This process adds significantly to the cost of bank blood. Following advice over the last 10 years, from three health service circulars, hospitals have introduced steps to reduce exposure and demand for bank blood in elective surgical operations, conserving it instead for emergency use. Many hospitals have introduced strict blood management guidelines to ensure that this scarce and valuable resource is not wasted. Autologous blood (transfusions involving the patient’s own blood) is fast becoming an integral part of hospital blood management strategy. Many factors govern demand for autologous blood products, apart from simply aiming to reduce bank blood use. Reducing bed stay, reducing infection, and ensuring clinical practice is evidence-based, are some of the key drivers to eliminate unnecessary blood transfusions. However, considering a medical device option in your blood conservation strategy, above all, means that implementation and use of such a product must be easy for the end user.
Astra Tech’s solution
Bellovac ABT® is celebrating its 10th anniversary and, with more than 900,000 units used to date, the device has proven to be a safe and effective solution for today’s blood management challenges. Bellovac ABT is ideal for post-operative cell salvage in total knee replacement surgery, while Sangvia™ – which was launched last year – is ideal for total hip replacement surgery, with the ability to collect both intraoperative and post-operative blood. Both devices work by filtration of the salvaged blood. The filter used is a threestage Sangopur microaggregate filter. In clinical studies, this filter arrangement consistently produced a higher yield of red and white blood cells compared with a Pall lipiguard leucodepleting filter.1 Clinically both products reduce the immunosuppression associated with allogeneic red cell transfusions, while they both preserve essential clotting factors and minimise transfusion associated disease transmission. From a practical point of view, Trusts value fast set up times as this minimises staff down time in a busy operating theatre. Both Bellovac ABT and Sangvia deliver this. They also have a dual function capability allowing for both autologous blood collection and a wound drainage option, once the autologous collection phase is complete. Both systems are capable of closed circuit blood collection and transfusion – invaluable should religious preferences dictate that this approach is necessary. Reducing bed stay is key to ensuring that waiting list targets can be met. A controlled THR study confirms that Bellovac ABT delivers a statistically significant reduction in bed stay in primary uncemented total hip replacement surgery.2
Blood quality
While user experience is often a good indicator of patient outcomes, there is no substitute for evidence-based assessment. Blood is a complex tissue and it is often difficult to distinguish between sequelae associated with a device, as opposed to surgical or anaesthetic technique. Controlled studies with Bellovac ABT confirm that the collected red blood cells exhibited excellent energy exchange and had full ability to transfer oxygen to tissues after six hours.3 Of course, one might expect raised complement split products and proinflamatory cytokines in collected blood and, indeed, increases have been observed. However, transfusion of this blood is deemed safe – provided low levels of autologous blood (<1500 mL) are transfused.4,5 Further studies confirm that the mean calculated blood loss in total knee replacement surgery is 1474 mL, including the mean hidden loss of blood of 735 mL (not normally collectable in a drainage type device).6 Therefore, orthopaedic prosthetic surgery patients present an ideal scenario for intra- and post-operative cell salvage with either Bellovac ABT or Sangvia.
Trusted support
Astra Tech recognises that supporting the implementation of a new system is pivotal to ensure long-term user satisfaction. Clinically trained sales specialists will deliver a new “train the trainer” training concept. The company has worked closely with the NHS to refine and develop training that is competency based and fits with the NHS approach to staff development – integrating the key skills framework with personal development programmes.
References
1 F.C.M. Moonen et al, Acta Orthop. Belg, 2008, 74, 210-215. 2 S.W. Sturdee et al, AnnR Coll Surg Engl, 2007, 89 000-000. 3 Daniele Sinardi, Transfusion, January 2005, 45. 4 Iréne Andersson et al, Can J Anesth, 2001, 48:3 pp 251-255. 5 A Kvarnström et al, Vox Sanguinis, 2008 6. K Sehat, The Knee, 2000, 7 issue 3, pp 151-155.