Cell Salvaging techniques is used during any operation that shows an indication for excessive bleeding. Blood processed by these machines can be suctioned from the surgical field, directly from the heart lung machine, or from sterile drainage containers such as the chest tube collection container. Use requires a vacuum source, heparinized saline or ACD, normal saline for wash, and appropriate tubing set. The waste or effluent that is removed contains the following:  
plasma protein fractions, plasma water, platelets, leucocytes, free hemoglobin, heparin, saline, and embolic debris
A packed red cell mass is collected into a separate bag, resuspended in 20 to 30mls of normal saline to produce a  hematocrit of  > 50% and a volume of 130 to 250mL. If large volumes are processed it will be necessary to administer platelets and fresh frozen plasma to the patient. (processing whole blood eliminates their components)  Other uses of the autotransfusion machine is for obtaining platelet rich plasma for growth factor administration and fibrin glue, or as a rapid infusion device. AABB guidelines for blood administration are followed when operating this machine 

 Advantages:  Hemoglobin is maintained or increased, reduced or no homologous blood use,  provides rapid availability of blood to patient, reduces total net loss of blood, and most Jehovah's Witness patients allow its use.

Aspirated blood is mixed with CPD-A, ACD or Heparin to anticoagulate collected whole blood.
Use at least 15cc of anticoagulant to 100cc of blood collected for CPD-A or ACD solutions.
Heparin: 15,000 Units in 500cc saline
Use vacuum (-120mmHg to -200mgHg) to collect blood into cardiotomy
Latham or BRAT bowls will separate RBC's from plasma using centrifugal forces.
Plasma will be removed from bowl to a waste bag.
Depending on bowl configuration, once enough RBC's are collected they are washed with NS.
Amount varies on type of surgery and how the blood is collected.
     Recommended washing, 4 X bowl volume for vascular or CV surgery.
     Orthopedic washing, 7 X bowl volume.
Do not use Ca containing solution for washing (e.g. Lactated ringers) or sterile water.
Monitor patient's calcium ion level after processing 4 X 250ml Washed PRBC's.
Re-Infusion:
    Within 6 hrs if stored at room temperature, otherwise at 1-6 degrees C  administer within 24 hrs.
    Label all processed PRBC's as per AABB Guidelines.

Contraindications to Perioperative Autotransfusion

 

TRANSFUSION RISKS ASSOCIATED WITH DONOR BLOOD
Risk   Per Unit of Blood*   Immunosuppression   1:1   Allergic Reactions   1:100   Antibody Development   1:100   Bacterial & Parasitic-Bacterial   1:12,000   Hepatitis C   1:4k - 100k   Human T-L Virus I/II   1:100k - 640k   Hepatitis B   1:200,000   HIV   1:550,000   Hepatitis A   1:1,000,000   Cumulative Serious or Fatal Reactions   1:3,333
	* Total blood transfused averages around 3 units per transfused patient, but in serious conditions, more units may typically be transfused, thereby increasing the risk factor.

Created 3/96; Modified 09/05/2005