Autotransfusion Devices: Atrium

Intermittent Reinfusion Method
1.  Prepare the autotransfusion-capable chest-drainage unit. Note that the Atrium units have an access line for autotransfusion (ATS access line), which allows access to the collection chamber without disconnecting the chest drain or interrupting drainage.
2.  Inject anticoagulant into the collection chamber before or during collection of blood from the patient (optional).
  a.  Citrate phosphate dextrose (CPD) (14 ml per 100 ml blood)
  b.  Citrate phosphate dextrose adenine (CPDA-1) (14 ml per100 ml of blood)
  c.  Add ACD in the amount recommended by the manufacturer.
3.  For self-filling ATS bags:
  a.  Turn off the suction.
  b.  Close the chest drain ATS access-line clamp and remove the spike port cap.
  c.  Insert the ATS bag spike into the chest-drain ATS access line spike port by using a twisting motion. Position the ATS bag below the base of the chest drain to facilitate filling. 

  d.  Open both clamps and hold the ATS bag 2 to 4 inches below the base of the chest drain. Gently bend the ATS bag upward to activate blood transfer.
  e.  To disconnect the ATS bag, close both clamps, remove the ATS spike, and insert it into the ATS bag spike holder. Recap the ATS access line spike port and place the access line in the holder located on top of the chest drain. The ATS bag is ready for infusion.
4.  For in-line ATS bags:
  a.  Open the patient-tube clamp and move it next to the in-line connector for easy setup and visual checks.
  b.  Close the patient-tube clamp and separate the connector by depressing the connector lock.
  c.  Remove the cap from the female ATS bag connector and insert it into the male patient-tube connector.
  d.  Remove the second ATS bag cap and insert the male ATS bag connector into the female chest-drain connector.
  e.  Open both in-line ATS bag clamps before opening the patient-tube clamp. Open the patient-tube clamp after both ATS bag clamps have been opened.
  f.  To remove the in-line ATS bag from the chest drain, close the patient-tube clamp and both ATS bag clamps. Disconnect the chest-drain side first, and then disconnect the patient-side connector. Place the male patient-tube connector into the female chest-drain connector and open the patient-tube clamp. Reconnect the ATS bag connectors to each other.
5.  Prepare for reinfusion.
  a.  Prime the blood tubing with saline solution.
  b.  Invert the ATS bag with the spike port pointing up and remove the tethered cap. Using a constant twisting motion, connect the filled ATS bag to a blood filter or blood administration set with a microfilter.
  c.  Open the air vent.
6.  Initiate infusion as prescribed.

Closed-loop, Continuous Reinfusion Method
1.  For direct reinfusion of shed autologous blood via a blood-compatible infusion pump, a microembolus blood filter and nonvented, blood-compatible IV pump tubing are required.
2.  Position the IV pump as close to the chest-drainage unit as possible.
3.  Prime the tubing with saline solution according to the directions of the pump manufacturer.
4.  Spike the ATS access line with the blood tubing setup, and connect it to an injection port on a preexisting IV site.
5.  Program the pump to deliver the blood at approximately the same rate that it is draining from the chest.