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Autotransfusion Using the Atrium Chest Tube (7.20)

Autotransfusion Using the Atrium Chest Tube (7.20) - Policies, Clinical, UWHC Clinical, Department Specific, Nursing Patient Care, Pulmonary

7.20

NURSING PATIENT CARE POLICY & PROCEDURE

I. PURPOSE

Autotransfusion is the collection of blood from an active bleeding site, the blood is then
filtered and reinfused into the same patient to prevent hypovolemia and hypoxia while
reducing the risk of transfusion reaction, disease transmission, and dependence on banked
blood. This procedure can occur in the Emergency Department and within an ICU
setting. Intraoperatively, refer to UWHC Surgical Services Policy 2.14, Intraoperative
Blood Salvage.

II. POLICY

A provider’s order is needed for this procedure. The amount of blood autotransfused
should not exceed 2000 mL in an adult. The provider will determine the amount to
reinfuse if used with pediatric patients.

Collected blood should be transfused or discarded within 4-6 hours.

III. EQUIPMENT

A. Atrium Oasis Autotransfusion (ATS) Chest Drain (CS# 4012244)
B. Atrium ATS Bag 2450 (CS# 4012245)
C. Blood administration set (Y-type) (CS# 9996031)
D. 40 micron blood transfusion filter (Pall) (CS# 1206070)
E. Normal saline (500 mL)

IV. PROCEDURE

A. Clinical indications are for the patient with chest trauma and large blood loss.
B. Contraindications:
1. Pulmonary or systemic infections
2. Blood contaminated with bowel contents (with a suspected thoracoabdominal
injury such as a diaphragmatic injury)
3. Injury is older than 4-6 hours
4. Blood potentially contaminated with malignant cells
5. Coagulopathies
C. Prepare the Atrium Oasis ATS chest drainage unit. Refer to UWHC Nursing Patient
Care Policy and Procedure 7.12, Closed Chest Tube Drainage System, for instructions
on how to set up the Atrium Oasis Autotransfusion Chest Drain.




Effective Date:
July 30, 2015

Administrative Manual
Nursing Manual (Red)
Other _______________

Policy #: 7.20 AP

Original
Revision

Page
1
of 4

Title: Autotransfusion Using the Atrium
Chest Tube (Adult and Pediatric)



Page 2 of 4

D. Perform hand hygiene according to UWHC Hospital Administrative Policy 13.08,
Hand Hygiene.
E. How to use the Self-Filling ATS BAG 2450 (CS# 4012245)
1. Unwrap and attach the Self-filling Atrium (ATS) Bag 2450 for auto-transfusing.
2. Close the chest drain ATS access line clamp (Figure 1), (on the bottom of the
collection chamber) and remove the spike port cap on the end of the access line.
3. Insert the ATS bag spike into the chest drain ATS access line using a firm
twisting motion.
4. Position the ATS bag below the base of the chest drain to allow for maximized
blood flow into the ATS bag.

F. Figure 1Activating the ATS bag
1. Once the self-filling ATS bag is connected to the ATS line and positioned below
the chest drain, open both clamps.
2. Holding the ATS bag below the chest drain, gently bend the ATS bag upward
where indicated to activate blood transfer out of the collection chamber and into
the blood bag. (Blood may drain more quickly if chest drain is raised slightly
higher than the ATS bag.)
a. Do not activate ATS bag prior to connecting to chest drain. If
accidentally activated prior to system connection, simply displace air
into the chest drain after system connection.
ξ Displace air from the ATS bag by gently squeezing ATS bag while
still connected to the ATS line.
ξ Repeat as necessary until all air is displaced and the ATS bag is
full of blood.
b.When you activate the self-filling bag it is normal to see the blue water in
the water seal chamber rise to the top of the chest drain, which is due to
the added negative pressure from the blood bag. It will go down after a
few seconds.
Attach the ATS bag to the ATS access line



Page 3 of 4

Figure 2. From
www.atriummed.com. Used
with permission.
G. Disconnecting the ATS bag
1. Once blood evacuation is complete and the ATS bag is full, close both the ATS
access line (on the collection unit) and the ATS bag.
2. Remove the ATS bag from the access line and recap the access line port.
3. Remove ATS spike from the ATS access line spike port and insert into the ATS
bag spike holder.
4. Recap the ATS access line spike port on the drainage system and position the
ATS access line in the holder located on top of the chest drain.
5. Keep ATS access line clamp fully closed at all times when not in use.
H. Reinfusion set-up (See Figure 2.)
1. Do not use rapid infusor or pressure bag to administer fluid in ATS bag.
2. Prime IV blood administration set and 40 micron (PALL™ Filter) blood filter
with sterile saline.
a. The ATS bag and 40 micron (PALL™ Filter) can be only used once. A
new blood filter must be used with each new ATS bag.
3. After chest drain disconnection, invert ATS bag with spike port pointing upward
and remove tethered cap using sterile technique.
4. Insert saline filter spike into ATS bag spike port using a firm twisting motion.
Hang ATS bag on IV pole.
5. Open filtered air vent located on top of ATS bag first, then open the IV clamp to
complete priming.
6. IV is now ready for patient connection.
7. The ATS blood bag has a filtered air vent with a tethered plug for reclosure after
use
a. The air vent must be OPEN for all non-pressure infusion (gravity or
infusion pump).
b. The air vent must remain CLOSED for pressure infusion (hand squeeze).
8. Stop the infusion before the blood bag is empty. Do not reinfuse entire blood
contents completely through blood filter and I.V. set, this could cause an air
emboli to occur.















I. Documentation
1. Document the amount drained in the chest tube section of the output section in the
Filtered air vent
Spike port



Page 4 of 4

patient’s clinical record.
2. Document the amount autotransfused in the intake section of the patient’s clinical
record. Enter a comment for this value to note that the amount was
autotransfused.

V. UWHC CROSS REFERENCES

A. Hospital Administrative Policy 13.08, Hand Hygiene
B. Nursing Patient Care Policy 7.12, Closed Chest Tube Drainage System
C. Respiratory Care Services Policy 3.20, Pulse Oximetry Check & Continuous
Monitoring (Includes Ambulating SPO2)
D. Surgical Services Policy 2.14, Intraoperative Blood Salvage

VI. REFERENCES

1. "Atrium Medical: ATS Blood Bags." Welcome to Atrium Medical.
http://www.atriummed.com/en/chest_drainage
2. Ashworth, A., & Klein, A.A. (2010). Cell salvage as part of a blood conservation
strategy in anaesthesia. British Journal of Anaesthesia 105(4), 401-406.
3. Emergency Nurses Association (2007). TNCC: Trauma nursing core course:
Provider manual (6th ed.) Des Plaines, IL: ENS
4. Rhee et al. (2015). Early autologous fresh whole blood transfusion leads to less
allogeneic transfusions and is safe. Journal of Trauma Acute Care Surgery 78(4),
729-734.
5. Upton, D. A. (2009). General principles of autotransfusion. In J.A. Proehl (Ed.).
Emergency nursing procedures (pp. 378-384). St. Louis, MO: Elsevier.


VII. REVIEWED BY

Clinical Nurse Specialist, Thoracic Surgery
Clinical Nurse Specialist, ED
Clinical Nurse Specialist, TLC
Clinical Nurse Specialist, Cardiovascular Surgery
Clinical Nurse Specialist, PICU
Nursing Patient Care Policy and Procedure Committee, July 2015

SIGNED BY

Beth Houlahan, DNP, RN, CENP
Senior Vice President Patient Care Services, Chief Nursing Officer