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

UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Learning Outcomes To identify the steps taken in making the decision to process To list the equipment used for blood processing and describe the function of each component To describe the steps required in preparing for and commencing blood processing To describe the risks of overriding the automatic functions of the machine To identify the steps necessary to complete the blood processing phase

Blood Processing* Separation of RBCs from waste products UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Processing* Separation of RBCs from waste products Concentration of RBCs Washing of RBCs with 0.9% sodium chloride (NaCl) Transfer of RBCs to reinfusion bag *Blood collection can continue during the processing phase

Blood Processing Decision to process UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Processing Decision to process Adequate blood loss in collection reservoir Anticipated adequate blood loss in collection reservoir due to rapid bleeding Patient factors Low Hb Anticipated postoperative benefit

Blood Processing Full processing setup UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Processing Full processing setup

Blood Processing Automatic mode UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Processing Automatic mode It is highly recommended that ICS machines are run in automatic mode* *Running the machine in manual mode could result in residual contaminants in the RBCs, which could be potentially harmful to the patient

Blood Processing Wash volume UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Processing Wash volume Always use the minimum wash volume as outlined by the manufacturer DO NOT decrease wash volumes - this could result in potentially harmful contaminants being reinfused to the patient Wash volumes may be increased where there are some types of contaminants e.g. fat in orthopaedic procedures

Blood Processing During processing Replace wash solution as necessary UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Processing During processing Replace wash solution as necessary Change reinfusion bag if necessary Empty the waste bag as needed

Blood Processing Incomplete bowls UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Processing Incomplete bowls Inadequate RBCs to fill the bowl and complete processing (fixed volume systems) Processing incomplete bowls manually is NOT recommended* Wait for more blood loss in the collection reservoir Concentrate function – uses already processed RBCs from the reinfusion bag to fill the bowl and complete the processing *Processing incomplete bowls may result in potentially harmful contaminants being reinfused to the patient

Blood Processing Completing processing Empty reinfusion line UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Processing Completing processing Empty reinfusion line Remove air from reinfusion bag Disconnect reinfusion bag

Blood Processing Troubleshooting Incomplete bowls UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Processing Troubleshooting Incomplete bowls Machine Alarms (on screen instructions)

Wet – Dry weight of swabs UK CELL SALVAGE ACTION GROUP EDUCATION WORKBOOK Blood Processing Blood loss calculations n.b. Irrigation relates to irrigation used within the surgical field and aspirated into the system and not to the volume of IV normal saline (0.9% NaCl) wash solution used during processing Calculation - - - + + + = Example - - - + + = Fluid in Irrigation fluid Anticoagulant used Swab wash Theatre suction Wet – Dry weight of swabs Approx. blood loss 2,500ml 200ml 400ml 1,000ml 150ml 1,250ml