Use of Reinfusion Drains in the Surgical Setting - Literature review Example

RUNNING HEAD: THE USE OF REINFUSION DRAINS IN THE SURGICAL SETTING Use of Reinfusion Drains in the Surgical Setting Name Institution Date Use of reinfusion drains in the surgical setting Introduction Blood loss following a surgical operation is a major problem that may require allogeneic (human blood donor) blood transfusion in order to prevent any given patient from becoming anemic. On the other hand, due to concerns relating to the transfused blood, a large number of patients have often opted for other safe alternative to donated blood transfusions. One such option believed to offer a safe alternative to donated blood transfusions is the use reinfusion drain in the surgical setting. Reinfusion drains are basically tubes commonly used following an intensive surgical procedures, often after joint replacement surgical processes. According to Smith et.al (2007), reinfusion drains have been employed, with the best intentions, in many surgical operations for a large number of years. Even so, their use in the surgical setting has been contentious. This particular paper therefore intends to provide an analysis with regards to the use of reinfusion drains in the surgical setting. One of the significant uses of reinfusion drains in the surgical setting can be based on the fact that their use in draining fluids from patients helps remove potential or possible sources of infections. According to Cheng (2005), allogeneic blood transfusions have often been regarded as the standard as well as the most effective methods of making up for blood lost during the surgical process.Besides, a number of reports confirm that approximately 1.5 litres of blood is lost once a surgical process is conducted, a factor that makes allogeneic blood transfusion very inevitable. On the other hand, studies confirm that about 20 percent of all allogeneic transfusions result in unfavorable effects, with approximately 0.5 percent being serious. According to Smith et.al (2007), for instance, a study looking at the efficiency of postoperative blood salvage following a hip arthroplasty in patients with as well as those without deposited autologous blood, revealed that the postoperative blood salvage considerably minimized the risks associated with allogeneic transfusions. Hence, according to Cheng (2005), the recovery of blood and postoperative reinfusion through the use of reinfusion drains is able to minimize the related undesirable reactions, including a number of various infections through its role in reducing the requirement for human donor blood transfusion (allogeneic blood transfusions).Consequently, Cheng (2005) argues that both surgeons and patients are increasingly becoming conscious of the problems (complications) associated with donor blood transfusion, especially disease transmission. As a result, the use of reinfusion drains as a safe method of minimizing the use of post-operative blood transfusion due to its potential to infection is inevitable. On the other hand, a number of questions have been raised as regards the efficiency of reinfusion drains in achieving the goal of eliminating the possibility of infections. According to Muñoz et.al (2011), the theoretical benefit of reinfusion drains is the reduction in the occurrence of infections. However, according to Muñoz et.al (2011) there are unanswered questions regarding their efficiency in as far as eliminating infections is concerned. Muñoz et.al (2011) highlights that in one of the latest meta-analysis of about 36 surveys involving a sample of 5,464 participants undergoing various types of surgery, the outcomes confirmed no (statistically) significant difference as regards the rate of infection, but a considerably greater requirement for ABT among the patients managed using a postoperative drain. Therefore, the researchers deduced that there is no sufficient evidence from randomized trial to back the efficiency of reinfusion drain’s usage in reducing the infection occurrence during the orthopaedic surgical process. Reinfusion drains have also a significant use in the recovery of the blood shed during the surgical procedures, as a result enabling a significant cut in the need for allogeneic blood transfusions. As Smith et.al (2007) highlights, generally large amounts of blood loss during the surgery process occur during the postoperative period. As such, reinfusion drains as one of the techniques developed to help salvage blood shed during the surgical process have been of significant use, especially at