The need for Intra-operative cell salvage training to reduce the use of Allogeneic ‘bank’ Blood during Surgery. Is the routine adoption of a competency-based assessment in Intra-operative cell salvage required?

摘要

We performed a survey of all specialist registrars and their equivalents in the Imperial (North West Thames) region to assess their experience of and training in Intra-operative red cell salvage (ICS) and asked whether they would be confident to use ICS unsupervised for emergency out of hours work. 85% of respondents said that they would not be confident to set up or use ICS unsupervised.Allogeneic blood transfusion is expensive, associated with uncommon but potentially severe adverse consequences and of limited availability. Intra-operative red cell salvage (ICS) is a well-tried, cost effective method of reducing the use of allogeneic blood. Many organisations including the UK Blood Transfusion and Tissue Transplantation Service (www.transfusionguidelines.org) and the Association of Anaesthetists of Great Britain and Ireland have advocated the use of ICS for all suitable cases [1]. An operating department assistant (ODA) or anaesthetic nurse, with the appropriate experience, may set up the equipment but it will have to be supervised and used by an anaesthetist or, in a cardiac theatre, a Perfusionist. Anaesthetists with appropriate training and experience are therefore necessary if use of ICS is to be maximised. Allogeneic blood transfusion is expensive, associated with uncommon but potentially severe adverse consequences and of limited availability. Intra-operative red cell salvage (ICS) is a well-tried, cost effective method of reducing the use of allogeneic blood. Many organisations including the UK Blood Transfusion and Tissue Transplantation Service (www.transfusionguidelines.org) and the Association of Anaesthetists of Great Britain and Ireland have advocated the use of ICS for all suitable cases [1]. An operating department assistant (ODA) or anaesthetic nurse, with the appropriate experience, may set up the equipment but it will have to be supervised and used by an anaesthetist or, in a cardiac theatre, a Perfusionist. Anaesthetists with appropriate training and experience are therefore necessary if use of ICS is to be maximised. Methods A questionnaire (see Appendix) was sent by email to all Specialist Registrars in the Imperial School of Anaesthesia (North West Thames) region. A range of questions were asked to gauge the training and experience Registrars had received with ICS. Questions were asked regarding the familiarity with any guidelines on ICS use, the number and type of cases in which ICS had been used in the past 6 months (surgical speciality and whether elective or emergency cases) and whether or not they had received training (either formal or informal) on using a cell salvage device. We also asked the trainees if they would be confident at setting up and operating a cell salvage device themselves. Results Questionnaires were sent by email to 150 Specialist Registrars (SPR 1-5 / ST 3-7) and Clinical Fellows in the Imperial region and 108 (72%) were completed and returned. ICS devices are available in all the main District General and Teaching Hospitals in the region. 53 Registrars (49%) surveyed were in years 3-5 of Specialist Registrar training (ST 5-7) and 8 were clinical fellows [see fig. 1]. 63.2% of those surveyed were not familiar with any guidelines on ICS use [see fig.2]. 75.2% of Registrars had been involved in cases using ICS only 3 times or less in the past 6 months with 35% not having used ICS at all during this period [fig. 3]. Just under 41% of Registrars had never received any training, formal or informal, on the use and set up of a cell saver device. Only 6.5% reported having received formal training [see fig.4]. Most commonly Anaesthetists delivered ICS training but ODA and Perfusionists also made a significant contribution [fig.5.]. The use of ICS was most commonly experienced in Vascular, Cardiothoracic and Obstetric surgery [fig.6]. 85% of Registrars had never set up a cell saver device themselves and were not confident at doing so and operating it. Discussion Due to risks of infection