/policies/,/policies/clinical/,/policies/clinical/uw-health-clinical/,/policies/clinical/uw-health-clinical/gen-care/,/policies/clinical/uw-health-clinical/gen-care/blood-products/,

/policies/clinical/uw-health-clinical/gen-care/blood-products/225.policy

20160363

page

100

UWHC,UWMF,

Policies,Clinical,UW Health Clinical,General Care and Procedures,Blood Products

Intraoperative Blood Salvage (2.2.5)

Intraoperative Blood Salvage (2.2.5) - Policies, Clinical, UW Health Clinical, General Care and Procedures, Blood Products

2.2.5


UW HEALTH CLINICAL POLICY 1
Policy Title: Intraoperative Blood Salvage
Policy Number: 2.2.5
Category: UW Health
Type: Inpatient
Effective Date: March 1, 2016

I. PURPOSE

To provide a standard method of assembling, operating and dismantling the intraoperative autotransfusion
device for all patients requiring autotransfusion. This policy will also address the various quality control
goals and objectives and will define training requirements.

II. DEFINITIONS

A. Autotransfusion is the collection, processing, and reinfusion of a patient’s own blood, which has been lost
during a surgical procedure. Autotransfusion requires special sterile equipment that simultaneously suctions
blood from the operative site, treats with anticoagulants, filters, washes and returns saline suspended
packed red blood cells to the patient. Intraoperative salvage of red blood cells, using an autotransfusion
apparatus, is an important part of blood conservation in the Operating Room.
i. Several reports document the safety of red blood cell saving. Specifically, no adverse CNS events,
1no increased infectious complications, 2no increased hemolysis or fat emboli, 3reduced circulating
markers of systemic inflammation from suctioned blood, 4and overall reduced complication rates
are associated with intraoperative use of autotransfusion devices.5 In addition, the reinfusion of a
patient's own blood significantly diminishes the complications of homologous transfusions, i.e.
incompatibility, coagulopathy, transmission of blood borne infections, transfusion reactions6 and it
also reduces the use of bank blood.7

III. POLICY ELEMENTS

The governing principle of this program is to assure that autotransfusion procedures are uniform and safe.
The Medical Director of Autotransfusion Services, in conjunction with the Perfusion Manager or designee
shall monitor and comply with the American Association of Blood Banks (AABB) standards, and form written
policies and procedures in accordance with the established guidelines. Blood collected perioperatively shall
not be transfused to other patients or stored in the Operating room or Blood Bank.

IV. PROCEDURE

A. Patients undergoing surgical intervention with an anticipated blood loss of 20% of estimated blood volume or
anticipated transfusion requirements of one unit are eligible for autologous blood collection and processing.
B. The patient should have a consent for blood transfusion in their chart. The attending physician or designee
is responsible for obtaining informed consent from the patient. See UWHC policy #4.17, Informed Consent.
C. The scheduling physician may place the request for autotransfusion via the surgeon preference card,
OpTime scheduling with a note of autotransfusion in the special request section or a case request card.
D. If autotransfusion is needed during a procedure, the surgeon will communicate that verbally to the circulating
nurse.
i. For non-cardiac procedures where a Perfusionist is not a part of the procedure, (vascular,
orthopedic, trauma, liver transplant, pediatrics) the circulating nurse will notify the on-call Surgical
Clinical Monitoring Tech.
ii. For procedures involving a Perfusionist (cardiac), the circulating nurse will notify the on-call
Perfusionist.
E. Primary Contraindications
i. Grossly contaminated wounds or sepsis.
ii. Clotting agents and Betadine irrigation.
iii. Bowel surgery or bowel perforation.
iv. Sickle cell disease.
v. Cold Agglutinin antibodies.
vi. Malignancy (see below).
vii. For additional AABB contraindications of and contraindications to perioperative autotransfusion see
Guidelines for blood recovery and reinfusion in surgery and trauma. American Association of Blood
Banks Autologous Transfusion Committee, 1996-1997 Committee.



