Autotransfusion Devices: Argyle

1.  Assess for signs and symptoms of hypovolemia, hypoperfusion, and hemothorax.
2.  Perform hand hygiene and apply gloves.
3.  The physician or nurse practitioner inserts a large-bore chest tube(s).
4.  This autotransfusion system requires prior assembly; therefore consider routinely setting the autotransfusion component for patients who are at high risk for hemothorax. Otherwise, blood that drains immediately on chest-tube insertion is lost to recovery.
5.  Obtain consent if possible.
6.  Prophylactic broad-spectrum antibiotics may be given prior to reinfusion.
7.  Prepare the chest-drainage unit. The vacuum should not exceed -25 cm H2O.
8.  If not preattached, attach the autotransfusion unit to the chest-drainage unit by using the hooks and the hook-and-loop closure. Connect the tubing so that the autotransfusion bag is in line between the patient and the chest-drainage unit (match the connectors: blue to blue and white to white).
9.  If prescribed, inject anticoagulant into the collection unit as soon as possible during or before blood collection. Anticoagulant options include the following:
  a.  Citrate phosphate dextrose (CPD) is a commonly used anticoagulant. One milliliter of CPD for every 7 ml of blood is recommended.2 Because it is difficult to estimate the amount of blood in a patient's chest, one approach is to instill enough CPD to anticoagulate one unit of blood initially (60 ml). When 1 unit of blood has been collected (about 500 ml total volume of blood plus CPD), it may be reinfused, or additional CPD may be added to continue the collection. The CPD injection may be facilitated by the use of a volume-control intravenous chamber; run the desired amount of CPD into the chamber and then infuse the CPD via the intravenous tubing to the injection port.
  b.  Citrate phosphate dextrose adenine (CPDA-1) may also be used at a ratio of 1 ml per 7 ml of blood.2 Instill as described in step a above.
10. Collect blood. When one unit of blood has been collected (about 500 ml of blood plus volume of anticoagulant), it may be reinfused, or additional anticoagulant may be added to continue collection. If bloody drainage is ongoing, prepare a new collection bag and inject anticoagulant as described in step 9 before disconnecting the filled collection bag for reinfusion.
11. To reinfuse via gravity, follow these steps:
  a.  Close all the tubing clamps and detach the blue and the white connectors. Place a new autotransfusion unit in line, or reconnect the patient directly to the chest-drainage unit by connecting the blue and the white connectors. Open all clamps.
  b.  Attach the blue and the white connectors on the top of the autotransfusion bag. Remove the autotransfusion bag from the plastic tower.
  c.  Prime the blood tubing with saline solution.
  d.  Spike the port at the bottom of the autotransfusion bag with the primed blood tubing. Hang the bag on an IV stand.
  e.  Open the roller clamp and initiate the transfusion. If pressurized infusion is anticipated, remove all of the air from the autotransfusion bag. Reinfusion pressure should not exceed 150 mm Hg.
12. To reinfuse via the continuous-reinfusion method, follow these steps:
  a.  When adequate blood has collected in the autotransfusion bag, prime the blood-compatible pump tubing with normal saline solution.
  b.  Spike the port at the bottom of the autotransfusion bag with the primed pump tubing.
  c.  Lower the IV pump as close to the level of the chest-drainage unit as possible. The chest-drainage unit must remain below the level of the patient's chest.
  d.  Set the pump to reinfuse the blood at a rate approximating the drainage rate. Monitor the amount of blood in the autotransfusion bag carefully and discontinue autotransfusion when there is 50 ml or less in the collection bag.
13. Discard supplies, remove gloves, and perform hand hygiene.
14. Document the procedure in the patient's record.
15. Assess cardiopulmonary status and vital signs frequently until 1 hour after the transfusion is complete.
16. Monitor laboratory data to include hematocrit, prothrombin time, partial thromboplastin time, platelet count, serum lactate, and arterial blood gas values.
17. Monitor and mark the amount and type of drainage from collection system hourly for 8 hours, then every 2 hours because volume loss can cause hypovolemia.
18. Evaluate and maintain drainage tube patency every 2 to 4 hours. Report inability to establish patency to physician or advanced practice nurse.
19. Mark the drainage level on the outside of the drainage-collection chamber in hourly or shift increments and document in patient record.