1. Cell Salvage Scenarios' Trainers copy

2. Scenario 1 You arrive at work and have been requested to help with cell salvage You notice that reinfusion bag has fat molecules inside it 2 bowls of packed red cells have already been re infused What will you do? Stop transfusion. Alert anaesthetist and surgeon Complete trust incident form https://aic.mhra.gov.uk/mda/sabresystem.nsf/Login?Open http://www.transfusionguidelines.org.uk/ Monitor patient

3. Scenario 2 You are in the middle of using the cell saver for a case when the surgeon informs you that the patient has cancer. Should you continue to salvage blood - check consent form regarding surgery and blood transfusion If yes why? If no why? What could you do to minimize the risk of transfusion to the patient? Surgeon or Anaesetists decision to proceed (check consent) Life saving (leucocytes depletion filters) Discard unfiltered blood Set up for new cell salvage kit and filter (medical decision) http://www.transfusionguidelines.org.uk/ The use of leukocyte depletion filters

4. Scenario 3 Your theatre team have been involved with a patient who has just encountered increased hypotension while transfusing autologous blood (transfusion reaction). The blood is being administered via a leucocytes depletion filter. What processes can you put in place to prevent a transfusion reaction occurring again  Review blood transfusion protocol within the trust.  Training  Vigilance  http://www.transfusionguidelines.org.uk/ http://www.transfusionguidelines.org.uk/ How would you reflect and learn from the incident  team de-brief  training  reflective evidence for portfolio  share with colleagues  Route cause analysis

5. Scenario 4 Surgeon informs the team that they have ruptured the patients bowel whilst carrying out a liver resection. What will you do?  Stop transfusion  Communicate with scrub team about contamination and the need to set up normal suction.  Discuss the need for more blood products to be organised with blood bank.  Review contra-indications for cell salvage (post-op) http://www.transfusionguidelines.org.uk/ http://www.transfusionguidelines.org.uk/  Aspiration in emergency is a medical decision

6. Scenario 5 You are using the cell saver when you notice blood clots in the centrifuge bowl. What will you do?  Check that haemostatic agent has been used  Increase flow rate of anticoagulant  Assess the need to change the consumable.

7. Scenario 6 At the end of the case you have a partial bowl of blood to reinfuse. What should you do?  Stop and do not use the blood in the bowl  Identify if the patient has rare anti bodies or blood type that would make cross matching blood difficult.  Concentrate the blood, wash and reinfuse  Wash a partial bowl (this will provide a lower Hcb, quality of blood not assured)