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 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

3. 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

4. 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

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

6. 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

7. 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

8. 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

9. 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

10. 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

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

12. 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