UW HEALTH CLINICAL POLICY 2
Policy Title: Intraoperative Blood Salvage
Policy Number: 2.2.5

F. Equipment List
i. One Autotransfusion device with cardiotomy holder.
ii. A filtered cardiotomy reservoir, suction tubing, bowl and harness set.
iii. Once vacuum source canister with sterile suction extension tubing.
iv. Three 1000 ml bags of 0.9% NS.
v. One Pharmacy prepared Heparin bag (30,000 units/1000 ml 0.9% NS)
vi. One cell saving record sheet with clipboard.
G. Blood Administration
i. Identifying the Recipient and Processed Blood
a. Processed units are identified in the same manner as Blood Bank issued units. Follow
Surgical Services departmental policy #2.04, Blood and Blood Components – OR. Primary
identification is carried out by the processor, secondary by the transfusionist.
ii. Starting the Transfusion
a. The transfusionist should record the patient’s pre-transfusion vital signs, i.e. temperature,
blood pressure, pulse, respiration rate on the OR record.
b. Record the date and time the transfusion was started.
c. The transfusionist should remain with the patient for the first few minutes of the
transfusion, which should be started slowly.
iii. Patient Care During Transfusion
a. After the first fifteen minutes, the patient should be observed and the vital signs recorded;
if the patient’s condition is satisfactory, the rate of infusion can be increased.
b. Personnel should continue to observe the patient periodically throughout the transfusion
and up to an hour after completion.
iv. Transfusion Follow-up
a. After the processed blood has been infused, personnel should record the following:
1. The date and time the transfusion was completed.
2. Indicate whether the entire unit was given.
3. Note any transfusion reaction.
4. Record post-transfusion vitals.
H. Transfusion Reactions
i. Stop the transfusion immediately. Follow Surgical Services departmental policy #2.04, Blood and
Blood Components – OR Section J. Compare salvaged blood with patient information for
identification errors. Notify Blood Bank at extension 3-8367 and return any unused blood with the
attached transfusion set and any intravenous solutions to the Blood Bank. Transfusion reactions
should follow UWHC policy #8.12, Blood and Blood Component Transfusion (Requiring Pre-
Transfusion Testing).
I. Special Situations: Massive Blood Loss and Disaster Preparedness
i. Massive Blood Loss: Some procedures may necessitate the use of two cardiotomy reservoirs and
two cell saving devices. Situations may require an additional autotransfusion reservoir and/or
processing device. Follow the same steps outlined in set up, by gathering an additional cardiotomy
reservoir, Heparin, saline, and a field suction line. Process the blood in the normal fashion using
the two autotransfusion devices.
J. Personnel and Training Requirements
i. Each technician will review this policy. Training will occur on an individual basis and will be the
responsibility of the Perfusion Manager or designee. Training consists of didactic instruction on the
principles of autotransfusion and actual hands on clinical training. The personnel who operate this
equipment must first complete the following: Identify surgical procedures which benefit from
autologous salvage. Describe contraindications and appropriate actions taken for a suspected
transfusion reaction. Describe mechanical operation of the equipment. Identify each disposable
component needed for the collection and processing of autologous blood.
ii. Competency of personnel performing autotransfusion will be checked annually during the user and
device proficiency testing and general performance review Competency results will be reviewed by
the Perfusion Manager. Immediate feedback and training will be provided as necessary.
K. Quality Control and Quality Assurance
i. In order to ensure the consistent quality of salvaged blood products, each individual and machine
will undergo annual testing. This testing will take place during an elective surgical procedure.
Samples of the processed blood will be sent to the laboratory for analysis. These samples will be
collected from routine cases using conventional processing techniques. It will be the responsibility



