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by Carson-DeWitt R

Bloodless Surgery

(Surgery, Bloodless; Bloodless Medicine; Medicine, Bloodless)

Definition

Bloodless surgery and medicine avoids using donor blood transfusions . Goals of bloodless surgery include:
  • Save and re-infuse the patient’s own blood (instead of donated blood)
  • Use medicines that will boost a patient’s blood production
  • Minimize blood loss

Reasons for Procedure

Lost blood during surgery is replaced by blood transfusions of donated blood. However, a patient may not want to receive donated blood. Reasons may include:
  • Concerns about blood-borne diseases (eg, HIV , hepatitis)
  • Complications from a blood transfusion
  • Religious beliefs
Bloodless surgery is an option for those who do not want or cannot have a donor blood transfusion.
There are also benefits of bloodless surgery:
  • Quicker recovery time
  • Shorter hospital stay
  • Faster wound-healing
  • Fewer blood transfusion complications

Possible Complications

Complications from bloodless surgery may include having a poor reaction to the medicines, fluids, and other methods used to prepare your body for the procedure. If you plan to use the bloodless approach, your doctor will review a list of possible complications specific to your situation, focusing on the type of surgery you will be having and your overall health.
Smoking may increase the risk of complications. If you smoke, your doctor may ask you to quit .

What to Expect

Prior to Procedure

Your doctor will:
  • Do a medical history and physical exam
  • Order tests
  • Give you instructions to prepare for surgery
The doctor will use your own blood if a blood transfusion is needed. To prepare, a nurse will collect and store your blood. You may be given fluids through a needle in your vein (IV) to replace any blood taken. To make sure that there is enough blood to use, your doctor will create a plan to help your body make more blood. This plan may involve:
Common IV Placement
IV arm
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Diet
  • Eat foods high in iron and/or take supplements to increase the amount of iron in your blood. Iron is an important component of blood.
  • Eat foods high in vitamin C , since this vitamin helps your blood absorb iron.
  • Take folic acid .
Medicines
Your doctor may give you medicines to boost blood production and improve clotting. She may also ask you to stop taking certain medicines, herbs, or supplements. You may be asked to stop taking:
  • Aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Blood-thinning drugs
  • Anti-platelet drugs
Oxygen
An important role of blood is to store and deliver oxygen to your body’s cells. Blood loss during surgery means less oxygen for your body to function properly. To prevent oxygen levels from dropping even if blood is lost, your doctor will “pump” your blood with extra oxygen. So even if blood is lost, remaining blood will have an extra supply of oxygen to keep your body functioning.
To “pump” the extra oxygen into your blood, you will be placed in a hyperbaric oxygen chamber . This is a sealed chamber with air that has a very high oxygen concentration. You will lie on a padded table and breathe normally. This is a painless process.

Anesthesia

Anesthesia may be used to block pain and keep you asleep during surgery. The anesthesiologist will carefully monitor your body temperature and blood pressure. She may reduce your temperature or blood pressure to below normal, since this is a way to slow or limit blood loss during surgery. You may be given special intravenous fluids that contain no blood elements, but can help your body deal with a loss of blood by increasing its circulating volume of fluids.

Description of the Procedure

What will happen during the procedure depends on the type of surgery you will be having and many other factors. Your doctor may decide to do minimally invasive surgery . This involves making small cuts and inserting small tools to do the procedure. Open surgery, on the other hand, results in more blood loss because larger cuts are made.
To further minimize blood loss, the doctor will:
  • Limit the amount of blood samples taken
  • Give medicines to help your body increase its own blood supply or increase the amount of oxygen in your blood
  • Use special surgery tools or techniques to control bleeding
The doctor may also collect your blood using a cell saver machine. This machine will suction, wash, and filter your blood during surgery so that it can be re-infused into your body if needed.

Immediately After Procedure

If a blood transfusion is needed after surgery, the doctor will re-infuse your blood that was collected pre-surgery. You may be infused with special fluids that contain substances found in blood. You may also be put in a hyperbaric oxygen chamber to increase the amount of oxygen in your blood.

How Long Will It Take?

Depends on the type of surgery

How Much Will It Hurt?

Anesthesia prevents pain during surgery. Pain or soreness during recovery will be managed with pain medicine.

Average Hospital Stay

How long you will stay in the hospital depends on the type of surgery. It may be possible to leave the hospital on the same day as the procedure. Talk with your doctor to see if this is an option.

Post-procedure Care

At the Hospital
You will be taken to your recovery room where the healthcare team will monitor you.
At Home
When you leave the hospital, the doctor will give you instructions on how to care for yourself at home. This may include instructions on diet, physical activity, medicines, lifestyle, and showering.

Call Your Doctor

After you leave the hospital, contact your doctor if any of the following occurs:
  • Signs of infection, including fever and chills
  • Redness, swelling, increasing pain, a lot of bleeding, or any discharge from the incision site
  • Nausea or vomiting
  • Pain that you cannot control with the medicines you have been given
  • Cough, shortness of breath, or chest pain
  • Dizziness or weakness
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • New, unexplained symptoms
In case of an emergency, call for medical help right away.

RESOURCES

Bloodless Surgery http://bloodlesssurgery.org/

No Blood http://www.noblood.org/

CANADIAN RESOURCES

Canadian Blood Services http://blood.ca/

Health Canada http://www.hc-sc.gc.ca/index-eng.php

References

Bloodless medicine and surgery. Bloodless Surgery website. Available at: http://bloodlesssurgery.org/ . Accessed May 6, 2011.

Bloodless medicine and surgery. Trinitas Regional Medical Center website. Available at: http://www.trinitashospital.org/bloodless%5Fmedicine.htm . Accessed May 6, 2011.

Bloodless Surgery Center. Division of Cardiothoracic Surgery, St. Luke’s-Roosevelt website. Available at: http://www.slrctsurgery.com/bloodless.html . Accessed May 6, 2011.

The Center for Bloodless Medicine & Surgery at Pennsylvania Hospital. Penn Medicine website. Available at: http://www.pennmedicine.org/bloodless/ . Accessed May 6, 2011.

Glossary of terms. Department of Cardiothoracic Surgery, University of Southern California website. Available at: http://www.cts.usc.edu/zglossary-cellsaver.html . Accessed May 6, 2011.

Hyperbaric oxygen (HBO) therapy process and applications. Englewood Hospital Medical Center website. Available at: http://www.englewoodhospital.com/pdf/HBOProcessandApplications.pdf . Accessed May 6, 2011.

Mizuno J, Ozawa Y, Arita H, Hanaoka K. Anesthetic management of a Jehovah's Witness for pancreaticoduodenectomy. Masui. 2011;60(3):383-386.

Nonblood management techniques. Bloodless Surgery website. Available at: http://bloodlesssurgery.org/index.php?/Techniques.html . Accessed May 6, 2011.

Stuart A. Hyperbaric oxygen therapy. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/ . Updated December 1, 2010. Accessed May 6, 2011.

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