Older adult surgical patients; herbal medicine use; blood cell salvage and autotransfusion; antibiotic prophylaxis

AORN Journal, Oct, 2004 by George Allen

Clinical implications. This study revealed that herbal medicine use is common among patients undergoing surgical procedures. Patients rarely reported use of herbal medicines, and perioperative personnel infrequently assessed patients for herbal medicine use. As a patient safety initiative, perioperative nurses should develop and implement a process to elicit information about patients' use of herbal medicines and communicate that information to the rest of the surgical team.

Perioperative cell salvage and autotransfusion

Annals of Thoracic Surgery May 2004

Allogenic or homologous transfusion uses blood collected from someone other than the patient. Autologous blood transfusion is the collection and reinfusion of a patient's own blood or blood components. During the past several years, increased awareness of diseases transmitted by allogenic blood has resulted in a dramatic increase in autologous blood transfusion.

Cell salvaging is one technique used for autologous blood collection during surgical procedures in which excessive bleeding is anticipated. Blood is suctioned from the surgical field directly from the heart-lung machine or from sterile drainage containers, washed and processed by a machine, and reinfused into the patient. The purpose of this randomized study was to determine whether cell salvage and autotransfusion after elective coronary artery bypass grafting (CABG) was associated with a significant reduction in the use of allogenic blood, clinically significant derangement of postoperative clotting profiles, or an increased risk of postoperative bleeding. (3)

Two hundred patients undergoing nonemergency, first-time CABG procedures using cardiopulmonary bypass were assigned randomly to one of two groups. The autotransfusion group underwent autotransfusion of washed intraoperative salvaged or postoperative shed mediastinal fluid as first-line blood replacement therapy. The control group was given only allogenic/homologous packed red cells as blood replacement therapy. Hemoglobin, hematocrit, and clotting profiles were assessed preoperatively, intraoperatively, and postoperatively. Standard statistical methods, including logistic regression techniques, were used to analyze differences between the groups.

Findings. Patients in the autotransfusion group were significantly less likely to require a homologous blood transfusion than patients in the control group (OR 0.40, 95% CI 0.22-0.71). There was no significant difference in the incidence of adverse events (eg, sepsis, bleeding) between the two groups. Compared with the effects of homologous blood transfusion, autotransfusion did not result in any significant derangement of postoperative clotting profiles, including thromboplastin time, activated partial thromboplastin time, and fibrinogen and fibrinogen D-dimer levels.

Clinical implications. The results of this study demonstrated that the use of intraoperative and postoperative salvage and autotransfusion of processed red blood cells was associated with a significant reduction in the need for allogenic blood. Autotransfusion was not associated with any clinically significant derangement of clotting pathways. Perioperative nurses should be prepared to assist the surgeon and anesthesia staff members with cell salvage and autotransfusion during procedures in which it is performed.