djjohnson

Mabel, we only do Hct/K+, and do a visual w. white paper background for visual hemolysis--that is recorded for each unit. My SOP says, only give unit back if wash is clear. Otherwise, wash more till it is clear. Each facility has to make your own acceptable range for K+,,,I did a total of ten, took average, then decided that 1/3 or less of base (from reservoir (before wash sample) is acceptable range. ALso, why are you doing cultures? Don't do them unless AABB requires----there will always be normal skin flora present. I was once told by an assessor,,,don't do extra unless have to---I was thinking of adding albumin to QC, and even tho it is simple and cheap test,,,I decided he was right and did not add it. With Fresenius, don't know if you can take a pre-wash sample to compare,,,but you can with all the others. ((Bend is beautiful--from a frustrated cowgirl !)

The benefit for my small hospital to have two cell savers, operated by a tech from lab has far outweighed the cost of allogeneic blood. We mostly do orthopedics/general/obgyn---not hearts/trauma/transplants where you might think that is the only place to use them. And, now with many blood management dictates, and more information about detrimental effects of banked blood....it makes even more sense. We have an in-house program, having gone from the contract situation in the past. You have more control on the education of the operators, quality control of your product, etc. We have had a program for 10 years now, and we have been AABB Periop Accredited for 6 years and will come up for it again next year. The AABB Spring Periop conference has been one of the most educational conferences, and also the SABM (Society for Advancement of Blood Management) conferences. You will see a cell saver (ours is from Sorin/Cobe) lists for about 35-40,000. , but you can get them for about 20,000, and maybe less for a used one. I am the main operator, and coordinator with two others-float pool to back me up. We do about 100 a year average--Spinal surg w. instrumentation/ Total Joints/gen.surg/OBGYN-TAHs. If I collect 300 cc with patient at normal Hgb,,,I can give back about 150cc each processing pass/batch. We can also use cell saver on Jehovah's Witnesses. We are not on-call, but could be,,,most surgeries are scheduled. If you have a surgeon who does AAA's, you might want to do an on-call,,,,even most of these are scheduled. I am also looking at making autologous platelet rich plasma. My budget for IAT (intraoperative autologous transfusion), is from BBK/lab. I also am certified by the company to do yearly maintenance, our biotech dept. only does the electrical checks. I would not start an inhouse program without budgeting for two machines---one for backup if something wrong w. the other---however, now, many times there are two ortho docs doing total hip at same time---and this can be done by one operator. Do NOT get ortho pat machines from Haemonetics----unless you plan to have an operator with that machine the whole time. Yes, they are cheaper---the company does NOT fix them--they just send you a new one---so, no machine history,etc--that should tell you something. Also, there is no way to check centrifuge speed with a tachometer (outside calibrated source), as is recommended by AABB.

conwaysbb, could you provide a copy of the manufacturer of the tubing letter? this would be really good as ammo. fax 410-414-4764.

It is becomming time for all hospitals/transfusion services to think ahead----not only is the supply of even 'old' blood been in danger because of donations going down, new diseases, old diseases, things like TRALI, and worring about pandemics, terrorism, etc---if you wait long enough, hospitals will be forced into formal conservation, rather than moving toward them now. I, for one want the best my money can buy--not unreasonable to want that---why wouldn't I want the youngest blood for my hip replacement from the blood bank for my surgery? The situation could get to that point where patients demand the best--again, not unreasonable---but if surgeries and hospitals begin to use the best blood saving practices out there--the likelihood of the situations will be diminished. Go to sites like Society for Advancement of Blood Management (SABM). For the immediate question for cardiac surgery, the 'freshest' blood is their own with cell salvage, and most of your hospitals doing cardiac surgeries already have perfusion teams using cell savers. Meticulous hemostasis in surgery, using latest techniques and technology, cell salvage, etc, are all part of blood conservation. I know I am rambling now, but it was only a matter of time when yet something else will impact the blood supply. There are a handful of forward thinking formal blood conservation programs in hopsitals that do transplants and heart surgeries with little or no allogenic blood. We should all be thinking in that direction.

Please take a moment to go to zoomerang below and answer a few questions about cell salvage in your facility: http://www.zoomerang.com/Survey/?p=WEB227L8WGJU9G ----thanks for participating.....

Definitely add anesthesia, and also if you do transplants, cardiac surgery, you probably have a perfusion team. These people are pretty well versed in management of blood, and blood conservation. Even if they are a contract group rather than an in-house, they can be a very valuable addition.

How about a topic discussing blood bank role with cell salvage in Op.Room, when looking towards "Perioperative Accreditation" for this from AABB?

4th Annual Perioperative Conference "Current Perspectives in Blood Conservation: Implications for Hospitals and Transfusion Services" March 31 - April 2, 2006 Dallas, Texas Westin City Center Hotel register at aabb.org website Do not miss this one. All the experts in blood management, autotransfusion (blood salvage in the operating room setting) will give talks. This will keep you current on best practices, techniques, and AABB accreditation for Perioperative activities.

Cliff, I too attended the AABB conference in Seattle. My first time there, - What a great venue and city! I did "do the TXPO", a couple of times, but did not see BBTalk pens. Here is a suggestion: How about a get together of BBTalk persons at the conference? Maybe an "after hour", since days and afternoons are busy with seminars. You could announce and advertise it well ahead on the forum. Also, what about making a link with the regional BB associations? The Mid-Atlantic Assn 0f Blood Banks (MAABB), has an upcoming Spring meeting in Annapolis, Md. What about sending brochures about the forum to pass out, or have on a pick-up table along with pens, etc? I applaud you and your teams efforts with the BBTalk forums. I was delighted to find this, and use it at least once a week. I told my Blood Bank supervisor to use it also. He has a recent post. Thanks again.

Here is information on a very interesting article from a military journal. You can access directly by search on internet,(DSP journal), but I will give you the address below. This is titled "Researching Long-Term Storage of Blood Products","Saving Lives and Easing Logistical Burdens"- By Joseph Bielitzki and Carl Holloway. Article is from January/March 2005 DSP Journal , pages 28-34. You will need adobe reader. www.dsp.dla.mil/newsletters/journal/DSPJ-01-05.pdf

You probably are aware, but I will re-state the position of Guidelines for Recovery and Reinfusion.....AABB----in the appendix of Complications of and Contraindications to Periop.Blood Recovery..... Under "Contaminants".A. ---Amniotic Fluid. Contains proteolytic enzymes, which may activate clotting. Recommendations are: Avoid aspiration in area where product is being used. Blood recovery is an option AFTER delivery of fetus, REMOVAL of amniotic fluid, AND copius irrigation w. 0.9 % Sodium chloride solution to an ALTERNATE SUCTION source. Also, suggestion to contact Dr.Shander, Englewood, NJ Hospital-----they deal with no blood surgery , and autologous salvage situations all the time. Hope this helps,

Dawn, In regards to this conference (which I could not attend), did you attend? Which did you attend? If you attended the Periop., what is your feedback? Are you new to Periop? Have you attended a Periop. conference, lecture, etc. in the past? Are you responsible in your institution for anything over Perioperative Transfusion/Collection?

I don't know if deglycerolizing rbc's has evolved since the old days of using color comparison, but I do know for quite some time now, this method has not been acceptable, owing to each individual person's interpretation of seeing "color". For cell salvage, the only acceptable 'color' of the supernatant from washing is CLEAR. If the wash is not clear with the volume of wash, then you continue to wash until it is clear. This method is still not quantitative, but is still acceptable by AABB. However, you can test (quality control), for plasma-free hemoglobin levels.