test 2

Question 1

Autotransfusion

Answer 1

• person receives their own blood for a transfusion, instead of banked allogenic (separate-donor) blood

Question 2

two main kinds of autotransfusion:

Answer 2

• Blood can be autologously “pre-donated”

* Alternatively, it can be collected during and after the surgery using an intraoperative blood salvage device

Question 3

Acute Normovolemic Hemodilution (ANH)

Answer 3

• Whole blood drained via gravity into a blood collection bag containing anticoagulant
  * Central line
  * Venous line
• Room temperature with agitation
• Good for 8 hours
• Properly labeled: name, MRN, date, time withdrawn

Question 4

Cell saver

Answer 4

• intraoperative cell salvage machine that suctions, washes, and filters blood so it can be given back to the patient instead of being thrown away
• Because the blood is recirculated, there is no limit to the amount of blood that can be given back to the patient

Question 5

Haemonetics

Answer 5

• Cell Saver 5
- have different bowl sizes
• Elite

Question 6

Medtronic

Answer 6

• Autolog

- use less saline solution

Question 7

Sorin

Answer 7

• Xtra

Question 8

Cobe (Sorin)

Answer 8

• BRAT2

Question 9

Dideco

Answer 9

• Compact Advanced Cell Saver

Question 10

Fresenius (Terumo)

Answer 10

• C.A.T.S

- Continuous Autotransfusion System

Question 11

Discontinuous cell salvage

Answer 11

• happen in 3 different phases
  1) fill
  2) wash
  3) empty

Question 12

Continuous cell salvage

Answer 12

• 3 phases happen all at once
  1) fill
  2) wash
  3) empty

Question 13

Aspiration Set

Answer 13

• Disposable
• Usually packaged separately from washing set
• Double line tube
  * Anticoagulant line with drip chamber and roller clamp control
  * Suction line for salvaged blood mixed with anticoagulant

Question 14

Anticoagulant

Answer 14

• Disposable
• Heparinized saline (30,000 units Heparin/1 L saline)
• CPD (citrate-phosphate-dextrose)
• ACD-A (anticoagulant citrate dextrose solution- solution A)

Question 15

Collection Reservoir

Answer 15

• Disposable
• ~3000 to 4000 mL capacity
• Gross filter or 30-100 micron filter

Question 16

Bowl

Answer 16

• Disposable
• Varying sizes from 50 mL to 250 mL
-based on blood loss expected and size of patient

Question 17

Wash Solution

Answer 17

• Disposable

* Normal saline

Question 18

Disk

Answer 18

• used in continuous cell salvage

Question 19

Latham bowl

Answer 19

• angled sides

Question 20

Baylor bowl

Answer 20

• straight sides

Question 21

C.A.T.S. process

Answer 21

1) first separation phase
- initial separation stage
- most of the unwanted constituents are separated out
- complete removal of non-emulsified fat
2) washing phase
- RBC resuspended with saline
- further removal of blood plasma
3) second separation phase
- final separation stage
- RBC packed to a hematocrit of 60-65%
- used saline removed
- monitors PRC filling level

Question 22

Wash Phase

Answer 22

• When the bowl is filled:
- The pump starts (clamps adjust)
- wash solution -> wash bowl
• Washing continues until the re-infuse/empty button is depressed (or the program ends and the predetermined amount of wash solution has been used)
• Effluent moves:
- wash bowl  waste bag
- Manual mode note : watch for clear effluent

Question 23

Empty Phase

Answer 23

• The centrifuge stops, then transfers
- wash bowl -> reinfusion bag
• The cycle ends and a new cycle can begin
• The reinfusion bag should not be used for direct pressure infusion -> patient
• The reinfusion bag may contain air
- Therefore, a separate blood bag attached to the reinfusion bag is used.
- disconnect -> purge air -> tie off

Question 24

blood reinfusion must begin within how many hours from

collection

Answer 24

6 hrs

Question 25

Ways of using Partially Filled Bowl

Answer 25

• “Concentrate” • Send washed PRBC from reinfusion bag back to bowl • Allows for a full bowl of RBC when no more blood is expected from patient reservoir • “Return” • Sends contents of bowl back to patient reservoir

Question 26

Labeling Specimens | anesthesia and transport

Answer 26

* Patients Registration sticker * Type: i.e. WPRBC’s * Time collected * Time of expiration * Volume * Initials

Question 27

Record Keeping

Answer 27

* A signed autologous cell salvage record must be kept for every case * All the input and output data is recorded

Question 28

Indications

Answer 28

* Intended for use in situations to control blood loss * Recovery of blood lost during surgery * Rare blood groups without blood available * Risk of infectious disease transmission * Autotransfusion is common intraoperatively/postoperatively * Recovery of blood in the extracorporeal circuit at the end of surgery or from aspirated drainage

