5.1.1

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    Step Instruction What it looks like
    1
    		 Using a dual lumen tube, anticoagulant is fed to the operation site to be mixed immediately with shed blood and sucked away.
    The choice of anticoagulant is made by the surgeon or anaesthetist based on the condition of the patient and the surgical procedure being performed. Either Heparin or Citrate may be used.
    2
    		 As blood and anticoagulant are carried into a sterile reservoir by vacuum, it is filtered to remove large clots and debris. Blood must be anticoagulated to prevent clotting and secondary fibrinolysis. Great care is taken to administer the proper amount of anticoagulant. A range of between 1:5 and 1:10 ratio of anticoagulant to collected blood is recommended.
    Most collection reservoirs have a filter in the 40-150 micron range
    3
    		 Blood and anticoagulant are drawn from the collection pot into a centrifuge to be processed. They are washed with a saline solution (Step 4) and red blood cells are separated from waste products (Step 5).
    The force supplied by the centrifuge holds the more dense red blood cells against the outer wall of the bowl. The less dense white blood cells, platelets, plasma and anticoagulant move towards the centre of the bowl where they spill over into a waste bag
    4
    		 A sterile isotonic saline solution is pumped into the centrifuge bowl. Only a 0.9% sterile normal saline is recommended.
    If citrate has been used as the anticoagulant, care must be taken so that the wash solution is pumped in when there is still enough plasma to prevent potential clotting in the bowl.
    5
    		 Waste products include white blood cells, platelets, plasma, anticoagulant, fat and free plasma haemoglobin. These are collected in a bag.
    The waste products are disposed of in harmony with procedures for clinical waste.
    6
    		 Packed red blood cells are separated from waste products and collected in a separate bag
    The quality of the collected red cells depends on the volume of wash solution used, the degree of concentration achieved, the quality of the blood prior to washing and the presence of various substances that remain in the red cell pack.
    7
    		 Red blood cells can then be reinfused immediately or taken to recovery or the Ward to be reinfused later. There is, however, a limit of 6 hours during which reinfusion can take place.
    Note: Most Jehovah's Witnesses who accept cell salvage request that a continuous circuit is maintained so that red cells may be reinfused immediately.
    8
    		 During an operation spilled blood that is not salvaged can be collected in swabs. These are carefully weighed to calculate the amount of blood contained in the swabs. The blood is then placed in the collection pot (at Step 2), awaiting processing (Step 3).
    This ensures that all available blood is salvaged. Considerable volumes of blood can be collected in swabs.
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