1. Cell Saver Audit Dr Richard Evans (CONS) Dr Vikram Halikar (SHO) Dr Kevin Chu (PRHO)

2. Introduction Fresenius CATS (Continuous AutoTransfusion System) Autologous blood transfusion Mechanism –Citrate –Collection & Filter –Centrifuge & Wash –Haematocrit 60% (depending on wash)

3. Why this Audit? Usage & efficacy Cost implications Problems / Suggestions

4. Why Use A Cell Saver Loss of Transfusion Risk –Infection –Transfusion Error –Difficult Cross Match Blood Shortage Cost Benefits

5. When not to use a Cell Saver Tumour Infection Chemicals

6. Data Collected Cell Saver audit forms –August 2002 – April 2003 inclusive –9 months –48 patients Theatre Ledger Emergency Operation Lists Diary of Bookings Blood bank records

7. Cell Saver Audit Forms

8. Operations Vascular –Emergency AAA –Elective AAA Urology –Cystectomy –Prostatectomy –Nephrectomy Orthopaedic –Revision Hips / Occasional Total Hip Replacment –Spinal Fusions

9. Usage - General

10. Usage – AAA Repair

11. Blood Returned & Units Transfused

12. AAA Repair – Units Transfused

13. Cost Effectiveness Capital Cost –Cell Saver £21,000 (Now £14,000) –ODP Training £300 * 7 = £2,100 Running Costs (over 9 months) –48 cases * £90 disposables/case = £4,320

14. Cost Effectiveness Total Salvaged 24,971ml (over 9 months) –Approx 250ml / unit i.e. 100 units –Cost / unit £120 –Total Saved £12,000 Predicted Saving –£12,000 - £4,320 = £7,680 (over 9 months) –£10,240 savings per year (at current usage) –£160 savings per case

15. Problems / Missed Cases Availability –Of Cell Saver (double booking) –Of ODP trained in usage –Of ODP for usage in Emergency AAA Under-usage –Especially in orthopaedics –Relatively new technique –Lack of awareness: surgical & anaesthetic

16. Conclusions Cell Saver is highly cost effective Second unit (in orthopaedics) would bring further cost benefit Expanding staff training would allow greater usage of the machine

17. Suggestions / Plans 2 nd Machine for Orthopaedics Increase awareness Routine collection for –All Hip operations –All Knee operations (not using tourniquet) –Femoral Nails Expand staff training

18. Re-Audit This audit was first presented at the anaesthetic meeting on 5 September 2003 Re-audit of use 6 months from then

19. Thank You Any Questions?