Autotransfusion (ATS) FAQ
The following questions may be often asked about
autotransfusion, and the answers are provided here for your
convenience. If you have further questions, please contact
our 24-hour technical support.
- During rapid blood
loss conditions, is it normal for the filter chamber
in the Ocean 2050, Oasis 3650, or Express 4050 ATS chamber
models to fill with clot?
- In the event that
the filter chamber does fill up with clot and drainage
starts to spill over into the ATS chamber, can I continue
reinfusion?
- What
should I do if the patient’s rate of bleeding
exceeds the maximum infusion pump rate setting?
- What
should I do when an “air-in-line” pump alarm sounds or
when an “occlusion” alarms sounds?
- What should I do
if the 2450 self-filling ATS bag does not fill completely
after activating blood bag?
- In the event blood
reinfusion does not appear to be flowing freely into
the patient during gravity (non-pressure) ATS bag reinfusion,
what should I check for?
- What do I do when
clotting within the ATS bag occurs during patient reinfusion?
- How long can I collect
blood before I reinfuse the patient?
- Do the Atrium Self-Filling
2450 and In-Line 2550 Blood Bags contain any latex?
1. During rapid blood
loss conditions, is it normal for the filter chamber in the Ocean
2050, Oasis 3650, or Express 4050 ATS chamber models to fill
with clot?
When rapid or massive blood loss is encountered, blood may not
be allowed to pool in the chest long enough to become defribrinated.
In general, the more
rapid the bleeding, the more clotting you can expect to see. The purpose of
the filter chamber is to screen large blood particulates during collection.
The filter chamber has a large 300ml filtering capacity and is calibrated to
give you useful diagnostic information about your patient’s condition,
i.e., is there a lot of clotting or a little? An important safety feature of
Atrium’s advanced filter chamber design is that it can allow drainage
to spill over in the rare event that the filter chamber would fill up or clot
off, preventing any possible fluid to backup the patient tube. The Atrium system
provides unrestricted patient drainage under all patient condition, thus helping
to reduce the risk of cardiac tamponade. When rapid or massive blood loss can
be expected, an effective dose of “citrate” anticoagulant is recommended
to help minimize clotting in the chest drain during such conditions. Return
to Top
2. In the event that
the filter chamber does fill up with clot and drainage starts
to spill over into the ATS chamber, can I continue reinfusion?
Yes. If the blood is considered suitable for reinfusion you may
continue ATS. The spill over safety feature of the filter chamber
does not preclude ATS because
a microemboli blood filter, which must be used during reinfusion, will screen
out any harmful particulates to the patient. However, during episodes of heavy
blood loss, you can anticipate a fair amount of clotting and accessing the
blood for subsequent reinfusion from the ATS chamber or ATS bag may be difficult.
If rapid or massive blood loss can be expected, an effective dose of “citrate” anticoagulant
is recommended to help minimize clotting and enhance ATS efficiency during
such conditions. Return to Top
3.
What should I do if the patient’s rate of bleeding exceeds
the maximum infusion pump rate setting?
For clinical situations where blood loss is massive or for emergency chest
traums, use of either an Atrium 2450 self-filling ATS bag or 2550 in-line ATS
bag will provide a more rapid infusion technique as compared with a continuous
infusion pump method. Use of multiple ATS blood bags will accommodate larger
blood volumes, faster than an infusion pump set at a maximum infusion rate.
The rate of gravity reinfusion from an ATS bag is equal to or faster than many
infusion pumps. Hence, use of a flexible ATS system such as Atrium may provide
the most efficient means for conducting hospital-wide chest drainage ATS. Return
to Top
4. What
should I do:
• When an “air-in-line” pump
alarm sounds?
Make sure that you are using a non-vented blood administration
set. Check to see that all connections are air-tight including
the filter spike and any luer-lock
connections. Failure to position drip chamber in a spike up position may result
in an “air-in-line” pump alarm. An alarm may also result if the “total
volume to be reinfused” setting on the pump exceeds the total volume
of blood in the Atrium chest drain. After you locate and correct the source
of the air in the IV circuit, commence repriming until all in-line air is fully
purged from the IV circuit and reset the infusion pump for continuous autotransfusion.
Failure to purge all air from the complete IV circuit can result in an air
emboli.
• When an “occlusion” alarms
sounds?
First, check to see that all clamps are open and there are
no kinks in the tubing. During continuous ATS, the infusion
pump is “pulling” against
both negative pressure in the chest drain and gravity. To minimize the force
of gravity, the infusion pump should be positioned low on the IV pole, at approximately
the same level as the drain. It is also recommended to set the pressure (psi)
setting on the pump to “maximum” or “high” setting.
If these steps are taken and the occlusion alarm persists, it may indicate
that clotting has occurred somewhere in the IV circuit, i.e., the ATS sump
port, ATS access line, microemboli blood filter, or IV blood set. Under certain
conditions, shed blood has been reported to clot during ATS collection which
requires a medical decision whether to continue or discontinue autotransfusion,
or add an anticoagulant such as ACD-A or CPD, to reinstitute patient reinfusion. Return
to Top
5. What should I do
if the 2450 self-filling ATS bag does not fill completely after
activating blood bag?
Any remaining air in the ATS bag can be easily displaced back into the chest
drain by gently squeezing the ATS bag. This procedure is quite normal and will
allow more blood volume to transfer from the ATS chamber directly into the
self-filling ATS bag. Repeat as often as necessary until all air is displaced
and the ATS chamber volume has been transferred into the ATS bag. Return
to Top
6. In the event blood
reinfusion does not appear to be flowing freely into the patient
during gravity (non-pressure) ATS bag reinfusion, what should
I check for?
Make sure the filtered air vent located on top of the Atrium ATS bag and all
IV line clamps are open to maximize flow to the patient. It is also important
to periodically check the ATS bag during patient reinfusion for any signs of
intra-ATS bag clotting by gently tipping the ATS bag to one side to observe
any clot formation.
To troubleshoot this situation,
first check to be sure that all connections are air-tight. Inspect
the suction
tubing and connections for possible cracks, leaks, kinks, or occlusions.
You may need to simply bypass a “leaky” wall canister.
Try connecting the chest drain to a different suction source or
wall regulator. When multiple chest drains are “Y” connected
to a single suction source, if possible, reconnect the drains to
separate suction sources. Finally, replace the chest drain if you
suspect the unit is cracked or damaged.
Return to Top
7. What do I do when
clotting within the ATS bag occurs during patient reinfusion?
Under certain conditions, shed blood has been reported to clot
during ATS collection. If you observe clot formation in the ATS
bag during reinfusion, unfortunately,
it may be too late to do anything about it. Adding “citrate” ACD-A
anticoagulant to the bag will reduce any further clotting, however, it will
not lyse, or break-up, clots which have already formed. In this situation,
you can try gently manipulating, or tipping, the ATS bag to one side. This
will often move clot formation away from the spike port area and improve blood
reinfusion to the patient. Return to Top
8. How long can I collect
blood before I reinfuse the patient?
The American Association of Blood Banks (AABB) dictates that blood no older
than 6 hours can be reinfused back to the patient. Within this time constraint,
is the ability to collect blood for 1 hour then reinfuse over 5 hours (for
a total of 6), collect blood for 2 hours then reinfuse over 4 hours (for a
total of 6), etc. Return to Top
9. Do the Atrium Self-Filling
2450 and In-Line 2550 Blood Bags contain any latex?
The 2450 and 2550 do not contain natural rubber latex (NRL) or
dry natural rubber (DNR) and bears labeling with the ‘LF’ symbol and the statement “Latex
Free”. Return to Top
|
