Published on May 2, 2008
Intra-operative Cell Salvage in UCHGFeb. 2002 - Aug. 2006: Intra-operative Cell Salvage in UCHG Feb. 2002 - Aug. 2006 Martina O’Connor, Haemovigilance Officer. Intra-operative Cell salvage: Intra-operative Cell salvage Intra-operative cell salvage is aimed at conserving or avoiding the use of allogenic blood. Blood collected from a surgical field goes through a process of centrifugation where the red blood cells are seperated from other blood components, washed and are ready for re-infusion. (Booke et al. 1997). Back ground of Cell salvage: Back ground of Cell salvage Technology available since the 1960s / 1970s, limited to simply filtering by gravity. Advanced from “bowl technology” (discontinuous processing system) to centrifuge system which involves continuous processing. Benefits of Cell Salvage/CATS: Benefits of Cell Salvage/CATS Avoids exposure to donated products Eliminates risks of transfusion reactions / errors Reduces demands on Blood Bank Cost effective Objections to Donor Blood / Religious beliefs Antibodies present CONTINUOUS AUTOTRANSFUSION SYSTEM (CATS): CONTINUOUS AUTOTRANSFUSION SYSTEM (CATS) Continuous Blood Processing System Maintains constant high Haematocrit Complete elimination of fat from bone marrow or subcutaneous fat deposits Fastest processing time Single disposable suitable for all applications (paediatric, orthopaedic, cardiac…) Contra-indications: Contra-indications Sepsis Malignancy Contamination Sickle Cell Anaemia Blood contaminated with agents e.g. antibiotics etc Implementation of CATS: Implementation of CATS Multi-disciplinary decision Patient Safety and Reduction in exposure to allogenic blood Concerns regarding future emerging pathogens Rising cost of blood products and increased demands on the blood supply Aims of Study: Aims of Study Demonstrate the potential and effectiveness of this system Assess the reduction in allogenic transfusion and thus the reduction in potential transfusion complications Assess the cost effectiveness of continuous use of this system Methods Used: Methods Used 143 patients included in study in an emergency / elective surgical setting. 93% were Vascular procedures 71% of patients were male Mean Age: 69yrs Range: 22 yrs - 89 yrs Procedures: Procedures Procedures: Procedures Elective Aneurysm Repair: Elective Aneurysm Repair Used a total of 85 times Total of 50,445 mls re-infused Range: 85 – 4,200mls Average: 593mls Emergency Aneurysm Repair: Emergency Aneurysm Repair Used a total of 35 times Total of 29,798 mls re-infused Range: 103 – 2,763mls Average: 851mls Other Vascular,Laparoscopies, Laparotomies & Spinal fusion: Other Vascular,Laparoscopies, Laparotomies & Spinal fusion Used a total of 23 times Total of 15,649 mls re-infused Range: 73 – 3,600mls Average: 680mls Cost Benefits: Cost Benefits Total of 95,892 mls blood re-infused = 331 units of Red Cells (average 290mls per unit) 331 units x € 230 (average price of unit of RCC) = €76,130 Savings on Blood = €76,130 Cost of disposables - €27,955 Total Savings = €48,175 Clinical Benefits: Clinical Benefits 21% (n=30) of patients did not receive any allogenic blood / blood components /products throughout their hospital stay. A further 10% (n=15) of patients did not receive any blood in the first 24hrs post-operatively, but did require blood prior to discharge. Benefits to Multi-disciplinary team: Benefits to Multi-disciplinary team Reduced requirement for phlebotomy Reduced requirement for cross-matching of blood and storage of blood Time saving for portering staff involved in transport of blood Time saving for Nursing / Medical staff involved in administration of allogenic blood. Emergency Laparoscopy post Hernia Repair: Emergency Laparoscopy post Hernia Repair 22 yr old male Developed Intraperitoneal bleed after open Inguinal Hernia repair Hb dropped from 12.1g/dl to 3.8g/dl Emergency Laparoscopy 5,190 mls of blood retrieved, 1,676 mls re-infused Required no extra blood at any time throughout hospital stay Discharge Hb: 9.6g/dl (3 days post-op) Elective Abdominal Aortic Aneurysm Repair: Elective Abdominal Aortic Aneurysm Repair 59 yr old male Reservoir Blood Loss: 5,500mls Volume Re-infused: 1,732mls Required no extra blood / blood components / blood products at any time throughout hospital stay. Pre-operative Hb:14.4g/dl Hct:.424L/L 24hr Post-operative Hb:12.1g/dl, Hct: .356L/L Discharge Hb: 10.0g/dl, Hct: .293L/L Post-operative hospital stay: 10 days Emergency Laparoscopy following Nissens fundoplication: Emergency Laparoscopy following Nissens fundoplication 27 yr old male Total Estimated Blood Loss: not recorded Volume Re-infused: 3,600mls Required no extra blood at any time throughout hospital stay. Pre-operative Hb: 13.8g/dl Hct:.417L/L 24hr Post-operative Hb: 11.5g/dl, Hct: .335L/L Discharge Hb: 9.9g/dl, Hct: .290L/L Post-operative stay: 7 days. Use of CATS in MPH: Use of CATS in MPH 2001 – 2006 Used a total of 38 times: THRs (2): 250ml Revision: THRs: (13) 4,883mls Spinal Fusions/ Decompressions: (23) 9,453mls Total 14,586mls = 50 Units of Red Cells. Savings on Blood = €11,500 Cost of disposables - €7,428 Total Savings = €4,072 Conclusion: Conclusion CATS has markedly reduced the amount of blood transfused and subsequent complications. Buffers the demand on the allogenic donor pool. Cost effective. Benefits for multi-disciplinary team. Success of CATS in UCHG: Success of CATS in UCHG A dedicated team was the driving force behind implememting this system and ensuring it would work. Anaesthetists, Anaesthetic Nurses, Surgeons, Blood Bank & Haemovigilance. Company support for on-going training. Written protocols in place re use of machine. Record of usage maintained Plans for the future in UCHG: Plans for the future in UCHG Continued use and monitoring of efficacy of CATS Purchase of two more CATS machines Proposed Usage for Cardiac Surgery Use in other areas being explored National Blood Strategy Group Recommendation 2004: National Blood Strategy Group Recommendation 2004 “All large hospitals set up cell salvage programmes which are well equipped and well staffed. It is in their opinion the best method in avoiding allogenic blood transfusion”.