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Blood Recovery Simulation Training

Blood Recovery Simulation Training . Bob Dyga RN, CCP, LP VP, Perfusion Operations. UPMC Blood Management Strategy. Implementation of evidence-based transfusion triggers Minimize preoperative autologous donation Preoperative anemia optimization Point of care monitoring

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Blood Recovery Simulation Training

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  1. Blood Recovery Simulation Training Bob Dyga RN, CCP, LP VP, Perfusion Operations

  2. UPMC Blood Management Strategy • Implementation of evidence-based transfusion triggers • Minimize preoperative autologous donation • Preoperative anemia optimization • Point of care monitoring • Education, physician awareness, auditing • Intraoperative Autologous Program A. Biologics B. ANH C. Blood recovery

  3. FY11 vs. FY12 Blood Recovery

  4. Objections to autologous blood recovery • Cost • Contraindications • Complications • Quality

  5. PRBC units = 31,351 units Cost per unit = $144.00 Allogeneic cost/unit =$200 Replacement cost = $6.3M Program cost = $4.3M SAVINGS =$2.0M Transfusion: Waters,JH, Jan 2011

  6. Relative Contraindications • Hypotonic and hypertonic fluids • Drugs not FDA approved for IV • Topical clotting agents • Contaminants • Malignancy • Hematologic disorders Options • Limit intake and rinse • Double suction • Leuko-reduction filter

  7. Potential Complications • Air embolism • Coagulopathy • DIC • Dilutional • Infection • Fat embolism • Microembolism

  8. Objections to autologous blood recovery • Cost • Contraindications • Complications • Quality

  9. AABB Guidelines for Blood Recovery and Reinfusion in Surgery and Trauma • Intraoperative blood recovery -Increase effectiveness -Contraindications -Complications • Postoperative blood recovery -Washed & Unwashed • Storage • Administrative aspects -Needs analysis -Responsibility for service -Regulatory consideration -Legal consideration -Quality assurance

  10. AABB Quality System Model Collect Process Test Distribute Transfuse Quality System Essentials 1. Organization 2. Resources 3. Equipment 4. Supplier and Customer 5. Process Control 6. Document/Records 7. Deviations, Nonconformances 8. Assessments 9. Process Improvement 10. Facilities and Safety

  11. UPMC Organization TBM Medical Director ITXM - Transfusion – Medical Director Local Medical Director Local Director of Clinical Pathology Clinical Manager Technician Technician Lead Technician supervisory function clinical and quality function

  12. Operator Training and Competency

  13. WHO PERFORMS RECOVERY? • Surveyed 3,815 hospitals • 2,008 or 53% responded Chapman B. CAP Today Vol 13, No. 11, 1999

  14. Manufacturers programs In-house developed programs Perfusion schools Anesthesia technology schools On-job training Current methods of blood recovery training

  15. Operator Competency-Current Practice • Meet Standard 2.1.3 • Establish competency guidelines • Content: A. Annual review B. Observation by manager C. Testing D. Ongoing quality control testing E. Ongoing physician feedback • Sample

  16. 11 KEY POINTS FOR QUALITY BLOOD RECOVERY • Medical leadership • Use only FDA approved devices, supplies, & solutions • Validate equipment • Perform procedures according to guidelines • Staff should not multi-task • Observe effluent line for clarity • Inspect product by technologist & anesthesia staff • 8. Perform periodic QC sampling • 9. Document activity • 10. Perform internal and external assessments • 11. Trained and competent personnel

  17. Simulated Blood Management Training • Course Director:Dr. Jon Waters • Target learner • Course objective • Outline • Modules

  18. Program Outline • Target learner: Clinical, Industry, Student • Class size: 6-12 learners/course • Frequency: 2-4/year based on demand • Objective: Develop and administer a comprehensive perioperative autologous blood simulation course appropriate for novice to expert . • Specific Learning Objectives: • Develop skills in safe management of blood salvage including equipment and team cooperation (function) 2. Deliver didactic content needed for understanding of blood salvage principles and procedures 3. Allow non-clinicians interaction and hands on practice to develop understanding environment and key interactions

  19. Program Outline – Training Modules • Obstetrics and Dirty Surgery • Contraindications • AABB Standards & Accreditation • ANH • Economics of Blood TX • Set-up Bowl and Tubing • Stand-by/Collect-First Mode • Processing Shed Blood • Maximizing RBC reinfusion. • Introduction • Basic Hematology • Basic Equipment Operation • Anticoagulation • Efficiency of RBC return • Estimated Blood Loss • Complication • Filtration • Managing Jehovah Witness • Blood Salvage & Malignancy

  20. Blood Salvage Risk

  21. Color of Waste Line Full bowl and clear waste Line Waste Line NOT Clear

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