Blood Salvage Transfusion Anticipation

Guidelines:

• The perioperative RN anticipates the need for intraoperative blood transfusion/salvage
  • Procedural Factors
    • Type of procedure
    • Patient position
    • Surgical incisions
    • Exposed bone
    • Sources of bleeding
  • Patient Factors:
    • Specific anatomical considerations
    • Medications
    • Coagulopathies
    • Medical conditions
    • Nutritional Status
  • Critical thinking skills
    • Advanced discussions with surgical team
    • Adequate assessment and planning

Considerations:

• Perioperative blood management
  • Improve patient outcomes by reducing unnecessary transfusion
    • Should only be done when clinically necessary to support optimal perioperative patient outcomes
  • Certain disorders (eg anemia), surgical procedures (cardiac surgery, liver transplantation), and medications that affect hemostasis are associated with increased potential for bleeding and transfusion
  • Identifying/managing anemia
  • Optimizing coagulation
  • Implementing interdisciplinary blood conservation modalities (eg cell salvaging)
  • Practicing patient-centered decision making to achieve improved patient outcomes

Nurse’s role:

• Universal Protocol Performance
  • Pre-procedural verification/identification
  • H&P, preanesthesia evaluation, consent
  • Pre-op labs
    • Hemoglobin-anemia normal is greater than 12 g/dL
    • Thrombocytopenia or platelet dysfunction
    • PT/INR, creatinine
    • T&S, T&C
  • Pre-op Medications
    • Anticoagulants (warfarin, factor Xa inhibitor)
    • Antiplatelet agents (aspirin)
    • Herbal medications that affect hemostasis (ginkgo biloba, garlic)
  • Team Communication
• Use surgical checklist
  • Verify need/availability of blood products
  • Preoperative autologous blood donation
• Intraoperative Interventions
  • Maintenance of normothermia
    • Hypothermia causes coagulopathy
    • Fluid warmer
    • Forced air warming devices and blankets
  • Intraoperative blood salvage
    • Aka blood recovery
    • Retrieving and salvaging blood that has already been shed
    • Collected blood is washed/filtered and returned back to the patient as transfusion is needed
• Patient Safety Advocate

Pitfalls:

• Patient Preferences
  • Discuss pre-operatively for patients at risk for heavy bleeding
  • Verify blood consent
• Blood scavenging systems should be discontinued after microfibrillar collagen hemostat is used
  • eg Avitene
  • Can move through filter
• Use a surgical checklist!

Examples:

• N/A

Linchpins (Key Points):

• Universal protocol: Pre-procedure verification process
• Nursing process: assessment, diagnosis, outcome identification, planning, implementation, evaluation, and repeat
• Surgical checklist: every patient, every time
• Patient-centered decision making: always