Autotransfusion- Exam 3 Flashcards
(71 cards)
1
Q
Autotransfusion
A
person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood
2
Q
Autotransfusion
A
person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood
3
Q
Two main kinds of autotransfusion
A
- Autologously “pre-donated”
2. Collected during and after the surgery using an intraoperative blood salvage device (ex. cell saver)
4
Q
Cell Saver
A
Intraoperative cell salvage machine suctions, washes, and filters blood so it can be given back to the patient’s body instead of being thrown away
5
Q
What’s the limit to the amount of blood that can be given back to the patient?
A
No limit because the blood is recirculated
6
Q
What’s the limit to the amount of blood that can be given back to the patient?
A
No limit because the blood is recirculated
7
Q
Types of intraoperative cell savers
A
Discontinuous
Continuous (CATS)
8
Q
Types of intraoperative cell savers
A
Discontinuous
Continuous (CATS)
9
Q
Autologous Cell Washing Devices
A
Haemonetics- Cell Saver 5
Haemonetics- Elite
10
Q
Autologous Cell Washing Devices
A
Haemonetics- Cell Saver 5 Haemonetics- Elite Medtronic-Autolog Sorin- Xtra Cobe- BRAT Dideco- Compact Advanced Cell Saver Fresenius (Terumo)- CATS
11
Q
CATS
A
continuous autotransfusion system
12
Q
CATS
A
continuous autotransfusion system
13
Q
Is the reinfusion bag used to reinfuse patient? Why or why not?
A
No, use transfer pack; blood must be filtered; air can get to the patient
14
Q
What disposables are involved when setting up the cell saver?
A
Aspiration set Heparinized saline collection reservoir bowl wash solution collection bag blood filter, lipid filter, leukocyte reduction filter transfer packs
15
Q
What disposables are involved when setting up the cell saver?
A
Aspiration set Heparinized saline collection reservoir bowl wash solution collection bag blood filter, lipid filter, leukocyte reduction filter transfer packs
16
Q
How is the aspiration set usually packaged?
A
usually packaged separately from washing set
17
Q
What type of tube is the aspiration set?
A
Dual lumen tube
- Anticoagulant line with drip chamber and roller clamp control
- suction line for salvages blood mixed with anticoagulant
18
Q
Anticoagulant Components
A
Heparinized Saline (30,000 units Heparin/1000 mL saline)
CPD (citrate-phosphate dextrose)
ACDA (anticoagulant citrate dextrose solution- Solution A)
19
Q
What is the capacity of the collection reservoir?
A
3000 to 4000 mL capacity
20
Q
Describe the filter on the collection reservoir.
A
Gross filter or 30-1000 micron filter
21
Q
What is the size of the bowl?
A
Varying sizes from 50mL to 250 mL
22
Q
What are the 3 types of bowls/disks?
A
- Turbo bowl (Medtronic autolog)
- Disk (CATS)
- Latham Bowl
23
Q
What are the 3 types of bowls/disks?
A
- Turbo bowl (Medtronic autolog)
- Disk (CATS)
- Latham Bowl
24
Q
What is the CATS system washing process?
A
- Separation phase (Hct 80%)
- Washing phase
- Second separation phase (Hct 60-65%)
25
What are the main phases of washing cells?
1. Fill
2. Wash
3. Empty
26
What are the main phases of washing cells?
1. Fill
2. Wash
3. Empty
27
Fill Phase
- Centrifuge/accelerates to the speed selected on the centrifuge speed control (~5600 rpm)
- Pump begins rotation, transferring reservoir contents to was bowl
- Application of centripetal acceleration separates the components of the fluid according to their weight (layering)
28
Fill Phase
- Centrifuge/accelerates to the speed selected on the centrifuge speed control (~5600 rpm)
- Pump begins rotation, transferring reservoir contents to was bowl
- Application of centripetal acceleration separates the components of the fluid according to their weight (layering)
29
During the fill phase, the wash bowl filling continues until what?
Until the buffy coat reaches the shoulder of the wash bowl
30
What happens in the "auto mode" of the fill phase?
Autotransfusion devices have automatic buffy coat sensor which is calibrated to detect a fill bowl.
Fill phase--> wash phase automatically
31
Wash phase
when the bowl is filled: the pump starts (clamps adjust)
| wash solution --> wash bowl
32
In the wash phase, washing continues until when?
Until the reinfuse/empty button is depressed (or the program ends and the predetermined amount of wash solution has been used)
33
What way does effluent move in the wash phase?
Wash bowl --> waste bag
34
What way does effluent move in the wash phase?
Wash bowl --> waste bag
35
In manual mode (wash phase), what do you need to watch for?
Watch for clear effluent
36
What happens in the empty phase?
The centrifuge stops, then transfers wash bowl --> reinfusion bag
The cycle ends and a new cycle can begin
The reinfusion bag should not be used for direct pressure infusion --> patient
The reinfusion bag may contain air
Therefore, a separate blood bag attached to the reinfusion bag is used
Disconnect --> air purge--> tied off
37
Blood should be reinfused within how many hours of washing?
AABB- 4 hours
| Manual of Clinical Perfusion- 6 hours
38
Blood should be reinfused within how many hours of washing?
