Manejo y cuidados de enfermería de los dispositivos recuperadores de sangre CBCII ConstaVacTM (Stryker(R)) en el posoperatorio de cirugías traumatológicas yu ortopédicas / Nursing care management of ConstavacTM (Stryker(R)) CBII blood conservation system in postoperative trauma and orthopedic surgeries

El empleo de dispositivos de autorrecuperación sanguínea tipo CBCII ConstaVacTM Stryker(R) (CBCII) (fig. 1) ha supuesto un gran avance en el manejo y recuperación de los pacientes sometidos a cirugías traumatológicas y ortopédicas. Las múltiples ventajas que dichos dispositivos ofrecen frente a las clásicas transfusiones homólogas los han colocado como referencia en este tipo de cirugías. Debido a esto, es habitual su manejo en diversas unidades hospitalarias como quirófanos, salas de despertar, UCI o unidades de reanimación posquirúrgica. De todo ello deriva la importante necesidad para el personal sanitario de conocer su manejo adecuado y funcionamiento, con el fin de evitar durante su uso posibles contratiempos e incidencias que pudiesen anular su efectividad y, por ende, privar al paciente de todas las ventajas que estos dispositivos pueden aportarle en su proceso de recuperación

The use of Blood Recovery Systems such as CBCII ConstaVacTM (Stryker(R)) (fig. 1), has brought about a great advancement in the management and recovery of orthopedic and trauma patients undergoing surgery. The many advantages that these devices offer, compared to classic allogenic blood transfusions, have placed them as a reference for these types of surgeries. Hence, they are frequently used in several hospital units including operating theatres, recovery rooms, intensive care units and reanimation units. It is of outmost importance that the sanitary personnel is well familiarized with their proper handling and operating instructions to avoid possible setbacks and incidents that could cancel their effectiveness, depriving patients from all the advantages that these devices can bring into the recovery process

Prevention of dimethylsulfoxide-related nausea and vomiting by prophylactic administration of ondansetron for patients receiving autologous cryopreserved peripheral blood stem cells.

PURPOSE/OBJECTIVES: To evaluate the effectiveness of ondansetron for the prevention of nausea and vomiting from dimethylsulfoxide (DMSO) during autologous stem cell transplantation (ASCT) infusion. DESIGN: Nonrandomized cohort using historical control. SETTING: Comprehensive cancer center outpatient infusion department. SAMPLE: 50 patients receiving ASCT in the outpatient setting. METHODS: Patients were assessed for nausea and vomiting on their infusion day using the Multinational Association of Supportive Care in Cancer Antiemesis Tool (MAT) at arrival, pre-ASCT infusion, pre-ondansetron administration, prior to the first bag, and after each bag of stem cells. A standard script was used to ensure consistency. Ondansetron, 16 mg IV, was administered 30-90 minutes prior to each ASCT infusion. Number and volume of stem cells bags, as well as infusion rate and emesis episodes, were recorded. Nausea scores and vomiting episodes were compared to historical data. MAIN RESEARCH VARIABLES: Subjectivity of nausea, potential Hawthorne Effect. FINDINGS: Forty-five percent of patients had an MAT score greater than 2 on arrival, decreasing to 18% after receiving ondansetron before the first bag. Twenty-four percent had MAT increases of more than two points by infusion end compared to 58% in the historic control group. Eighteen percent of patients vomited compared to 28% of historic controls. CONCLUSIONS: The administration of 16 mg of IV ondansetron significantly reduced DMSO-related nausea and episodes of vomiting in patients receiving ASCT. IMPLICATIONS FOR NURSING: Prophylactic administration of ondansetron had a positive effect on reducing nausea symptoms and episodes of vomiting during ASCT infusions. These results prompted a change in clinical practice. More research is required to determine whether the inclusion of other antiemetic agents would provide even greater benefit. KNOWLEDGE TRANSLATION: To date, no other published studies have explored the benefits of premedicating patients with ondansetron prior to ASCT infusions. This study is the first to establish efficacy of ondansetron for an unlabeled indication. These results may pave the way for future research in decreasing nausea and vomiting in this setting.

Adequacy of nutritional support in pediatric blood and marrow transplantation.

The use of nutrition support has become standard practice in blood and marrow transplantation, but what remains unclear is whether patients receive adequate nutrition supplementation during this time. This study is a retrospective audit of the nutritional supplementation of 34 pediatric patients admitted to a pediatric oncology unit for a blood and marrow transplantation. All patients received parenteral nutrition (PN) as their standard nutritional therapy with an average of 79 +/- 10.6% of their estimated requirements given over the transplant period. The glucose/amino acid infusion was inadequate on 40% of PN days mainly because of fluid overload causing a reduction in infusion rates. The lipid infusion was inadequate on 60% of PN days mainly because of stoppages when drugs and/or blood were infused. The mean percentage weight change on discharge was +0.3 +/- 4.7%. This had a large range of between -9.9% and +7.9% of body weight and did not seem to be related to adequacy of nutrition during transplant. This study showed that although frequent rate reductions in nutrition infusions did occur, most patients still received the majority of their nutritional requirements.