Question 29

Advantages

Answer 29

* High levels of 2,3-DPG * Normothermic * pH relatively normal * Lower risk of infectious diseases * Functionally superior cells * Lower potassium (compared to stored blood) * Quickly available * Eliminates need for compatibility testing * Reduces risk of TRALI (transfusion related acute lung injury) * Acceptable for most religious groups * Cost-effective

Question 30

PRBC vs cell salvaged blood

Answer 30

``` Packed red cells have a higher: 1) total volume 2) HCT 3) RBC volume 4) potassium 5) plasma free Hgb Cell salvage blood have a higher 1) remaining volume 2) pH 3) 2,3 DPG ```

Question 31

Substances washed out

Answer 31

* Plasma * Platelets * WBC’s * Fat * Anticoagulant solution * Plasma free hemoglobin * Cellular stroma * Activated clotting factors * Intracellular enzymes * Potassium * Plasma bound antibiotics

Question 32

Relative Contraindications

Answer 32

* Presence of bacterial contamination of the surgical site * Malignancy of the surgical area * Obstetrics * Topical hemostatic agents

Question 33

Contamination of the surgical site

Answer 33

• Any abdominal procedure poses the risk of contamination • 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 • Standby w/ reservoir • If the blood is contaminated the entire contents should be discarded - If the patient's life depends upon this – it may be re-infused with the surgeon's consent - Large amounts of a 0.9% NS will reduce the bacterial contamination of the blood, it will not be totally eliminated

Question 34

Malignancy

Answer 34

• The possibility exists of reinfusion of cancer cells from the surgical site

Question 35

Possible exceptions to this malignancy

Answer 35

• Removal of an encapsulated tumor is possible • If an inadequate supply of blood exists **The use of leukocyte reduction filters is recommended

Question 36

Obstetrics

Answer 36

• do not want to suck up Amniotic fluid because it can cause inflammatory rxns that can cause an embolism - washing cycle clears the amniotic fluid • Can be used In a Jehovah's witness patient to remove amniotic fluid and then suctioning the blood that is being lost

Question 37

Topical Hemostatic Agents

Answer 37

- Do not get into cell saver because of clot formation • Waste or wall suction source must be used • Autotransfusion can be resumed once these products are flushed from the surgical site • If Gelfoam, Surgicel, Thrombogen or Thrombostat are used, autotransfusion possibly can continue

Question 38

Special Considerations- Sickle Cell Anemia

Answer 38

* Debated issue * Blood may sickle and further reduce oxygen-carrying capacity * No trials, only case reports

Question 39

Special Considerations Pheochromocytoma

Answer 39

* Adrenalectomy * Blood may contain catecholamines that may cause severe hypertension when re-infused * Cell salvage does not wash out catecholamines

Question 40

Special Considerations - Orthopedic

Answer 40

• Antibiotics which are plasma bound can be removed, topical antibiotics which are not plasma bound may not be washed out - may actually become concentrated to the point of being nephrotoxic • Cement is often used or encountered during primary or revision total joint replacement surgery. Cement in the liquid or soft state should not be introduced into the autotransfusion system - use small bowl and 1.5x wash

Question 41

Special Considerations - Emergency

Answer 41

• 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 - NOT YOUR CALL

Question 42

Contraindications a Perfusionist is most likely to encounter

Answer 42

* Wound infections * Pleural effusion (fluid behind lungs) * Betadine * Warm solutions * Sterile water and other irrigation solutions * Malignancy * Topical hemostatic agents * Thrombin

Question 43

Jehovah’s Witness Patients

Answer 43

``` • Refuse transfusion of whole blood and it’s products • Red cells • Platelets • White cells • Plasma • Many will accept • Albumin • Cryoprecipitate • Clotting factor concentrates • Immunoglobulins - circuit needs to be one continuous circuit ```

Question 44

Disadvantages

Answer 44

• Depletion of plasma and platelets - Removes plasma/platelets to eliminate activated clotting factors and activated platelets (causes coagulopathy if re-infused) - This disadvantage is evident when very large blood losses occur

Question 45

Typically, patient may require FFP/platelets when:

Answer 45

- estimated blood loss > half of the patient's blood volume | • Must test to determine the need for blood products

Question 46

IBBM-CPBMT Certification

Answer 46

• Currently, the International Board of Blood Management is the governing body for certification in autotransfusion (CPBMT)

Question 47

IBBM's mission

Answer 47

• The IBBM's mission is to promote education and sound scientific principles to advance the safe and competent practice of perioperative blood management

Question 48

In order to become a Certified Perioperative Blood Management Technologist (CPBMT)

Answer 48

* Have a minimum of a high school diploma/ equivalent * Be practicing in the field of blood management for a minimum of one (1) year * Complete fifty (50) autotransfusion procedures/y