To wash or not to wash? That is the question.
An audit to investigate whether washing of surgical swabs increases the return from cell salvage
Intra-operative Cell Salvage (ICS) is becoming
increasingly common in obstetric practuce.
It is both cost effective and reduces the demand on red cell donors
Conversion rates for ICS (ie when collection leads to returning of blood) has been
as low as 23%.
Blood loss in surgical swabs can account for 30 – 50 % of
the total estimated loss.
The washing of swabs in aortic surgery increased the amount of blood available
In 2014, 966 caesarean sections were performed ompared to 980 caesarean sections in 2015.
With the introduction of washing of surgical swabs, nearly three times
as much blood was returned to patients in 2015 compared to
2014 (93166ml vs 37846 ml), with a conversion rate of 81.1%.
For cases in 2015 where the washing of surgical swabs was used compared to when it was not, as per consultant
preference, the conversion rate for ICS in caesarean sections
increased significantly (from 12.5% when swabs were not washed to an average of 80.7% when washed).
Theaim of this audit was to investigate whether the washing of surgical swabs
increased the amount of blood available from ICS and whether this had an impact
on the conversion rate for caesarean sections.
This audit collected retrospective data from 2014
and prospective data from 2015.
• how many times ICS was used
• how often cell salvage blood was returned to the patient (conversion rate)
• whether the washing of surgical swabs resulted in an increased amount of
blood available for use via ICS.
No washing of swabs occurred in 2014, and the data from this year was used
This audit shows that the use of washing of surgical swabs increases the conversion rate for
ICS in caesarean sections, as well as an increased in the volume of lood returned.
We are performing a prospective study to look
for the impact on transfusion rates and the impact upon the
cost effectiveness of ICS in obstetric practice.
1. AAGBI Safety Guideline. Blood transfusion and the Anaesthetist.
Intraoperative cell salvage. Published September 2009.
2. Intraoperative blood cell salvage in obstetrics NICE interventional
procedure guidance [IPG144] Published date: November 2005
3. Brearton C, Bhalla A, Malliah S et al. The economic benefits of cell
salvage in obstetric haemorrhage. Int J Obstet Anesth 2012; 21 (4):