Pharmacological Agents

Substances

Effects

Recommended Action

Clotting agents

Microfibrillar Products
Examples:
Avitene®, Helitene®, Oxycel®,
Gelfoam® Powder, Instat®
MCH

May cause platelet aggregation and clot formation.
Reported to pass through a microaggregate filter into the bloodstream, causing emboli.

Avoid aspiration when product is being used.
Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Sponge/Fabric Materials
Examples:
Surgicel™, Surgicel™ NuKnit®, Gelfoam® Sponge, Helistat®, Instat™, Hemopad®, Super Stat®, HemoFoam®

Activates clotting sequence by acting as a contact agent.
May clot off system.

Avoid aspiration in area where product is being used.
Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Topical Liquids
Examples:
Thrombin–JMI™,
Thrombostat®,
Thrombogen®

Creates a fibrin clot by direct action on fibrinogen.
May clot off system.

Avoid aspiration in area where product is being used.
Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Irrigating solutions

Alcohol

Causes red cell lysis.

Avoid aspiration in area where product is being used. Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Antibiotics
Examples: Bacitracin, Neomycin, Polymyxin

Can result in renal and neural toxicity if blood is not washed.

Increase amount of wash volume by 500 mL.

Betadine

Causes red cell lysis.

Avoid aspiration in area where product is being used.
Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Chloropactin (Bleach)

Causes red cell lysis.

Avoid aspiration in area where product is being used.
Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Hydrogen Peroxide

Causes red cell lysis

Avoid aspiration in area where product is being used.
Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Hypertonic Solution
Examples: 3% NaCl, 7.5% NaCl, Dextrose solutions

Causes red cell crenation.

Avoid aspiration in area where product is being used.
Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Hypotonic Solution
Examples: Sterile water, glycine

Causes red cell lysis.

Avoid aspiration in area where product is being used.
Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Lactated Ringers (in presence of citrate anticoagulant)*
*Not an issue if heparin is the anticoagulant used

Calcium present may bind with citrate, negating the anticoagulant effect.

Avoid aspiration in area where product is being used.
Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Methylmethacrylate

Liquid or Powder Form

May cause circulatory collapse.

Avoid aspiration in area where product is being used.
Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Hardened Form

May cause clogging of the system

Avoid aspiration in area where product is being used.
Flush suction line occasionally with anticoagulant or normal saline to keep clear.

Contaminants

Substances

Effects

Recommended Action

Amniotic Fluid

Contains proteolytic enzymes that may activate clotting.

Amniotic fluid should ideally not be aspirated into the collection reservoir, but should be removed by separate suction prior to starting cell salvage. This recommendation will reduce the initial contamination, although in vitro evidence demonstrates that the cell salvage process can effectively remove plasma phase elements of amniotic fluid whatever the initial load. In life-threatening haemorrhage, therefore, a clinical decision to salvage red cells from the start of the procedure could be carefully considered.

Bone Chips/Bone Grafting Materials

May cause clogging of the system.

Flush suction line occasionally with anticoagulant solution or normal saline to keep clear.

Bowel Contents

Potential for bacteremia.

Do not aspirate into system.
Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Fat

May not wash out completely.

Retain visible fat layer in reservoir and reinfusion bag.
Increase wash volume. If visible fat layer exists in reinfusion bag, piggyback two microaggregate filters between reinfusion bag and transfer pack or infusion set. Use lipid filter.

Gastric and Pancreatic Fluid

Proteolytic enzyme may cause red cell lysis.

Do not aspirate into system.
Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source

Infection at Site of Aspiration

Potential for bacteremia.

Avoid aspiration in the presence of purulent material.

Skin Lesions (Infectious)

Incising a lesion may introduce organisms.

Blood recovery may be used if incision is not through a lesion.

Urine

Potential for bacteremia if urinary tract infection is present.

Avoid aspiration into system in the presence of a urinary tract infection.

Mucous Membrane Procedures
Examples: Oral, nasal, vaginal

Potential for bacteremia, due to normal resident bacteria.

Medical risks and benefits should be discussed between the surgeon and the clinician responsible for cell salvage

Malignancy

Substances

Effects

Recommended Action

Primary at Operative

Evidence indicates the procedure is safe and does not increase the incidence of metastatic disease.
The decision to use cell salvage in malignancies must be left to the discretion of the surgeon.

Avoid blood recovery at tumor site.

Medical risks and benefits should be discussed between the surgeon and the lead clinician for Cell salvage

Consider the use of a leucoreduction filter.

Metastatic at Operative Site

Potential for further spread of disease.

Disease already systemic. Use at discretion of surgeon.

Pheochromocytoma

Potential for marked hypertension due to high concentrations of catecholamines.

Avoid aspirating at the tumor site. Resumption is an option after copious irrigation with 0.9% sodium chloride solution to an alternate suction source.

Ascites

Tumor cells may be present.

Avoid aspirating into the system if the surgical procedure is for ovarian malignancy

Haematologic Disorders

Substances

Effects

Recommended Action

Sickle Cell Trait

Wash procedure produces potential sickling of salvaged cells.

Alert staff of potential for red cell sickling.

Confirmed Sickle Cell Anemia

Wash procedure produces potential sickling of salvaged cells.

Medical risks and benefits should be discussed between the surgeon and the lead clinician for cell salvage

Cold Agglutinin Antibody

Agglutination of red cells may occur at temperatures lower than 37°C (98.6°F). Cold agglutinins are in plasma and will be washed off.

If cold agglutinins show significant activity at room temperature recommend transfusion of blood through a blood warmer.

Miscellaneous

Substances

Effects

Recommended Action

Titanium Alloy Prosthesis

Effect of darkened tissue or clots (blue/green/black) surrounding prosthesis unknown to systemic circulation.

Discontinue cell salvage until the prosthesis and all darkened tissue have been removed. Resume after the wound has been irrigated with 0.9% sodium chloride solution to an alternate suction source.

Liposuction

Fat concentration in salvaged blood may be too high to remove by washing.

Avoid blood recovery.