Cell Saver QC

[Mabel Adams]

Our facility has Fresenius cell savers in the OR. We are responsible for the QC. We test Hct, K+, & culture quarterly on each unit. I am new here and trying to make sense of what is an acceptable level for the K+. All I have is a chart from the company showing a curve correlating HCT to K+ (they say the K+ can be higher if the Hct is higher). This chart is a line plot that I think was extrapolated from some data the company did on how K+ and Hct correlate in their machines. There is no range on this plot, just a single point for each Hct level. Unless the K+ is right on, I have no way to tell if it is in range! There is no list of a standard deviation or CV. I understand that this company does not recommend doing free Hgb testing.

Does anyone that is using these same machines have any QC parameters that are meaningful that they can share?

[Eagle Eye]

We do HCT on each machine every month.I think each time tech doing a procedure is looking at color of the saline for hemolysis and make a note on the chart....that's about it. we do not do culture. Are you getting all your cultures negative? what do you do if they are positive?

[Mabel Adams]

If the culture is positive (not just a one colony contaminant) we would call biomed to troubleshoot the intrument.

What is your protocol if the tech sees hemolysis?

[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 !)

[bloodpumper]

Hi guys,

The AABB Standards for perioperative blood collection and handling states that you should have a working quality control program in place. If you use the manufacturer recommendations, then you won't be able to comply using potassium as a value signifying adequate wash unless you decrease the recommended percent washout from 80% to 60%. Albumin and plasma free hemoglobin or haptoglobin are the most sensitive markers of adequate wash, but are the most labor intensive and costly. We use potassium because we can run the sample on a point of care blood gas and electrolyte analyzer and get immediate results before the washed unit is transfused. You need one indicator of adequate wash and one to ascertain that you achieved the end product hematocrit in the specified range per the manufacturer. Using the visual means of a clear effluent line does not always work if the device has an autorun feature and you miss the wash cycle or your determination is different than mine. Everyone has a different view on what is a clear line. Not very scientific. Establish a means by which you can have consistency of results and actions in your quality procedure. Sampling is performed by inserting an adaptor between the reservoir and the wash disposable and also an adaptor in the product collection bag. All of which must be done under the usual sterile technique for assembly of the disposable on the device and aseptic technique should be used to remove those samples during the processes. Establish your own system and show how you came to your protocol for quality monitoring in autotransfusion. Until the AABB comes out with a definite and specific protocol, stating exactly how you should perform this function, then use what you have devised.

Mark Lucas, MPS, CCP

Blood Management Consultant

Director, International Board of Blood Management

www.intbbm.org

Edited December 24, 2008 by bloodpumper

[estiner]

We use Fresenius as well - we do HCT and K for our QC. We do not do cultures. Our ranges are HCT: >50% for large bowl and >40% for small bowl.

K: <5.0 Mmol/L. We have been using this company for at least 5 years and their QC is very consistent. One of their strong points is their adherence to AABB guidelines and their documentation of personnel competency.

[Judy hedglin]

At the VAMC in Jackson MS, we have a Haemonetics 5+ Cell Saver. We only perform about one case a month. Our QC indicators include on the first bowl a Hct, plasma free hemoglobin and a culture. Due to our lack of frequency we felt that including a culture with each case was appropriate.