Recuperadores sanguíneos postoperatorios / Post operatory blood recuperators. Bibliographical review

El uso de los recuperadores postoperatorios, sobre todo en cirugía ortopédica, es una práctica habitual en nuestros días. Las enfermeras tienen un especial protagonismo en su manipulación; por ello se comentan las razones para el empleo de estos dispositivos. También se exponen las diferentes evidencias científicas tras revisión bibliográfica sobre la efectividad de estos sistemas, la utilidad, la calidad del producto, el coste beneficio y la ausencia de efectos indeseables. Se concluye que existe un determinado perfil de paciente que se beneficia del empleo de este tipo de dispositivos. Tras unos años de alta implantación, se produce actualmente un ligero descenso en su uso debido, en primer lugar, al empleo prequirúrgico de agentes hematínicos y, en segundo lugar, al desarrollo de ciertas técnicas quirúrgicas menos invasivas. A pesar de ello, este procedimiento se ha demostrado como coste efectivo. El rol de las enfermeras en su manejo es importante y combinado con otras medidas (como el uso de dispositivos de análisis de la hemoglobina en cabecera del paciente) puede contribuir a una mejor gestión de los requerimientos transfusionales(AU)

The authors presented this report at the Apheresis Workshop at the Mexican Congress on Transfusions. VI Annual Congress AMMTAC in Monterrey, Nuevo León district. The use of post operatory recuperators, especially in orthopedic surgery, is a habitual practice nowadays. Nurses play a special role in their handling and use; therefore, the authors comment on the reasons why these devices should be used. The authors also state different scientific evidence, based on a bibliographical review, regarding the effectiveness of these systems, their utility, their product quality, their cost benefit, and the absence of undesirable effects. The authors conclude that there is a determined patient profile for when a patient benefits from the use of these devices. After some years of high use, at present times, there has been a reduction in using these devices due to, firstly, the pre-surgical use of hematin agents, and secondly, due to the development of certain less invasive surgical techniques. In spite of this, this procedure has proven to be cost effective. Nurses have an important role in the handling and use of these instruments which, combined with other measures such as the use of hemoglobin analysis devices at the head of a patient’s bed, can contribute to an improved management of transfusion requirements(AU)

[Handling of a Bellovac ABT drainage recuperation--blood auto transfusion device]. / Manejo del drenaje recuperador y autotransfusor de sangre. Tipo Bellovac ABT.

The authors describe the characteristics of the Bellovac ABT drainage recuperation -blood auto transfusion device along with its proper handling and the required nurses' care in order to minimize the risks and to provide optimum safety for patients. The authors also explain the potential complications and they discuss the main advantages and inconveniences this type of drainage has.

Evaluation of postoperative blood salvage and re-transfusion in a total knee arthroplasty patient population: a retrospective study.

Patients at risk for postoperative anemia may benefit from blood salvage and retransfusion. This study is a retrospective chart review of 148 total knee arthroplasty patients to determine the impact of the procedure on hematocrit and hemoglobin.

Toward reducing perioperative transfusions.

Even though the supply of blood products has never been safer, disease transmission remains the chief patient concern about transfusions. The primary concerns for anesthetists center on risks associated with blood transfusions, such as transfusion-related acute lung injury, anaphylactic transfusion reaction, clerical errors resulting in ABO incompatibility, and blood products contaminated with infectious organisms. These concerns, combined with patients' religious tenets and other factors, have contributed to renewed efforts to minimize blood transfusion without negative patient consequences. Achieving this goal requires a concerted effort by surgeons, perioperative nurses, and anesthesia providers.

Changing blood transfusion practice in elective joint arthroplasty: a nursing initiative.

The use of re-infusion drains on 99 consecutive patients undergoing total knee arthroplasty surgery at a large hospital was analysed. As a control group the records of 99 patients treated without re-infusion were analysed retrospectively. The primary aim was to ascertain the cost effectiveness of the drains. Secondary aims were to assess safety of the drains, whether or not they reduced the need for allogeneic blood transfusion and whether they decreased the length of stay in hospital. The direct cost of consumables increased for the evaluation period. There was a smaller proportion of allogeneic blood transfusion (27% vs 38%) and a smaller mean number of units transfused (0.92 vs 0.54) in the re-infusion group compared to the control group. Patients benefited directly in that the mean length of stay was also significantly shorter in the re-infusion group. We anticipate more direct cost saving with experience and best practice and conclude that the use of re-infusion drains is a cost effective blood saving method in total knee joint arthroplasty.

