Cell Saver

Blood loss is a factor to consider in many surgeries and is especially important for longer surgeries in which blood loss is expected. This can be for reasons such as prior anticoagulant use, antiplatelets, or hemodialysis. Reversal agents are typically given, however there is still bleeding. Sometimes elevated blood pressure goals are needed and this can further contribute to blood loss. There are also social or religious concerns that might prevent patient from using donated blood products. In these instances, recycling a patient’s own blood can be useful.

The recycling of a patient’s blood is an appealing idea. This can avoid some reactions from the use of allogenic transfusions. The blood is the patient’s own, and therefore risks of infection are those from the sterility of the collection, washing, and transfusing as opposed to from being transmitted by blood donor. 

The blood is collected during the surgery. Therefore, exposure to elements of the surgery can corrupt the integrity of the collected blood in which could lead to problems if given back. In order to avoid the contamination of collected blood a separate suction is used for “harvesting” or saving blood and the other suction is used for keeping the surgical field clean.

The suction used for collecting blood should not be used to suck bone chips or dust from the field. As you can imagine this could create an embolism if given back into a patient’s circulation. The risk of embolism can therefore be extended to other elements such as fat, urine, bowel contents, methylmethacrylate, and amniotic fluids since they could theoretically create an embolism. Hemostatic agents used during surgery such as avitene, surgical, gel foam, surgiflo, floseal are all meant to promote clotting. Therefore if collected with blood in the cell saver, then these agents can contaminate the collected blood and be a risk for causing embolism. Therefore, don’t suction hemostatic agents with cell saver systems.

Other elements to consider are the surgical and patient pathology. If operating on a malignancy, then collecting tumor cells in the blood and transfusing into the patient could lead to hematologic spread of malignancy. If the pathology includes pheochromocytoma, then there may be hormones or vasoactive substances that affect blood pressure. If a patient has a thalassemia or sickle cell disease then transfusion of the collected blood could also lead to a sickle cell crisis or ischemic or embolic events.

Another element to consider during cell saver use is the irrigation. Suction is often used to clear irrigation from the surgical field. Irrigation may not be problematic. However, the type of irrigation makes a difference. If the irrigation is something other than an isotonic solution it could lead to red blood cell hemolysis defeating the purpose of reclaiming red blood cells. Irrigation is also often infused with antibiotics. If sufficient antibiotics are captured with the irrigation, then the concentration of antibiotic in the collected blood could exceed a safe dose to be given intravenously.

Suctions are also often used to clear smoke from electrocautery. Electrocautery can generate carbon monoxide. Carbon monoxide can bind with hemoglobin to decrease the oxygen carrying capacity of blood. I’m not sure if the amount of smoke suctioned has a sufficient amount of carbon monoxide to be clinically relevant. However, with another suction tube on the field there isn’t really a need to test the theoretical disadvantage if the other suction can be used instead.

Otherwise enjoy the pictures below of one type of cell saver.