P R OC E D UR E 1 9

Autotransfusion
Robin M. Beard

PURPOSE:
Autotransfusion is the collection and filtration of blood from an active bleeding site and reinfusion of that
(autologous) blood into the same patient for the maintenance of blood volume.

PREREQUISITE NURSING KNOWLEDGE

• Understanding of transfusion and intravenous therapy and fluid balance is necessary.
• Significant blood loss, related systemic hypoperfusion, and the associated decrease in oxygen-carrying capacity, with
its impact on hypoxemia, often necessitate the replacement of blood with whole blood or packed cells. In appropriate
patient populations (trauma, cardiovascular, or orthopedic surgical patients), autotransfusion should be considered as
the need to replace blood becomes apparent.
• Autotransfusion is commonly used for trauma victims and for patients undergoing cardiovascular and orthopedic
procedures; it reduces the need for banked blood transfusions with the inherent risks of transfusion reactions and
disease transmission.
• A variety of autotransfusion devices are available. An autotransfusion system may be a standard water-seal chest
drainage system (see Fig. 24-1, A), a separate autotransfusion setup, or a modified chest drainage autotransfusion
system. In addition, continuous and intermittent systems are available. A continuous system has an intravenous line
connected directly from the drainage unit collection chamber to the patient. An intermittent system uses a blood
collection bag in-line between the chest tube and the collection chamber.
• Many disposable systems available today have the ability to act as a reservoir for autotransfusion if the need arises. To
initiate autotransfusion, the autotransfusion bag is disconnected from the disposable system and connected to the
saline solution–filled blood administration tubing. Nurses should gain familiarity with their institution’s
autotransfusion system and policies.
• Indications for autotransfusion in the appropriate patient populations include active bleeding (greater than 100 mL/hr)
and the accumulation of greater than 300 mL of drainage in the collection chamber.
• Contraindications to autotransfusion include the following:
Active infection or contamination of shed blood
Malignant cells in shed blood
Renal or hepatic insufficiency
Established coagulopathies
Blood that has been in the autotransfusion system for longer than institutional standards allow or as recommended
by manufacturers
• Any contraindications to autotransfusion are overruled in the presence of exsanguinating hemorrhage in the absence
of an adequate supply of banked blood.
• As with banked blood, patients may refuse to receive autologous blood based on religious beliefs.
• Informed consent should be obtained in nonemergency situations.

EQUIPMENT
• Personal protective equipment
• Autotransfusion collection system
• Autotransfusion system replacement bag
 • Blood administration set
• 40-µm microemboli filter
• Normal saline (NS) intravenous (IV) solution

PATIENT AND FAMILY EDUCATION

• Explain the procedure to the patient, if appropriate, and the family, including the risks and benefits of using the
patient’s own blood. Rationale: Information enhances patient and family understanding and decreases anxiety.

PATIENT ASSESSMENT AND PREPARATION

Patient Assessment
• Signs and symptoms of hypovolemia and associated hypoperfusion include the following:
Pale clammy skin
Hypotension
Tachycardia
Dyspnea
Decreased central venous pressure (CVP), pulmonary artery pressure (PAP), or pulmonary artery wedge pressure
(PAWP)
Decreased cardiac output or index
Oliguria
Decreased hemoglobin or hematocrit

Patient Preparation
• Verify correct patient using two identifiers. Rationale: Prior to performing a procedure the nurse should ensure the
correct identification of the patient for the intended intervention.
• Ensure that the patient understands preprocedural teachings. Answer questions as they arise, and reinforce
information as needed. Rationale: This communication evaluates and reinforces understanding of previously
taught information.
Procedure for Autotransfusion
References
1. American Association of Blood Banks, Guidelines for blood recovery and reinfusion in surgery and trauma .
American Association of Blood Banks, Bethesda, MD, 1997.
2. American Association of Blood Banks. Technical manual, ed 16. Bethesda, MD: American Association of Blood
Banks; 2008.
3. Purcell, TB. Autotransfusion. In: Roberts JR, Hedges JR, eds. Clinical procedures in emergency medicine. ed 4.
Philadelphia: Saunders; 2004:410–426.

Additional Readings
Americ an Assoc iation of Blood Banks Guidanc e for standards for perioperative autologous blood c ollec tion and administration. Americ an Assoc iation of Blood
Banks, Bethesda, MD, 2002.
Brown, M, Whalen, PK, Red blood c ell transfusion in c ritic ally ill patients. emerging risks and alternatives. Crit Care Nurse 2000; 1–14. [(S uppl)].
Cross, MH, Autotransfusion in c ardiac surgery . Perfusion 2001; 16:391–400.
Dial, S , Nguyen, D, Menzies, D, Autotransfusion of shed mediastinal blood. a risk fac tor for mediastinitis after c ardiac surgery? Results of a c luster investigation.
Chest. 2003; 124(5):1847–1851.
Ley, S J, Intraoperative and postoperative blood salvage . AACN Clin Issues 1996; 7:238–248.
Oeltjen, AM, S antrac h PJ, Autologous transfusion tec hniques. J Intra ven Nurs . 1997; 20:305–310.
S irvinskas, E, Veikutiene, A, Benetis, R, et al. Influenc e of early re-infusion of autologous shed mediastinal blood on c linic al outc ome after c ardiac surgery.
Perfusion. 2007; 22(5):345–352.
Weniger, J, von der Emde J, S c hric ker, K, et al. Autotransfusion of drainage blood after heart surgery. La ngenbecks Archiv Für Chirurgie. 1980; 351(4):229–241.
[(author’s transl)].