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LETTER TO THE EDITOR

Needleless Adaptation to Blood Collection Bags Used for Acute Normovolemic Hemodilution

Champlain Valley Heart Center, CVPH Medical Center, Plattsburgh, NY, pgl{at}ncac-pa.com

To the Editor:

The conduct of acute normovolemic hemodilution entails the intraoperative collection of autologous blood into blood collection bags that contain anticoagulant (1). For acute normovolemic hemodilution, we use standard Teruflex® blood collection bags (Terumo Corporation, Tokyo, Japan) containing 63 mL of citrate-phosphate dextrose anticoagulant, which are supplied by the manufacturer with a 16-g, 1.5-in needle attached to the blood collection tubing. (Fig. 1A). As more facilities institute hospital-wide "needleless systems," injection ports on IV tubing that heretofore could be accessed with needles are now "needleless." Inserting a needle through these ports frequently lacerates the material within the ports, rendering them incompetent or subject to subsequent leakage.

View larger version (121K): [in this window] [in a new window]   Figure 1. A, Distal end of blood collection bag tubing with needle attached. B, Needle replaced with male-to-male Luer Lock adapter.

I have adapted our blood collection bags to be compliant with our hospital’s needleless systems initiative. First, the needle and a short segment of adjacent tubing are excised from the distal end of the blood collection bag tubing. Then, maintaining aseptic technique, a standard male-to-male Luer Lock adapter (Mallinckrodt Critical Care, Glens Falls, NY) is attached to the distal end of the tubing. The adapter fits the tubing snugly and provides a secure, stable connection. (Fig. 1B) The other end of the male-to-male Luer Lock adapter may now be attached to the female Luer Lock connector of any needleless port or standard 3-way stopcock.

I have found this simple adaptation to be safe, efficient, and inexpensive. It has been successfully used in more than 100 cases without problems related to blood flow into the collection bag or inadvertent disconnections. Although blood banks have more elaborate devices for modifying blood bag tubing, such as tubing welders, these services are typically remote from the operating room environment. In addition, they require advance coordination with the blood bank, which may be time consuming and inconvenient for the busy anesthesiologist.

Reference

1. Goodnough LT, Brecher ME, Kanter MH, AuBuchon JP. Transfusion medicine. Second of two parts: blood conservation. N Engl J Med 1999;340:525–33.[Free Full Text]

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