REVISION:
PROCEDURE APPROVED: 06/06
PROCEDURE FOR THE STRYKER AUTOLOGOUS REINFUSION SYSTEM
PURPOSE:
EQUIPMENT: Stryker CBC II Infusion System
NURSING ACTION: Autologous blood will be collected and re-infused from the patients wound site per physician order and according to AABB Standard.
GENERAL INFORMATION: 1. CBC II must be monitored by an RN. The reservoir is suctioning when the vacuum is set to I, II, or III and the red cap is inverted. Suction settings are determined by the physician.
2. An air leak in the system is a contraindication for re-infusion. This is an extension of the wound site and must remain closed and sterile.
3. Collection units must be upright at all times.
4. Collected amounts of 300 ml to 400 ml of blood may be re-infused up to every 5 hours for 24 hours. Blood must not sit in the reservoir more than 5 hours. After 5 hours of less than 200 ml collected, cut the bag and use as a drainage device. Per AABB guidelines, the maximum amount that may be infused is 1400 ml in 24° time period.
5. In PACU, strict attention to labeling the container with the time the collection began must be observed.
a. Attach patient label to canister and blood bag.
b. Start of first collection will be the OR “finish time”.
c. Label blood bag with time infusion begins. That same new time should be placed on the collection canister.
d. Expiration time is 5 hours from time collection begins. Blood must be infused completely 4 hours from that time.
6. 75 ml to 100 ml of blood do not drain from the system. This contains fat and must be counted as output and recorded when the canister is emptied the first time.
7. Patients with multiple antibiotics/PCA analgesia must have a second IV site placed in PACU.
PROCEDURE STEPS: 1. First Re-infusion
a. Uncoil blood bag and tubing. Hold the blood bag tubing so that it forms half a loop at the base of the reservoir while the bag rests on a towel on the floor.
b. When collection canister reaches 400 ml or 5 hours has past, the blood should be re-infused.
c. Fully depress and hold down the release lever on top of the unit to transfer blood into the blood bag. Once blood is flowing the tubing can hang freely.
d. When transfer is complete, release the lever and use the slide clamp to clamp off the blood bag tubing as close to the bag as possible.
e. Observe collected blood in bag for any visible clots. Do not re-infuse if clotting present.
f. Label canister with time new collection has begun.
g. Re-infuse using standard blood administration criteria (see Nursing Procedure 27-1). Standard blood administration set with a LipiGuard SB Filter along with normal saline should be used. Instructions for priming the filter are contained in the package and must be followed closely. The filter is single use only. Y-tubing is changed after 2 infusions.
h. Infuse via gravity. Do not use a pressure bag or IV pump. Maximum infusion time is 4 hours.
i. Record time and amount of blood infused.
j. If less than 200 ml is collected in a 6 hour period, cut the bag and use container only as a collection device.
2. Wound Drainage
a. Drainage output is measured directly from the canister when auto-transfusions are discontinued.
b. If the canister should tip or fall saturating the air filter, the system must be changed per M.D. Label “Drain Only”.
c. Changing opens the system. Then the unit may only be used as a drain.
REFERENCES: Stryker Instruments Protocol for CBC II –The Stryker Autologous Reinfusion System. “Autologous Blood Donation and Transfusion,” Chapter 5, AABB Manual, 14th Edition. “Standards for Perioperative Autologous Blood Collection and Administration,” AABB. 2nd Edition. Pall Medical, LipiGuard SB package insert
RESOURCE PERSON(S):
Betty Casali BSN,