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. Learning Outcomes To identify the indications for ICS
UK CELL SALVAGE ACTION GROUP
EDUCATION WORKBOOK
Learning Outcomes
To identify the indications for ICS
To identify the relative contraindications for ICS
To outline when the risks/benefits of using/not using ICS change

3. Indications and Contraindications
UK CELL SALVAGE ACTION GROUP
EDUCATION WORKBOOK
Indications and Contraindications
Indications and patient selection
Elective and emergency surgical procedures
Clinical decision (surgeon and/or anaesthetist)
Estimated blood loss >20% of patient’s estimated blood volume
Patient factors
Risk factors for bleeding
Low preoperative Hb
Rare blood group / multiple antibodies
Unwilling to receive allogeneic blood on religious or other grounds

4. Indications and Contraindications
UK CELL SALVAGE ACTION GROUP
EDUCATION WORKBOOK
Indications and Contraindications
Relative Contraindications
Bowel contents in the surgical field
Infected surgical fields
Sickle cell disease
Heparin induced thrombocytopenia (if heparin is the only available anticoagulant for ICS)

5. Indications and Contraindications
UK CELL SALVAGE ACTION GROUP
EDUCATION WORKBOOK
Indications and Contraindications
Warnings
Contaminating substances* e.g.
Non-intravenous substances
e.g. antibiotics not licensed for IV use; Iodine; topical clotting agents; orthopaedic cememt
Non-intravenous bodily fluids
e.g. gastric/pancreatic secretions; pleural effusions; metal fragments from implants
*Action when contaminating substances present:
Avoid aspirating (discontinue ICS)
Irrigate with 0.9% Sodium Chloride (NaCl)
Resume ICS

6. Indications and Contraindications
UK CELL SALVAGE ACTION GROUP
EDUCATION WORKBOOK
Indications and Contraindications
Cautions
Hartmann’s can inhibit the action of ACD-A anticoagulant if used as an irrigant or wash solution
Air will be present in the reinfusion bag (risk of air embolus)
Automatic mode is recommended

7. Indications and Contraindications
UK CELL SALVAGE ACTION GROUP
EDUCATION WORKBOOK
Indications and Contraindications
Areas for further consideration
Infected fields
Malignancy
Obstetrics
The decision to use blood that is potentially contaminated with bacteria, malignant cells or amniotic fluid 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.