Cell saver

[anbuitachi]

I was trying to find more info on this but couldnt find answers i was looking for. If anyone know, what is the recovery rate of cell saver? Like how much of the blood that gets suctioned actually gets centrifuged and packaged to be given back after all the filtration/washing, etc. And how do you guys roughly estimate blood loss from cell saver? I currently do usually cell saver x3 to be EBl to cover blood on field, pads, stuff not suctioned, stuff lost in saver, etc. (obviously not if there's unusual amts on the field/floor or something etc)

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[dhb]

Some versions give you that info.

 

[Neogenesis]

I do 3x what you get back for an estimate.

 

[Noyac]

I just record what the surgeons say the loss is.
Not because I'm a pushover. But because I really don't care how much is lost as long as I know where I stand with regards to H/H and vitals. They always underestimate. We occasionally over estimate. I'm just not that good at estimating how much is lost when it's in the cell saver, soaked laps and on the floor. Much less hidden in the drapes, on the walls and ceiling, in their shoes, etc.
I just giggle when they give me some ridiculous number and then I type it in.
After all, they are the ones that will have to address it when the pt leaves the PACU.

 

[Noyac]

I do 3x what you get back for an estimate.

Just curious, where did this come from?

 

[Robotic Wis-Hipple]

Most machines will tell you the blood/volume processed, but who knows how much of that is irrigation etc. But I agree with Noy, we are horrible at estimating blood loss, and I'm not sure it matters. I follow my Hct if it's a case to do so and otherwise treat it as binary; a lot of blood loss, or "normal". For example, in a c-section, >1L by my or OB's estimation I consider abnormally high.

But in the end why does it matter?

1.) for charting purposes and as a type of indicator for surgical success vs complication

2.) to replace blood loss. But I think most would agree Hct and other goal directed indicators guide your volume resuscitation. If Hct is 28, hemostasis has been achieved, pt is hemodynamically stable, and no evidence of end organ dysfunction would you transfuse because your 3x cell saver blood loss makes you think you lost 30% of their blood volume?

 

[Neogenesis]

Just curious, where did this come from?

Honestly, no scientific basis that I can talk to. It was something I learned in residency and haven't really done any cases with it since leaving residency. I guess I should look and see what the basis for that was.

 

[Noyac]

Honestly, no scientific basis that I can talk to. It was something I learned in residency and haven't really done any cases with it since leaving residency. I guess I should look and see what the basis for that was.

I wouldn't waste my time. I was taught the same thing in residency and I never knew where it came from either.

 

[ScarfTheVerb]

Hct of cell saver is 60-70% so you can do a rough calculation based on what you think the crit of the blood they lost was. Agree it doesn't real matter. In a bloody case I usually throw out half of what I think the real EBL was, surgeon usually counters with half of that, and I type it in-- because who cares what the chart says EBL was

 

[anbuitachi]

I actually did a ABG of the cell saver blood and the crit was ~50%. But i do find it funny when i give back X amount of blood thru cell saver, and the surgeon says the EBL is half of the cell saver blood amt. haha.
Most cases i dont care about EBL but for bigger cases where blood loss is in the liters, i try to do a decent estimate mainly for if i need to go back and review the case later on or if another ppl needs to see my record post op the information is there.

 

[Shimmy8]

Our machine can tell you exactly how much EBL, irrigation used (from that circuit).

I take their number and add whatever looks to be on the field, drapes, laps, etc.