Autotransfusion
The effectiveness, safety, and cost-savings of intraoperative cell salvage in people who are undergoing thoracic or abdominal surgery following trauma is not known.
Where appropriate, it carries certain advantages, including the reduction of infection risk, and the provision of more functional cells not subjected to the significant storage durations common among banked allogenic (separate-donor) blood products.
[2] This is important in pregnancy, because the uterus (at the later stages of fetal development) can hold as much as 16% of the mother's blood supply.
Intraoperative autotransfusion refers to recovery of blood lost during surgery or the concentration of fluid in an extracorporeal circuit.
Postoperative autotransfusion refers to the recovery of blood in the extracorporeal circuit at the end of surgery or from aspirated drainage.
[3] Further clinical research in the form of randomized controlled trials is required to determine the effectiveness and safety of this procedure due abdominal or thoracic trauma surgery.
[1] For elective surgeries, cell salvage techniques may not be linked to more negative outcomes or adverse effects and there is weak evidence indicating that this approach may reduce the chances that the person needs an allogenic transfusion.
When possible diagnostic tests should be performed to determine the need for any blood products (i.e. PRBC, FFP and platelets).
[citation needed] The use of blood recovered from the operative field is contraindicated in the presence of bacterial contamination or malignancy.
If there is a question of possible contamination the blood may be held until the surgeon determines whether or not bowel contents are in the surgical field.
While washing with large amounts of a sodium chloride solution will reduce the bacterial contamination of the blood, it will not be totally eliminated.
[citation needed] Autotransfusion is not normally used in Caesarean sections, because the possibility of an amniotic fluid embolism exists.
[citation needed] In life saving situations with the consent of the surgeon, autotransfusion can be utilized in the presence of the previous stated contraindications i.e. sepsis, bowel contamination and malignancy.
[citation needed] Utilizing a special double lumen suction tubing, fluid is aspirated from the operative field and is mixed with an anticoagulant solution.
If the patients HCT is normal, the amount needed to process a unit is roughly two times the bowl volume.
[citation needed] When Avitene, Hemopad, Instat, or collagen type products are used, autotransfusion should be interrupted and a waste or wall suction source must be used.
Simultaneously, the pump begins counterclockwise rotation, enabling the transfer of the reservoir contents to the wash bowl.
The reinfusion bag attached to the autotransfusion wash set should not be used for high pressure infusion back to the patient.
Postoperative autotransfusion begins in the operating room when the drain line is placed and the surgical site is closed.
[citation needed] In some institutions to maximize the effectiveness of autotransfusion and provide the best conservation and return of red cells the soaking of sponges is employed.
The sponges are periodically wrung out and removed from the basin, the remaining solution can be suctioned into the autotransfusion reservoir so that the red cells can be recovered.
This unsophisticated method resulted in a 75% mortality rate, but it marked the start of autologous blood transfusion.
[22] The devices used during the Korean and Vietnam War collected and provided gross filtration of blood before it was reinfused.
As the Bentley system lost favor Wilson and associates proposed the use of a discontinuous flow centrifuge process for autotransfusion which would wash the red cells with normal saline solution.
[citation needed] Individuals of the Jehovah's Witness religion in particular refuse to accept homologous and autologous pre-donated blood.