Finding alternatives to blood transfusion.

Here, you'll find out how to reduce your patient's need for donated blood and discover what's new in the search for an artificial blood substitute.

Atención de enfermería en personas ancianas sometidas a un proceso de autotransfusión / Nursing care of elderly people undergoing autologous blood transfusion

En la actualidad el aumento de la esperanza de vida y su mejor calidad, permiten incluir cada vez mayor número de pacientes ancianos en procedimientos quirúrgicos protésicos. Estas intervenciones agresivas suponen una alta posibilidad de transfusión, con el riesgo de efectos secundarios añadidos que supone. La autotransfusión es una técnica de ahorro de sangre, que además disminuye el número de complicaciones asociadas a la transfusión alogénica. Motivados por el aumento de peticiones de hemodonación predepósito (autotransfusión) en personas ancianas, hemos realizado un estudio retrospectivo en nuestro centro de trabajo sobre nuestra experiencia en este procedimiento. Se ha observado que las complicaciones y efectos secundarios son relativamente bajos si se realiza una buena selección de los pacientes, y por el contrario las ventajas obtenidas son múltiples: permite al paciente llegar al momento de la intervención quirúrgica con unas buenas cifras de hemoglobina en sangre, lo que supone un menor riesgo de transfusión y un mayor ahorro sanguíneo en los bancos, y por otra parte no se expone a los riesgos infecciosos e inmunes que conlleva la transfusión convencional (AU)

Autotransfusión con predepósito / Self-transfusion using a previously deposited blood unit

Se analiza la experiencia obtenida en el desarrollo de un Programa de Autotransfusión Predepósito en pacientes candidatos a Cirugía Ortopédica y Nefrourológica. Los 69 pacientes que se incluyeron en el programa dieron en predepósito 183 unidades de sangre (2,6 unidades/paciente; rango: 1-5), de las cuales 153 fueron transfundidas. Los niveles iniciales de hemoglobina y hematócrito fueron de 14,3 g/dl (rango: 11,4-16,8) y 43,3 por ciento (rango: 36-50) respectivamente; al finalizar el Programa de Autotransfusión estos valores se situaron en 12,4 g/dl (rango: 10,0-15,6) y 37,7 por ciento (rango: 31-48). Se evitó la transfusión homóloga en el 88,4 por ciento de los casos. El Programa de Autotransfusión que se presenta es seguro, eficaz, de fácil implantación, bien tolerado y puede llevarse a cabo con un riesgo aceptable para los pacientes (AU)

How can autologous blood transfusions help our patients?

In modern day clinical nursing practice, respecting and encouraging patient autonomy, together with acting as advocate for the patient, is an integral part of holistic patient care. We have a 'duty of care' to our patients. So why, in the early days of the 21st century, are we still transfusing our patients with homologous blood products when there is a safer alternative which has been recognised for almost 200 years?

Situaciòn de la transfusiòn de sangre inocua en el Paraguay durante el periodo 1990-1994 / Annual reports 1996 / Situation of the tranfusion of inocue blood in Paraguay during the period of 1990-1994

La transmisiòn de enfermedades infecciosas por vìa transfusional ha adquirido cada vez màs importancia debido a la gran migraciòn de contingentes poblacionales de paìses endèmicos a otros no endèmicos, agravada por la falta de control serològico en los bancos de sangre. Con el propòsito de aportar mayor informaciòn sobre la mayorìa de bancos de sangre en el Paraguay el presente trabajo revisa la informaciòn pre-existente sobre seroprevalencia de las enfermedades serocontroladas en bancos pùblicos y privados. Ademàs, realiza una descripciòn de datos actualizados sobre la administraciòn de sangre inocua en el Paraguay.

Situaciòn de la transfusiòn de sangre inocua en el Paraguay durante el periodo 1990-1994 / Annual reports 1996 / Situation of the tranfusion of inocue blood in Paraguay during the period of 1990-1994

La transmisiòn de enfermedades infecciosas por vìa transfusional ha adquirido cada vez màs importancia debido a la gran migraciòn de contingentes poblacionales de paìses endèmicos a otros no endèmicos, agravada por la falta de control serològico en los bancos de sangre. Con el propòsito de aportar mayor informaciòn sobre la mayorìa de bancos de sangre en el Paraguay el presente trabajo revisa la informaciòn pre-existente sobre seroprevalencia de las enfermedades serocontroladas en bancos pùblicos y privados. Ademàs, realiza una descripciòn de datos actualizados sobre la administraciòn de sangre inocua en el Paraguay