this particular period when there is an increasing demand for blood coinciding with a considerable reduction in the number of individuals donating blood. In addition to this, conservative blood transfusion guidelines and techniques to bring under control the need for perioperative blood components have provided a growing attention by surgeons, anaesthetists as well as transfusion medicine experts. This ever-increasing focus on perioperative blood management has resulted in the use of a number of techniques, many of which requiring the involvement of laboratories so as to minimize the exposure to allogeneic blood. According to Liumbruno & Waters (2011), for instance, during the year 2005, about 320,000 postoperative collection apparatus were sold in the US, an indication that there is an increased focus on perioperative blood management as shown through the increased use of these systems. According to Henderson et.al (1999), a research carried out involving a sample of 399 patients undergoing different types of knee replacement procedures, and prospectively studying the postoperative recovery and reinfusion of unwashed blood in order to reduce the use of allogeneic blood requirement confirmed that the use of reinfusion greatly minimized the requirement for allogeneic transfusion of blood. Orthopaedic literature, however, is very controversial on the use of reinfusion drains in matters concerning complete joint arthroplasty. In its support, many studies have also expressed a considerable doubt in the benefits of using the reinfusion drains. Abuzakuk et al (2007) highlights that, following the total knee arthroplasty, there is insufficiency in terms of available drainage to influence the post-operative hemoglobin. According to Abuzakuk et al (2007), a research with a sample number of 90 patients categorized the patients who were undergoing a complete knee arthroplasty in to three main groups. The first group was without drain, the second group had the autologous reinfusion drained, while the third group had the suction drain. It was observed that there was no difference in the needed amount of homologous blood by the patients in the three groups. As such, it was concluded that the use of post-operative drainage in complete knee arthroplasties had no clear benefits. Likewise, a research comparing the application of reinfusion drains and non-application of the reinfusion drains in 398 patients experiencing a complete replacement of their knees and their hips supports this. The findings indicated that the application of reinfusion drains in both of the replacement cases was needless (Abuzakuk et al, 2007). Another significant use of reinfusion drains in the surgical setting is argued based on their effect on the difference in hemoglobin levels of the patient salvaged blood after arthroplasty. As highlighted by Smith et.al (2007), recent studies have confirmed the benefits of reinfusion drains in total hip arthroplasty in as far as blood hemoglobin levels are concerned. In a recently randomized review involving a series of approximately 158 patients, for instance, reinfusion drain’s use resulted into a fewer patients having a post-operative level of hemoglobin lower than 9 g/dL,lower transfusion rates in addition to a slightly overall cost savings. High hemoglobin levels are indicative of particular diseases or basically adaptive metabolic reactions. Generally, hemoglobin greater than 17.2 g/dL is argued to be of high value, and possibly indicative of a physiological anomaly, hence the importance of reinfusion drains in detecting the hemoglobin levels. On the other hand, other studies have confirmed that reinfusion drains have no significant effect on the postoperative hemoglobin levels. According to Lakshaman et.al (2010), for instance, a study conducted to establish the effect of reinfusion drains use on the difference in terms of hemoglobin levels founded out that autologous blood from reinfusion drains had no significantly improved postoperative hemoglobin levels of the patients’ blood. Out of the 158 patients went through a total knee anthroplasty, 74 of them had autologous blood transfusion through the use of reinfusion drains while the other 84 patients did not undergo the procedure of autologous transfusion.Instead,they used ordinary suction drains to drain their wounds during the postoperative period. According to Lakshaman et.al (2010), the results of the study confirmed that the difference in terms of their hemoglobin levels between the two groups, before and after the surgical process had no significance. This