AABB- 4 hours
| Manual of Clinical Perfusion- 6 hours
39
Labeling Specimens (Anesthesia and transport)
```
Patients Registration Sticker
Type: WPRBCs
Time collected
time of expiration
Volume
initials
```
40
Labeling Specimens (Anesthesia and transport)
```
Patients Registration Sticker
Type: WPRBCs
Time collected
time of expiration
Volume
initials
```
41
Record Keeping
A signed autologous cell saver record must be kept for every case
All the input and output data is recorded
Usually single sheet that may contain:
-Volume collected for reinfusion
-Hct for reinfusion volume (WPRBC's -QC)
-Type and volume of wash solution used
-Heparinized saline/CPD concentration & amount used
-Date/time/patient information
42
Record Keeping
A signed autologous cell saver record must be kept for every case
All the input and output data is recorded
Usually single sheet that may contain:
-Volume collected for reinfusion
-Hct for reinfusion volume (WPRBC's -QC)
-Type and volume of wash solution used
-Heparinized saline/CPD concentration & amount used
-Date/time/patient information
43
Indications
Control blood loss
Recovery of blood lost during surgery
Rare blood groups w/o blood available
Risk of infectious disease transmission
Autotransfusion is common intraoperatively/postop
recovery of blood in ECC at end of surgery from aspirated damage
44
When can autotransfusion be done?
Post protamine
CPB circuit salvage
ICU pre-washing
pRBCS for pediatrics
45
What are some advantages of autotransfusion?
```
High levels of 2,3-DPG
Normothermic (bank blood is cold)
pH relatively normal
lower risk of infectious disease
functionally superior cells
lower potassium (compared to stored blood)
quickly available
```
46
What does 2,3-DPG do?
Helps with oxygen transfer
47
What substances are washed out?
```
plasma
platelets
WBCs
anticoagulation solution
plasma free hemoglobin
cellular stroma
activated clotting factors
intracellular enzymes
potassium
plasma bound antibiotics
```
48
What are some contraindications?
presence of bacterial contaminations at surgical site
malignancy of surgical area
C-section (obstetrics)
topical hemostatic agents
49
Any ________ procedure poses risk of contamination.
Abdominal
50
If there is a question of possible contamination, what should happen?
Blood may be held until the surgeon determines whether or not bowel contents are in the surgical field (standby w/ reservoir)
51
If blood is contaminated what should happen?
Entire contents should be discarded
| *If patient's life depends on this, it may be reinfused with the surgeon's consent
52
What will reduce the bacterial contamination of blood, but will not be totally eliminated?
Large amounts of 0.9% NS
53
What will reduce the bacterial contamination of blood, but will not be totally eliminated?
Large amounts of 0.9% NS
54
Malignancy
The possibility exists of reinfusion cancer cells form the surgical site
55
What are some possible exceptions to the malignancy contraindication?
Removal of an encapsulated tumor possible; blood may be aspirated from the surgical site, processed and reinfused with the surgeon's consent
-If an inadequate supply of blood exists (wprbcs may be used to support the patient with the surgeon's consent
56
What is recommended if using autotransfusion with malignancy?
Leukocyte reduction filters
57
Why is autotransfusion not usually used in C-sections?
Possibility of amniotic fluid embolism exists, but emerging literature surggests that amniotic fluid is being cleared during the wash cycle
58
Can a cell saver be used in a Jehovah's witness patient?
Cell saver can be used with strict guidelines of irrigating profusely to remove amniotic fluid and then suctioning the blood that is being lost
59
What are some topical hemostatic agents?
```
Avitene
Helistat
Hemopad
instat
collagen type products
```
60
Topical Hemostatic Agents
```
Avitene
Helistat
Hemopad
instat
collagen type products
```
Waste or wall suction must be used
Autotransfused can be resumed once these products are flushed form the surgical site
If gelfoam, surgicel, thrombogen, thrombostat are used, autotranfusion possibly can continue (direct suctioning of these products should be avoided)
61
Contraindications a perfusionist is most likely to encounter
```
Wound infections
Pleural effusion
betadine
warm solutions
sterile water
malignancy
topical hemostatic agents
```
62
Disadvantages of Autotransfusion
Depletion of plasma and platelets- to eliminate clotting factors and activated platelets, causes coagulopathy if reinfused
63
When is the disadvantage of depletion of plasma and platelets evident?
When very large blood losses occur
64
Typically, patient may require FFP/platelets when...
Estimated blood loss is greater than half of the patient's blood volume; must test to determine the need for blood products
65
Typically, patient may require FFP/platelets when...
Estimated blood loss is greater than half of the patient's blood volume; must test to determine the need for blood products
66
Special Considerations: Orthopedic
Antibiotics which are plasma bound can be removed, topical antibiotics which are not plasma bound may not be washed out (may actually become concentrated to the point of being nephrotoxic)
Cement is often used or encountered during primary or revision total join replacement surgery. Cement in the liquid or soft state should not be introduced into the autotransfusion system
67
The use of ultrasonic equipment during revision of total joints does what?
Changes the cement to a liquid or soft state precluding autotransfusion during the use of such equipment
68
Special Considerations: Emergency
in life saving situations with the consent of the surgeon, autotransfusion can be utilized in the presence of the previous stated contraindications i.e. sepsis, bowl contamination and malignancy
69
What is the governing body of autotransfusion?
International Board of Blood Management (CPBMT)
70
What is the IBBM's mission?
TO promote education and sound scientific principles to advance the safe and competent practice of perioperative blood management
71
In order to become a Certified Perioperative Blood Management Technologist (CPBMT)
Min high school diploma/equivalent
Be practicing in the field of blood management for a min of 1 year
Complete 50 autotransfusion procedures/year
