Intraoperative blood cell salvage in obstetrics

Summary

The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on intraoperative blood cell salvage in obstetrics.

NICE considered the evidence relating to the efficacy and safety of intraoperative blood cell salvage in obstetrics (IPG144) and for intraoperative red blood cell salvage during radical prostatectomy or radical cystectomy (IPG258) in response to concerns expressed about theoretical risks associated with the procedure. These concerns were the possibility of amniotic fluid embolism and haemolytic disease in future pregnancies when used in obstetrics, and reinfusion of malignant cells when used in radical prostatectomy/cystectomy.

The evidence relating to safety of cell salvage in these procedures was considered adequate and therefore NICE does not intend to review its use in other specific clinical situations unless notified of new indications for intraoperative cell salvage in which there may be new safety concerns.

In accordance with the Interventional Procedures Programme Process Guide, guidance on procedures with special arrangements are reviewed 3 years after publication and the procedure is reassessed if important new evidence is available.

This guidance was considered for reassessment in May 2011 and it was concluded that NICE will not be updating this guidance at this stage. However, if you believe there is new evidence which should warrant a review of our guidance, please contact us via the email address below.

Description

Intraoperative cell salvage is a commonly used technique in cardiac and orthopaedic surgery. However cell salvage has not been routinely adopted in the obstetric field for use in women at risk of postpartum haemorrhage following Caesarean section, where there may be specific safety concerns regarding embolism, or haemolytic disease as a result of re-infusion of foetal cells, or amniotic fluid.

During intra-operative blood cell salvage during Caesarean section, blood that is lost during the operation is aspirated from the surgical field using a catheter. The blood is then suctioned in a reservoir in which a filter removes gross debris. The filtered blood is then washed and re-suspended in saline for transfusion, which may be re-transfused either during or after the operation.

A leukocyte depletion filter may also be used in this process to reduce the number of leukocytes in transfused blood which may reduce adverse reactions to re-infused blood and limit disease transmission.

NICE Pathways

This guidance has been incorporated into the following NICE Pathways, along with other related guidance and products.

Visit the NICE Pathway: caesarean section

OPCS4.6 Code(s):

This procedure is outside the scope of the OPCS-4 classification.

_{The NHS Classifications Service of NHS Connecting for Health is the central definitive source for clinical coding guidance and determines the coding standards associated with the classifications (OPCS-4 and ICD-10) to be used across the NHS.   The NHS Classifications Service and NICE work collaboratively to ensure the most appropriate classification codes are provided.  www.connectingforhealth.co.uk/clinicalcoding}

Details

Contact details:

Links:

	IPG144 Intraoperative blood cell salvage in obstetrics: guidance (web format)	08 February 2011
	IPG144 Intraoperative blood cell salvage in obstetrics - guidance	21 November 2005
	IPG144 Intraoperative blood cell salvage in obstetrics - information for the public	23 November 2005
	Interventional Procedures Consultation Document - intraoperative blood cell salvage in obstetrics	22 February 2005
	Interventional procedures overview of intraoperative blood cell salvage in obstetrics	22 February 2005