A quality assurance programme for cell salvage in cardiac surgery

Abstract

Summary At the same time as cell salvage was introduced into our institution for all patients undergoing cardiac surgery with cardiopulmonary bypass, we established a supporting programme of quality assurance to reassure clinicians regarding safety and efficacy. Data collected in patients operated on between 2001 and 2007 included pre‐ and post‐wash heparin concentration, haemoglobin concentration and free haemoglobin concentration. Cell salvage was used in 6826 out of a total of 7243 patients (94%). Post‐wash heparin concentration was consistently low (always < 0.4 IU.ml−1). There was a significant decrease in post‐wash haemoglobin concentration in 2003 compared to 2001, from a median (IQR [range]) of 19.6 (16.7–22.2 [12.9–25.5]) g.dl−1 to 17.5 (13.6–20.8 [12.6–23.7]) g.dl−1 (p < 0.015). In addition, there was a significant increase in free plasma haemoglobin in 2006 compared to 2001, from 0.5 (0.3–0.8 [0.1–2.6]) g.l−1 to 0.8 (0.3–1.4 [0.3–5.2]) g.l−1 (p < 0.001). This programme led to the detection of a change in operator behaviour in 2003 and progressive machine deterioration resulting in appropriate fleet replacement in 2006. You can respond to this article at http://www.anaesthesiacorrespondence.com

Lactate dehydrogenase and Haemolysis Index as quality control markers of haemolysis in intra‐operative cell salvage

“…Quality control (QC) is an integral part of laboratories though less common in clinical anaesthesia (Kelleher et al, 2011). QC should be seen as a fundamental part of any intra-operative cell salvage (ICS) blood conservation programme, however, due to lack of available knowledge, familiarity and experience QC is still a relatively new subject.…”

Performance of a new‐generation continuous autotransfusion device including fat removal and consequences for quality controls

“…The implementation of quality management is an important tool to provide patient safety and to provide a washed RBC product of high quality (Hansen et al ., ). As shown by Kelleher et al ., () quality management can have an impact on the clinical routine. They described replacing cell salvage devices due to lower performance, which was uncovered by quality controls.…”

“…Recently, a new‐generation continuous autotransfusion device CATSmart has been introduced into the market. In order to provide a safe red blood cell (RBC) product and to meet high‐quality standards, the implementation of a quality management system is necessary (Hansen and Altmeppen, ; Kelleher et al ., ). Accordingly, the performance of this new device has to be evaluated.…”

Assessment of intra‐operative cell salvage haemolysis in the obstetric and orthopaedic clinical setting, in comparison with allogeneic blood

“…NO is a regulator of smooth muscle tone and platelet activation and acts as a vasodilator in the microcirculation (Rother et al, 2005;Ley et al, 2012). Reduced NO levels result in vasoconstriction, systolic and diastolic blood pressure (BP) increases, reduced tissue oxygenation, smooth muscle dystomies, gastrointestinal (GI) contractions, endotheliac dysfunction and platelet aggregation with increased thrombotic events (Rother et al, 2005;Sloan et al, 2009;Kelleher et al, 2011;Vermeulen Windsant et al, 2012). Haemolysis also results in the release of enzymes that can affect NO synthesis (Rother et al, 2005).…”