UW HEALTH CLINICAL POLICY 3
Policy Title: Intraoperative Blood Salvage
Policy Number: 2.2.5

of the Perfusion Manager or designee to coordinate the collection of the blood samples according
to Surgical Services departmental policy #2.15, Laboratory Specimen Guidelines. The costs of
these QA tests will be those of the Operating Room and will not be billed to the patient. Laboratory
findings may include any of the following: potassium, hematocrit, plasma free hemoglobin, and
Anti-Xa concentration.
ii. Results are logged in an excel spreadsheet, approved and retained by the Perfusion Manager.
L. Record Keeping
i. The Perfusion Manager will retain the following record for at least five years:
a. Primary records are maintained within the facility patient clinical record. In the event of
computer downtime, paper copies of the Intraoperative Autotransfusion Record (UWH
Form #1289250) will be used.
b. Quality Assurance Logs
c. Employee Training Documents
d. Equipment Maintenance Records

V. FORMS

Intraoperative Autotransfusion Record UWH #1289250

VI. COORDINATION

Author: Director, Surgical Services
Senior Management Sponsor: SVP, Patient Care Services and CNO
Reviewers: Surgical Services Supervisor; Perfusion Manager; Anesthesia Support Services Manager
Approval committees: Surgical Services Policy and Procedure Committee; UW Health Clinical Policy
Committee
UW Health Clinical Policy Committee Approval: February 15, 2016

UW Health is a cohesive, united and integrated academic medical enterprise comprised of several entities.
This policy applies to facilities and programs operated by the University of Wisconsin Hospitals and Clinics
and the University of Wisconsin Medical Foundation, Inc., and to clinical facilities and programs
administered by the University of Wisconsin School of Medicine and Public Health. Each entity is
responsible for enforcement of this policy in relation to the facilities and programs that it operates.

VII. APPROVAL

Peter Newcomer, MD
UW Health Chief Medical Officer

J. Scott McMurray, MD
Chair, UW Health Clinical Policy Committee

VIII. REFERENCES

1. Svenmarker and Engstrom KG. The inflammatory response to recycled pericardial suction blood and the
influence of cell-saving. Scan Cardiovasc 2003; 37:158-164.
2. Ishida T, Nakano K and Nakatani H, et al. Relation between intraoperative salvaged blood transfusion
and postoperative infection after cardiac surgery. Kyobu Geka 2002; 55:763-767.
3. Jewell AE, Akowuah EF, Suvarna SK, Braidley P, Hopkinson D and Cooper G. A prospective randomized
comparison of cardiotomy suction and cell saver for recycling shed blood during cardiac surgery. Eur J
Cardiothorac Surg 2003; 23:633-636.
4. Perttila J, Leino L, Poyhonen M and Salo M. Leucocyte content in blood processed by autotransfusion
devices during open-heart surgery. Acta Anaesthesiol Scand 1995; 39:445-448.
5. Moran JM, Babka R and Silberman S, et al. Immediate centrifugation of oxygenator contents after
cardiopulmonary bypass role in maximum blood conservation. J Thorac Cardiovasc Surg 1978; 76:510-
517.
6. Laub GW, Dharan M, Riebman JB, et al. The impact of intraoperative autotransfusion on cardiac surgery.
A prospective randomized double-blind study. Chest 1993; 104:686-689.



UW HEALTH CLINICAL POLICY 4
Policy Title: Intraoperative Blood Salvage
Policy Number: 2.2.5

7. Murphy GL, et al. Safety and efficacy of perioperative cell salvage after coronary artery bypass grafting; a
randomized trial. Ann Thorac Surg 2004; 77:1553-1559.

UWHC policy #4.17, Informed Consent
Surgical Services departmental policy #2.04, Blood and Blood Components – OR
UWHC policy #8.12, Blood and Blood Component Transfusion (Requiring Pre-Transfusion Testing)
Surgical Services departmental policy #2.15, Laboratory Specimen Guidelines

IX. REVIEW DETAILS

Version: Revision
Next Revision Due: March 1, 2019
Formerly Known as: Surgical Services departmental policy #2.14