Issue |
J Extra Corpor Technol
Volume 52, Number 2, June 2020
|
|
---|---|---|
Page(s) | 146 - 150 | |
DOI | https://doi.org/10.1051/ject/202052146 | |
Published online | 15 June 2020 |
Technique Article
Using a Modified CPD Blood Bag to Store Blood from either ECMO or RRT Circuit Blood in Pediatric Patients
Department of Cardiac Surgery, Department of Nursing, Department of Anesthesiology and Critical Care Medicine, and Division of Pediatric Nephrology, Mayo Clinic, Rochester, Minnesota
Address correspondence to: James R. Neal, CCP, FPP, Perfusionist, Department of Cardiac Surgery, Mayo Clinic, 1216 2nd St. SW, Rochester, MN 55902. E-mail: neal.james@mayo.edu
Received:
16
March
2020
Accepted:
14
May
2020
By adapting a citrate phosphate dextrose (CPD) whole blood storage bag, residual blood from a renal replacement therapy (RRT) circuit can be saved in pediatric patients, decreasing in donor exposure later. The techniques used for autologous preoperative blood storage are the basis of storing the RRT circuit blood. The CPD anticoagulant has a benefit of having a commonly used reversal agent for its anticoagulant properties, i.e., calcium. Also, unlike the traditional anticoagulants used in extracorporeal membrane oxygenation (ECMO), i.e., heparin, and direct thrombin inhibitors, i.e., bivalirudin, there is no increase in anticoagulation laboratory parameters after administration. The CPD volume in the bag is reduced but keeps the original ratio the same between CPD and blood. This is accomplished by removing all CPD from the bag, adding back only the exact amount of CPD needed for the smaller amount of blood being transferred from the circuit. The RRT circuit managed at our institution uses 23 mL of CPD for 165 mL of circuit blood when stored with this technique. This calculation assumes a normal patient calcium level. This technique has been used successfully multiple times in more than 30 pediatric patients without incident for 7 years at our center. The CPD bag can also be used to store the residual blood from ECMO circuits after removal of ECMO to allow the blood to be given back to the patient at a later time by keeping the same citrate-to-blood ratio.
Key words: ECMO / CRRT / blood conversation / CPD / storage
© 2020 AMSECT
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