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P.140
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.
Board Board 8 / Wed 13:00, 11 May 2016

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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

 

Introduction

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

by 67%.

Results

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).

 

Objective

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.

Methods

This audit collected retrospective data from 2014

and prospective data from 2015.

We reviewed

• 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

for comparison.

Discussion

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.

References

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):

329-33

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