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[Risks and side effects of intraoperative autotransfusion].

W Engelhardt1, D Blumenberg

  • 1Institut für Anästhesiologie, Universität Würzburg.

Beitrage Zur Infusionstherapie = Contributions to Infusion Therapy
|January 1, 1991
PubMed
Summary

Autotransfusion using cell salvage machines effectively saves blood in surgery. Careful management, including clamping tubes and monitoring coagulation, minimizes risks like air embolism and contamination.

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Area of Science:

  • Anesthesiology and Perioperative Medicine
  • Transfusion Medicine
  • Surgical Patient Management

Context:

  • Autotransfusion has been standard practice for orthopedic and surgical patients at the University of Würzburg since the 1970s.
  • Current methods utilize the Haemonetics-Cell-Saver 3 for preparing autologous erythrocyte concentrates.
  • Older autotransfusion devices pose risks, primarily venous air embolism during manual operation.

Purpose:

  • To outline critical safety measures for autotransfusion procedures to mitigate potential hazards.
  • To emphasize the importance of managing coagulation parameters during extensive blood replacement.
  • To address the risks of air embolism and blood contamination associated with cell salvage.

Summary:

  • Venous air embolism is a significant risk during manual autotransfusion; clamping the connecting tube to the patient during filling and between the centrifuge and retransfusion bag is crucial.
  • Extensive autotransfusion necessitates monitoring hemostaseological parameters (e.g., Quick, thrombin time, antithrombin III) after replacing half the estimated blood volume to manage coagulation disorders.
  • Substitution of antithrombin III is often required to reduce risks of venous thrombosis and pulmonary embolism.
  • Potential blood contamination from operating room suction requires minimizing personnel and optimizing suction device function.
  • Implementing these safety protocols minimizes the risks associated with this effective blood-saving procedure.

Impact:

  • Enhances patient safety during autotransfusion by detailing specific preventative measures.
  • Guides clinical practice for anesthesiologists and surgeons performing cell salvage procedures.
  • Contributes to the understanding of managing coagulation and preventing thromboembolic events in patients undergoing massive blood replacement.

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