cell saver and ebl

We have scanned the surface on blood loss, and I have not learned how to replace without knowing your Hg/Hct. My guess is it's a crap shoot anyway, but if you're giving cell saver, you should have the capability to run an H/H. Obviously the blood loss depends on the case, the patient, pre-existing factors, body weight, coagulopathy. We've learned allowable blood loss thus far, which is

ABL= Estimated body water x (inital hemoglobin-hemoglobin allowed)/ hemoglobin initial.

Based on your laboratory values, you should be able to determine how much blood to give. 1 unit PRBC's should increase your HG 1gm/dl, and one unit of FFP should increase your clotting factor by 2-3%. Each unit of plts. should increase your count 5-10,000.

what is the ebl with cell saver? I had always heard to estimate the blood loss as three times what you gave back---so if you give 500cc back, the ebl is 1500cc--is this the same as you learned, if so can someone provide a link---

thanks

First - any "estimate" you receive from your cellsaver tech is a GUESS at best. YOU need to be the judge of EBL, not the tech, not the circulator, not the surgeon. In general, 2-3x the volume of what you give back is a VERY ROUGH estimate. Remember there's often blood on the drapes and floor, are the laps washed in saline and then the lap wash sucked up or are the laps tossed on the floor, etc. Lots of factors to consider.

The quality of salvaged blood from a cellsaver varies tremendously from unit to unit, case to case, day to day. Blood collected and processed from "pooled" blood (ruptured AAA for example) will generally be of higher quality with significantly less hemolysis than that suctioned during a spine case or total hip. Turning the suction up higher also increases hemolysis - and of course surgeons never want the suction on low.

I agree 100% with jwk.

I only remember one case where the we were doing a CABG and the patient was a Jehovah's Witness. Cell-saver was used from the very beginning and it was the dryest surgery that I have ever seen. Laps did not have more than a small spot on them, and those were very few.

If I remember correctly, the final EBL was about 50 ml. It was definitely an amazing surgery to watch, as well as participate in.

There are a number of hospitals that promote themselves as having "bloodless surgery". IMHO it's more of a marketing gimmick, and the only difference I've seen is a lot more bovie.

Also, be aware that some JW patients will not accept cellsaver. And as far as a 50cc EBL for a CABG - no way. Between the pump and the cellsaver and the surgery itself, you're gonna lose more blood than that. That's about as believable as an OB doc thinking they lose 50cc of blood on a C-Section.