Perioperative (Cell Saver) Collections

[bbbirder]

We always struggle with what to do for "Quality Control" for the cell saver blood. The 1st edition of the Guidance for Standards makes several suggestions. We used to do a culture, but as the guidance suggests, there is often skin flora present. We just started doing H&H, but haven't found any recommended results (I guess we'll figure it out soon enough based on what we get over time.)

The color of the waste line is now incorporated in the cell washer itself, and the OR staff documents this. We don't do Free Hemoglobin testing.

All of it seems after the fact and of questionable value.

So I am wondering what other facilities are doing?

Thanks,

Linda Frederick

[bloodpumper]

Hi BB,

I am a perfusionist and if you want to consult the professionals in this arena you need to speak with the perfusionists at your facility. I will share my experience with you though. We perform a cardiotomy sample for albumin and a post product sample for albumin and hematocrit. This serves two functions, the albumin verifys that the device is washing properly and the hematocrit is to verify that you are returning a quality product. The manufacturers specifications on post wash product hematocrit should be readily available in the operating manual. AABB guidelines say that typically there is a 95% washout. We have set our own standards at 70% as there is often a large amount of saline in the cardiotomy. The AABB Guidelines are just that, guidelines. Check the AABB Perioperative Autologous second addition. JCAHO just asks that you have a QA process in place and functioning to address possible problems with the device or personnel training. Another function of the QC is to maintain that the patient does receive a quality product and that the staff are properly trained and maintain their proficiency by performing the QC and competency by testing, education and clinical experience. Ask your cell salvage device manufacturer for assistance in setting up your QC process or your facility perfusionists. Another marker for washout can be plasma free hemoglobin(expensive test) or potassium. There is usally a high potassium from hemolyzed red cells. We are constantly reviewing our process in our transfusion committee and updating it when necessary.

[ANORRIS]

Is anyone performing perioperative cell saver QC? If so, what exactly are you doing?

[o28or1]

I am also a perfusionist. At our institution we do QC testing on our users and devices monthly. Post procesing our hematocrit and potassium values are target at 40's -50's and >1 respectively. The conundrum here is the hemolysis grade which is graded by the Siemens analyzer, so I feel it is objective in nature. We have altered (lowered)our fill speed on the cell saver and wash techniques (intermittent and use 3.0 liters per cycle) which has helped but still I would like to get the hemolysis grade lower. Using surrogate markers such as potassium is useful but I feel there is not much correlation with hemolysis. I also have not discounted that I may be chasing my tail never being able to get it lower because of the vortices and changes we subject the cells to. Any thoughts or pearls of wisdom would be greatly appreciated. Have a blessed Christmas season.