Innovation Spotlight: Maximizing Intraoperative Blood Salvage for Better Patient Care

Since 2017, Carter BloodCare has managed the transfusion service at John Peter Smith Hospital (JPS) with our staff and equipment. JPS has 573 beds and a Level I Trauma Center. Over the last six years, the JPS Perioperative Services has implemented protocols that have led to increased use of intraoperative blood salvage which, in turn, has decreased the use of banked blood. This has improved cost savings for JPS by lowering their use of blood products and decreasing patient length of stay.

Central to JPS's success is placing a cell salvage machine within the OR for surgeries where there is a high likelihood of blood transfusion, including trauma, cardiovascular thoracic, exploratory laparotomy, total hysterectomies, and hip surgeries. Additionally, a machine is placed in the OR for any procedure when the estimated blood loss is greater than 750mL, underscoring a preemptive approach to blood conservation.

Operating a blood salvage machine requires special training, so JPS outsources the actual processing of blood collected intraoperatively to a third-party agency. Personnel from the agency have 30 minutes to arrive at the OR after being notified. Meanwhile, all circulating nurses, scrub technicians, and anesthesia technicians have been cross trained to setup the cell salvage machine, open and install the blood collection kit, and begin to suction blood until the contracted cell salvage operator arrives and takes over the process. This cross training mitigates delays and optimizes the blood given back to the patient. Banked blood is used if blood transfusion is needed prior to the contracted worker arriving. Despite the nominal cost associated with each blood collection kit opening, if blood is not processed and given back to the patient, the hospital has shown a commitment to minimizing expenses while prioritizing patient care to justify the cost of this practice.

The efficacy of JPS's blood salvage program is underscored by ongoing education on the use of intraoperative blood salvage to staff and physicians, as well as meticulous monitoring and analysis of perioperative metrics. The perioperative nurse specialist and patient blood management coordinator review multiple data points, ranging from evaluating the frequency of blood salvage usage across different service lines to assessing the volume of salvaged blood returned to patients. Data from October 2022 through January 2024 showed approximately 195,917 mL of salvaged blood has been returned back to patients. When compared to the cost of transfusing banked blood, this represents a savings of $120,182.

JPS remains steadfast in its pursuit of continuous improvement. With the success of increasing the use of intraoperative blood salvage, JPS now has a total of 10 cell salvage machines at its disposal. The efforts and protocols already in place can be harnessed to further expand its blood salvage program. By prioritizing innovation, efficiency, and patient safety, JPS serves as an example of how hospitals can improve their blood utilization practices.