Practical considerations when collecting "shed blood" into a disposable system for blood reinfusion

A colleague in Southern California reports that his hospital's current practice for some postoperative or posttraumatic conditions is to collect "shed blood" into a disposable system for blood reinfusion. The expiration date and time for the shed blood is limited to 6 hours from the start of the collection. If the patient continues to shed additional blood for more than 6 hours, and there is a desire to collect that additional shed blood and reinfuse it, a new disposable system must be used to collect the additional shed blood. Bacterial contamination and red cell function are the principal concerns that account for this approach, as well as compliance with AABB Standards for Perioperative Autologous Blood Collection and Administration. The inquiring colleague asks if others agree that it is mandatory that a second (new) disposable system must replace the initial disposable system if more than 6 hours has elapsed after the start of the shed blood collection, provided that more shed blood is to be collected and reinfused? Does anyone see a problem with continuing the collection of shed blood post-operatively beyond the initial 6 hours as long as a new disposable system for blood reinfusion replaces the used system at least every 6 hours?

The following responses have been received.

1. In response to the above query, two anesthesiologists who routinely use disposable systems for blood reinfusion report that if it is medically necessary to collect shed blood for a patient beyond the initial 6 hours of starting shed blood collection, they would use a new collection device. They would err on the side of using a new sterile container which is less likely to promote infection, especially since the cost of an additional collection device is not excessive.

ADDENDA Sept. 21, 2007

2. The Chief of the Department of Anesthesiology located at a hospital in Pennsylvania wonders about the response of the anesthesiologists who report that they would change out their postoperative collection reservoirs after six hours. In the experience of the Pennsylvania anesthesiologist, most postoperative salvage is conducted by nurses under the direction of cardiac or orthopedic surgeons. So, how do the anesthesiologists fit in? Second, in his experience, most postoperative blood loss occurs in the first 4 hours after surgery. If significant blood loss is occurring at 6 hours where there is enough blood to retransfuse, then serious consideration needs to be made about taking the patient back to the OR. Since most postoperative blood has bacterial contamination, he is not sure of what is being accomplished through disposing of the reservoir.

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