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Industry: Email Alert RSS FeedGlutaraldehyde fixation
AORN Journal, Jan, 2008 by Sharon Giarrizzo-Wilson
QUESTION: A pediatric surgeon at our hospital wants to use a "glutaraldehyde bath" on autologous pericardial grafts before placing the graft back into the patient. I have been unable to find information on this technique. Is there supporting literature for this practice? What advantage does the glutaraldehyde bath provide for grafts, and how should the bath be identified on the sterile field?
ANSWER: glutaraldehyde fixation has been investigated for use on autologous and bovine pericardial tissue and as a cross-link component (ie, cells were molecularly altered at the atomic level) in bovine collagen for human implantation. (1-4) Historical and emerging research on this topic is reported in cardiovascular, thoracic, and biomedical journals.
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The technique of exposing human autologous tissues to fixation by glutaraldehyde is based on the resulting molecular enhancements to the tissue. Treated tissues become firmer and stiffer and have improved tensile strength. (1,3,4) Augmentation of the tissue's mechanical properties helps to facilitate tissue implantation by reducing graft curling and shrinkage and makes graft tailoring and suturing easier. (1,3) Unlike tissue that has undergone alternative fixation treatments (eg, heat, periodate, chloroform/methanol, ethanol), glutaraldehyde-treated tissue demonstrates decreased histologic changes including calcium and granulation formation. (2,4)
When using glutaraldehyde fixation for autologous grafting procedures, perioperative nurses should be familiar with the technique and process used to prepare the donor tissue for reimplantation. Policies should describe the technique and the responsibilities of involved individuals. As with any medication placed on the sterile field,
* the solution must be identified and actively communicated by the circulating nurse to the scrub person before it is transferred onto the sterile field;
* the scrub person must clearly label the reservoir with the solution name, composition, and expiration date immediately before receipt of the solution; and
* the circulating nurse and scrub person must concurrently verify all related information before the circulating nurse dispenses the fixation solution onto the sterile field. (5)
New procedures and techniques require proactive learning and planning to protect the patient from harm. Conducting and reviewing literature searches, consulting experts in the field, and questioning practices that are uncommon not only enhances clinical knowledge but also permits perioperative nurses to intelligently advocate on behalf of perioperative patients.
REFERENCES
(1.) D'Andrilli A, Ibrahim M, Venuta F, De Giacomo T, Coloni GF, Rendina EA. Glutaraldehyde preserved autologous pericardium for patch reconstruction of the pulmonary artery and superior vena cava. Ann Thorac Surg. 2005;80(1):357-358.
(2.) Alkan M, Talim B, Ciftci AO, Enocak ME, Calar M, Buyukpamukcu N. Histological response to injected glutaraldehyde cross-linked bovine collagen based implant in rat model. BMC Urol. http://www.biomed central.com/1471-2490/6/3. Accessed October 25, 2007.
(3.) Grimm M, Eybl E, Grabenwoger M, et al. Improved biocompatibility of bioprosthetic heart valves by L-glyutmatic acid treatment. J Card Surg. 1992;7(1):58-64.
(4.) Sanches DM, Gaitan DM, Leon AF, Mugnier J, Briceno JC. Fixation of vascular grafts with increased glutaraldehyde concentration enhances mechanical properties without increasing calcifications. ASAIO J. 2007;53(3):257-262.
(5.) AORN guidance statement: Safe medication practices in perioperative settings across the life span. In: Standards, Recommended Practices, and Guidelines. Denver, CO: AORN, Inc; 2007:337-343.
SHARON GIARRIZZO-WILSON
RN, MS, CNOR
PERIOPERATIVE NURSING SPECIALIST
AORN CENTER FOR NURSING PRACTICE
COPYRIGHT 2008 Association of Operating Room Nurses, Inc.
COPYRIGHT 2008 Gale, Cengage Learning
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