Transfusion-free Surgery is a Treatment Plan for All Patients

AORN Journal, Nov, 1998 by Tricia Trovarelli, Barbara Kahn, Sharon Vernon

Many surgeons choose to employ hypotensive epidural anesthesia for arterial hypotension. The benefit of this technique is decreased blood loss, decreased incidence of deep vein thrombosis, and decreased mortality rates while maintaining cardiac function.

In many patients, a major factor that contributes to anemia is iatrogenic blood loss due to blood testing. One study indicates that the average patient loses one unit of blood for every week spent in an intensive care unit setting due to blood sampling. Microsampling eliminates this problem. All blood draws are completed with pediatric tubes and 21-g needles, and discard blood from central lines is reinfused by way of a closed system. Blood tests are ordered only when necessary, as blood conservation is the priority.

Bloodless surgery has been cited as becoming the gold standard of patient care.(4) The techniques are advocated and used by bloodless surgery centers across the United States. Bloodless surgery centers are run by health care providers who coordinate patient care from preadmission to discharge and act as patient advocates. When a patient wishes to avoid a transfusion or refuses homologous blood under any circumstances, the bloodless surgery center coordinator will discuss the patient's medical options, alternative treatments, and legal aspects of bloodless medicine and surgery. Any legal forms, such as release of liability or advance directive forms, are available for the patient to sign. The patient then is identified by means of a wrist-band, and a placard that indicates the patient is in the bloodless program is placed above the head of the patient's bed.

All health care providers agree to honor the patient's wishes. The bloodless surgery center coordinator meets with the patient on a daily basis. He or she also educates the patient about signs and symptoms of anemia and discusses medication and lifestyle. The coordinator monitors the patient's medical care to ensure that all caregivers use blood-saving techniques (eg, microsampling, reinfusion of blood loss, limited blood draws). Coordinators frequently are called on to help in crisis situations in which a patient may be in a facility that does not have the means to provide "bloodless" care. The coordinator will facilitate a transfer and comfort family members during the crisis.

Many bloodless surgery centers provide services in several medical and surgical specialties (Table 1). These centers are powerful arenas that attract patients who, for religious or personal reasons, refuse blood or blood products.

Table 1 SPECIALTY SERVICES PROVIDED BY BLOODLESS SURGERY CENTERS

* Allergy and immunology

* Anesthesiology

* Cardiology

* Dermatology

* Dentistry and oral surgery

* Family practice

* Gastroenterology

* General surgery

* Hematology

* Infectious diseases

* Internal medicine

* Neurology and neurosurgery

* Obstetrics and gynecology

* Oncology

* Open heart surgery

* Ophthalmology

* Orthopedic surgery

* Pediatrics

* Plastic surgery

* Radiation oncology

* Rheumatology

* Thoracic and vascular surgery

* Urology and urologic surgery