Sodium Chloride (NaCl) Resume ICS

Indications and Contraindications UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Indications and Contraindications Cautions Hartmann’s can inhibit the action of ACD-A anticoagulant if used as an irrigant or wash solution Air will be present in the reinfusion bag (risk of air embolus) Automatic mode is recommended

Indications and Contraindications UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Indications and Contraindications Areas for further consideration Infected fields Malignancy Obstetrics The decision to use blood that is potentially contaminated with bacteria, malignant cells or amniotic fluid 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.