[Red251078]

Hey guys....I'm a new ortho nurse....just graduated in Dec. 2003. I've got a question about Stryker drains. We sometimes get patients post op with these. What is the basic protocol? I know you start reinfusion of RBC's 4 hrs after collection begins and you must transfuse within 6 hrs. What I'm wondering is as soon as you transfuse your first 250 cc or more....do you begin the 4 hr collection of blood in the drain again and tranfuse the second amount within 6 hrs?? I'm just confused and would appreciate any more information on these type of drains! Thanks!

[meownsmile]

I'm not that clear about the Stryker drains,, but we do autotransfusions.. I think you are thinking in the right time frame. I usually use the time the patient comes from the OR to the PACU as the first start 4 hr. start time. I DONT use the time the patient arrives at the unit as the initial start time because that would leave it to drainage >4hrs. At 4 hr, or >400 ml the transfusion should be hung to run over no more than 2 hours. So the second container is documented as being open to drainage at the time you start infusion of the first container. So if your first container actually took 2 hours to infuse, in 2 more hours you would be ready to either hang the second and attach the thrid container or discard and connect to HV if drainage is less than 100ml. I try to look at it in 4 hr drainage/ 2 hr infusion increments.
This probly sounds clear as mud.

[P_RN]

Let me opine on this and probably furthur muddy the water.

We used several different brands, but the Constavac is my personal favorite.

Nonetheless......The last thing done before closing the incision is the placement of the drain - be it hemovac or a reinfusion device.

So look on your OR sheet and drain placement time should be noted there. Train your nurses to get this information from the PACU nurse.

SO you get the time and the clock starts ticking.......you have 6 hours from the drain insertion time until you can no longer infuse anything from it.

The different brands have different measurements and different doctors have different preferances. In the Constavac 100 cc more or less is fat and "trash" so that is never infused. Only the drainage over 100cc is ever used.

Most docs will specify to reinfuse when the drainage reaches 250-300 cc's.

Now remember the hematocrit of this blood/liquid is only like 15, so 250 ccs is not a lot of red cells.

From placement of the drain until conversion to a non suction device is SIX hours. SO if it takes 2 hours to get 250cc's you can reinfuse that over 2-4 hours....usually its less than 2. If you still have time and can get enough more blood you can reinfuse that as long as it stays inside that 6 hour window.

I guess all of the systems still use the Pall type filter which is only good for 1 unit. Cost wise and time wise it's not worth it to get another for only 25-50cc more blood.

So clear or still muddy water????

And by all means check your rules and procedure manual for your facility's protocol.

[Thunderwolf]

We use the Constavac as well. The procedure you describe is much like our own. The start time IS the time of insertion, not upon arrival to any given floor. We only begin reinfusion when 400 cc is obtained within the first 4 hours (50 cc always remain in the container when emptied, so really reinfusing 350 cc). A second reinfusion is done if another 300 cc is obtained within any remaining time of the 6 hour window. The doc prescribes in his/her postop order the max amount that can be reinfused within the 6 hour window. If, however, a pt is draining significantly, providing another 300 cc within this time frame, the physician is contacted with regard to reinfusion of a third and last reinfusion...rarely happens. The doc provides the order if yeah or neah. If the patient is draining slowly over hours (but within the 6 hour window) and finally reaches an initial 400 cc in the container and the drainage is separated into layers, the container is manually shaken to observe if the drainage continues to be layered or dissolved. If dissolved, it is reinfused. If it remains layered, it is not reinfused and discarded as drainage. Good question.

[kiwideb]

our surgeons use stryker drains tho it appears our hospital's protocal is slightly different to all of yours! we start the clock at the time the drain was inserted and this time is handed over when picking a patient up from PACU as well as actually being written on the stryker drain itself. all blood that is going to be reinfused has to be collected within 6 hrs and reinfused within 8 hrs. would normally start reinfusion once collection gets to about 300cc, infusing no more than 1000.

[chelsea_j]

we reinfuse within 6 hours and only if there is more than 250cc in the drain and no limit on the amount that they will get back. only thing is at 1000cc we turn off the suction and hold their CPM

[Lorbun]

Funny, we never transfuse.... Help me understand, do you use the blood in the drain container itself? If our patient needs a transfusion based on thier H/H - HGB <25 warrants attention and probably a transfusion, we go to the blood bank and get what is on hold for them. We throw away any blood in the drain container, once the Dr. removes it - usually day 2-3. We use both Constavac and Stryker. Wow, things sure are different in various hospitals.

[P_RN]

Hi Lorbun. These are special reinfusion systems that have a battery pack to draw the fluid into a container which can be clamped off. The Stryker Constavac is the one I am most familiar with but there are others.
http://www.stryker.com/instruments/orproducts/blood.htm

Then you have a blood bag that you can drain the contents in to and reinfuse. We're not talking about the regular pancake hemovac type.