1. 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

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. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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.

11. 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.