confirmed that reinfusion drains did not significantly enhance the postoperative hemoglobin levels. Conclusion From the above analysis, it can be argued that although a large number of studies exploring the use of reinfusion drains in surgical settings are available, there seems to be a general view that the effectiveness as regards the use of reinfusion is surrounded by a lot of controversies. Generally, there have been no randomized controlled studies to quantify the effectiveness of the use of these devices amongst the general population. One major thing, however, is the general consensus by many studies that one method for enhancing post-operative blood recovery (salvage) and reinfusion in order to avoid allogeneic blood transfusion is the use of reinfusion drains. A number of studies have found this particular technique to be superior as compared to others in as far as compensating perioperative loss of blood is concerned. On the otherhand, again, a number of studies have challenged these particular findings with a few of the studies challenging even the use of the drains in the first place. A Preparation Table Summarizing a Sample of key points Cheng, S. (2005).Investigation of the Use of Drained Blood Reinfusion after Total Knee Arthroplasty: A Prospective Randomized Controlled Study, Journal of Orthopaedics Surgery, Vol 13(2), Pp 120-124. Cheng(2005) argues that the use of reinfusion drains helps in the elimination of infections associated with allogeneic transfusion Both surgeons and patients are increasingly becoming conscious of the problems (complications) associated with donor blood transfusion, especially disease transmission. Abuzakuk, T. et al. (2007). Autotransfusion drains in total knee replacement. Are they alternatives to homologous transfusion? International Orthopaedic Journal, 31(2): 235–239 Abuzakuk, T. et al. (2007) argues the insignificance of reinfusion drains in as far as reducing allogeneic transfusion is concerned Smith, L.K, Williams, D.H & Langkamer,V.G, V.G. (2007).Postoperative Blood Salvage with Autologous Retransfusion in Primary Total Hip Replacement, Journal of Bone Joint Surgery, Vol 89, Pp1092 Smith et.al (2007) generally argues in support of reinfusion drain’s usage in terms of their effect on the hemoglobin levels of the patient after arthroplasty Muñoz, M, Slappendel, R & Thomas, D. (2011). Laboratory characteristics and clinical utility of post-operative cell salvage: washed or unwashed blood transfusion? Vol 9(3), Pp 248–261 Muñoz et.al (2011) challenges the efficiency of reinfusion drains in eliminating the possibility of infections associated with allogeneic blood transfusion. Argues that there are several unanswered questions regarding reinfusion drains’ efficiency in as far as eliminating infections is concerned Concludes that there is no sufficient evidence from randomized trial to back the efficiency of reinfusion drain’s usage in reducing the infection occurrence during the orthopaedic surgical processes Lakshaman, P, Purushothamna, B & Sharma, A. (2010).Impact of Reinfusion Drains on Hemoglobin Level in Total Knee Arthroplasty, The American Journal of Orthopedics, Pp 70-74 Lakshaman et.al (2010) argue that Studies have confirmed that reinfusion drains have no significant effect on the postoperative hemoglobin levels References Abuzakuk, T. et al. (2007). Autotransfusion drains in total knee replacement. Are they alternatives to homologous transfusion? International Orthopaedic Journal, 31(2): 235– 239 Cheng, S. (2005).Investigation of the Use of Drained Blood Reinfusion after Total Knee Arthroplasty: A Prospective Randomized Controlled Study, Journal of Orthopaedics Surgery, Vol 13(2), Pp 120-124, Retrieved on April 7, 2013 from http://www.josonline.org/pdf/v13i2p120.pdf Henderson, M.S, Newman, J.H & Hand.G.C. (1999).Blood Loss Following Knee Replacement Surgery, Use it Don't Lose it, Vol 6,Iss 2,Pp 125-129 Lakshaman, P, Purushothamna, B & Sharma, A. (2010).Impact of Reinfusion Drains on Hemoglobin Level in Total Knee Arthroplasty, The American Journal of Orthopedics, Pp 70-74 Liumbruno, G.M & Water, J.H Unwashed Shed Blood: Should We Transfuse It? Vol 9, Iss 3, Pp 241–245. Muñoz, M, Slappendel, R & Thomas, D. (2011). Laboratory characteristics and clinical utility of post-operative cell salvage: washed or unwashed blood transfusion? Vol 9(3), Pp 248– 261. Smith, L.K, Williams, D.H & Langkamer, V.G. (2007).Postoperative Blood Salvage with Autologous Retransfusion in Primary Total Hip Replacement, Journal of Bone Joint Surgery, Vol 89, Pp1092 Read More