Blood Salvage Transfusion Anticipation for Certified Perioperative Nurse (CNOR)
Included In This Lesson
Outline
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
- Procedural Factors
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
- Improve patient outcomes by reducing unnecessary transfusion
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
- Maintenance of normothermia
- 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
Transcript
References:
- Cahn, J. (2022). Clinical Issues. AORN Journal, 116(4), 359-364. http://doi.org/10.1002/aorn.13791
- Graetz, T.J., Nuttall, G., & Shander, A. (2022). Perioperative blood management: Strategies to minimize transfusions. UpToDate.https://www.uptodate.com
- Moss, R. (2013). Management of Surgical Hemostasis: An independent study guide. AORN Foundation. https://www.aorn.org/
NCLEX
Concepts Covered:
- Circulatory System
- Emergency Care of the Cardiac Patient
- Cardiac Disorders
- Cardiovascular
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Disorders of the Thyroid & Parathyroid Glands
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Lower GI Disorders
- Multisystem
- Neurological
- Nervous System
- Central Nervous System Disorders – Brain
- Renal
- Respiratory
- Urinary System
- Respiratory System
- Noninfectious Respiratory Disorder
- Test Taking Strategies
- Note Taking
- Basics of NCLEX
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- EENT Disorders
- Basics of Chemistry
- Adult
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- Emergency Care of the Respiratory Patient
- Respiratory Emergencies
- Studying
- Substance Abuse Disorders
- Disorders of the Adrenal Gland
- Behavior
- Documentation and Communication
- Preoperative Nursing
- Endocrine System
- Legal and Ethical Issues
- Communication
- Understanding Society
- Immunological Disorders
- Infectious Disease Disorders
- Oncology Disorders
- Female Reproductive Disorders
- Fetal Development
- Terminology
- Anxiety Disorders
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Renal Disorders
- Eating Disorders
- Prenatal Concepts
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Depressive Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Peripheral Nervous System Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Labor and Delivery
- Proteins
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Skeletal System
- Digestive System
- Urinary Disorders
- Postpartum Care
- Basic
- Musculoskeletal Disorders
- Bipolar Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Postpartum Complications
- Basics of Human Biology
- Postoperative Nursing
- Neurological Emergencies
- Prioritization
- Disorders of Thermoregulation
- Writing
- Community Health Overview
- Dosage Calculations
- Neurological Trauma
- Concepts of Mental Health
- Health & Stress
- Endocrine and Metabolic Disorders
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Basics of Sociology
- Somatoform Disorders
- Reading
- Intelligence and Language
- Oncologic Disorders
- Med Term Basic
- Med Term Whole
- Central Nervous System Disorders – Spinal Cord
- Muscular System
- Neonatal
- Learning Pharmacology
- Pediatric
- Psychological Disorders
- State of Consciousness
- Sensory System