Intra operative blood_conservation
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This document discusses different methods for intraoperative blood conservation. It describes three main types of autologous blood transfusion: preoperative autologous donation, acute normovolumic hemodilution, and intraoperative cell salvage. Intraoperative cell salvage involves collecting blood lost during surgery, washing and separating red blood cells, and reinfusing them to the patient. The document outlines the detailed cell salvage process and different devices used, including cell processors that centrifuge and wash blood and ultrafiltration devices that filter whole blood. It notes advantages and considerations for each method of autologous blood transfusion.
![Intra operative
blood
conservation
Direct transfusion is a blood salvaging
method associated with cardiopulmonary
bypass (CPB) circuits or other
extracorporeal circuits (ECC).
Following bypass surgery the ECC circuit
contains a significant volume of diluted
whole blood that can be harvested in
transfer bags and re-infused into
patients. Residual CPB blood is fairly
dilute ([Hb] = 6–9 g/dL) and can also
contain potentially harmful
contaminants such as activated
cytokines, anaphylatoxins, and other
waste substances
Direct transfusion
DIRECT
TRANFUSION](https://image.slidesharecdn.com/intraoperativebloodconservation-191118170656/85/Intra-operative-blood_conservation-21-320.jpg)
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Intra operative blood_conservation
- 3. Intra operative blood conservation Advantages of autologous blood Prevents transfusion-transmitted disease Prevents red cell alloimmunization Supplements the blood supply Provides compatible blood for patients with alloantibodies Prevents some adverse transfusion reactions Provides reassurance to patients concerned about blood risks AUTOLOGUS BLOOD TRANFUSIO N
- 4. Intra operative blood conservation Autologus Transfusion •PAD/SFDN-Pre op autologus donation. •ANH-Acute normovolumic hemodilution •ICS-Intra operative cell salvage AUTOLOGUS BLOOD TRANFUSIO N TYPES
- 5. Intra operative blood conservation •The technique of collecting and reinfusing blood lost by a patient during surgery. Intra operative cell salvage ICS Intra op cell salvage
- 6. Intra operative blood conservation ICS Intra op cell salvage •Management of severe, rapid blood loss •Reported in 1917 •Started as life saving procedure than regular. •Most cases were hemothorax & turp •1970-Bently autotranfusion system •1974-Hemonetics cell saver HISTORY
- 7. Intra operative blood conservation Three general types of salvage procedures: 1.Cell processors and salvage devices that wash and save red blood cells, i.e., "cell washers" or RBC-savers 2.Direct transfusion 3.Ultrafiltration of whole blood Blood salvage proceduresTYPES
- 10. Intra operative blood conservation 1.COLLECTION •Using a dual lumen tube, anticoagulant is fed to the operation site to be mixed immediately with shed blood and sucked away. •The choice of anticoagulant either Heparin or Citrate. Method
- 11. Intra operative blood conservation •Blood and anticoagulant are carried into a sterile reservoir by vacumm. •It is filtered to remove large clots and debris. •Most collection reservoirs have a filter in the 40-150 micron range. •Between 1:5 and 1:10 ratio of anticoagulant to collected blood. 2.STORAGEMethod
- 12. Intra operative blood conservation Blood and anticoagulant are drawn from the collection pot into a centrifuge to be processed. The force supplied by the centrifuge holds the more dense red blood cells against the outer wall of the bowl. The less dense white blood cells, platelets, plasma and anticoagulant move towards the centre of the bowl where they spill over into a waste bag 3.CENTRIFUGE Method
- 13. Intra operative blood conservation Blood is washed with a saline solution and red blood cells are separated from waste products. A sterile isotonic saline solution is pumped into the centrifuge bowl. Only a 0.9% sterile normal saline is recommended. 4.washing Method
- 14. Intra operative blood conservation Waste products include white blood cells, platelets, plasma, anticoagulant, fat and free plasma haemoglobin. These are collected in a bag. 5.Waste separation Method
- 15. Intra operative blood conservation Packed red blood cells are separated from waste products and collected in a separate bag 6.Processed RBC Method
- 16. Intra operative blood conservation Red blood cells can then be reinfused immediately or taken to recovery or the Ward to be reinfused later. There is, however, a limit of 6 hours during which reinfusion can take place. 7.Reinfusion Method
- 18. Intra operative blood conservation Practical consideratios 1. If not transfused immediately, units collected from a sterile operating field and processed with a device for intraoperative blood collection that washes with 0.9% saline, USP, shall be stored under one of the following conditions prior to initiation of transfusion: At room temperature for up to 4 hours after terminating collection; At 1–6° C for up to 24 hours, provided that storage at 1– 6° C is begun within 4 hours of ending the collection. 2. Transfusion of blood collected intraoperatively by other means shall begin within 6 hours of initiating the collection 3. Each unit collected intraoperatively shall be labeled with the patient's first name, last name, and hospital identification number; the date and time of initiation of collection and of expiration; and the statement "For Autologous Use Only." 4. If stored in the blood bank, the unit shall be handled like any other autologous unit.
- 19. Intra operative blood conservation •Hemofiltration or ultrafiltration devices filter the patient's anticoagulated whole blood. •The filter process removes unwanted excess non-cellular plasma water, low molecular weight solutes, platelet inhibitors, and some particulate matter including activated cytokines, anaphylatoxins, and other waste substances through hemoconcentration; thus making concentrated whole blood available for reinfusion. • Hemofilter devices return the patient's whole blood with all the blood elements and fractions including platelets, clotting factors, and plasma proteins with a substantial Hb level. Ultrafiltration of Whole Blood Ultrafiltration
- 20. Intra operative blood conservation Ultrafiltration of Whole Blood Ultrafiltration These devices do not totally remove potentially harmful contaminants that can be washed away by most RBC- savers That coagulation and homeostasis are immediately improved with the return of concentrated autologous whole blood
- 21. Intra operative blood conservation Direct transfusion is a blood salvaging method associated with cardiopulmonary bypass (CPB) circuits or other extracorporeal circuits (ECC). Following bypass surgery the ECC circuit contains a significant volume of diluted whole blood that can be harvested in transfer bags and re-infused into patients. Residual CPB blood is fairly dilute ([Hb] = 6–9 g/dL) and can also contain potentially harmful contaminants such as activated cytokines, anaphylatoxins, and other waste substances Direct transfusion DIRECT TRANFUSION
- 22. Thank you