Bloodless Surgery and Medicine Programs
What is a Bloodless Surgery and Medicine Program?
A Bloodless Surgery and Medicine Program generally refers to a surgical program in a hospital where homologous blood transfusions (blood from another patient) are carefully and intentionally avoided in order to fulfill a patient’s desire to avoid receiving a blood transfusion. Blood conservation is one of the keystones of a comprehensive Bloodless Surgery and Medicine Program. Many sophisticated techniques are used to minimize the loss of blood and prevent the patient from going into shock without administering a blood transfusion.
A Bloodless Medicine and Surgery Program is expansive, detailed and complex. It is not something thrown together by a hospital on a whim. In order for hospitals and surgeons to continue to hold their licenses and avoid malpractice suits all of the techniques used in Bloodless Surgery have to meet the highest standards possible.
All of the techniques used in Bloodless Surgery in the United States are approved by the FDA. None of them are experimental. Most have been in use for years; some for decades. It is estimated that from 20,000 to 30,000 Bloodless Operations are performed every year in the United States alone.
"This is nothing experimental. These are procedures being done other places. We have data from around the country to support everything we're doing here." Dr. Jerry Kelley, Northeast Baptist Hospital in San Antonio. -MasterControl
A comprehensive program
Bloodless Surgery Programs involve a comprehensive system of treating a patient who does not want homologous blood transfusions. Therefore, careful handling of the Bloodless Patient is required prior to, during and following surgery. Bloodless Patients need special attention. Certain prescription drugs may be avoided prior to, during or after surgery to avoid excessive bleeding. Other medicines, such as Erythropoietin, may be administered prior to, during or after surgery to stimulate red blood cell production. A special diet may be implemented prior to surgery to promote red blood cell growth. Complementary and alternative medicines may be temporarily discontinued to ensure there is no interference with other medicines. Specially trained nurses are involved in the care of a Bloodless Patient. Administrators institute special protocols to ensure the safe and specialized care needed to make a Bloodless Program work well. This may include special forms, legal notices, even simple things like No Blood bracelets and signs to identify Bloodless Patients.
Usually a comprehensive Bloodless Surgery Program will have a special liaison or coordinator. Here is a part of job description of an RN Coordinator for a Bloodless Surgery and Medicine Program posted on Nurse.com:
"The RN Coordinator oversees the clinical and quality functions of the Bloodless Surgery and Medicine Programs for inpatients and outpatients of Legacy Health System. The RN Coordinator is responsible for patient assessment, and analyzes, plans, implements, and evaluates patient care for patients referred to the Bloodless Surgery and Medicine program. The RN Coordinator is responsible for monitoring and relaying critical laboratory values to physicians. The RN Coordinator is responsible for supervising health care provider education and participates in community education and promotion of the program. The position requires working closely with patients, interdepartmental personnel, administration,… any patient requesting services of the program, physicians, and the Medical Directors of the program. The RN Coordinator will serve as a liaison between patients, physicians, families, and staff members, while working to ensure quality care within the scope of the patient religious beliefs."
A successful Bloodless Medicine and Surgery Program has professionals on staff that are dedicated, knowledgeable and motivated.
A look at a Bloodless Medicine and Surgery Program
To give an idea of the breadth of a Bloodless Medicine and Surgery Program note what another website says:
"Established in 1994, the Institute has provided medical care to over 45,000 patients from the U.S. and abroad. A medical staff of over 200 physicians from every discipline has been specially trained and practice bloodless medicine and surgical techniques. Additionally, 25 medical and surgical specialties including Anesthesiology, Cardiology, Gastroenterology, Hematology, Infectious Disease, Neurology, Pediatrics, and Vascular Surgery, utilize The NJ Institute's "no blood transfusion" philosophy.
"Highly complex procedures such as brain surgery, open-heart surgery, liver tumor removal, prostate, vascular, gynecological, and gastrointestinal surgery have all been successfully performed without blood transfusions at The NJ Institute." -Englewood Hospital
Bloodless Medicine is a serious endeavor; patients looking for the first time into the possibility of a Bloodless Operation can have full confidence that the science involved is time tested and safe. Bloodless Medicine is for everyone.
Other highly skilled professionals
Bloodless Surgery often involves the use of the patient’s own blood which is removed by cell salvage machines and re-infused back into the patient. A highly skilled perfusionist operates the cell salvage machine. He is one of may specially trained professionals essential to a successful Bloodless Surgery Program.
However Bloodless Surgery does not necessarily mean avoiding a transfusion since many medicines and solutions may be transfused into the patient prior to or during surgery - but instead means avoiding a homologous blood transfusion.
Special procedures and devices are used in Bloodless Surgery Programs
• Ultrasonic scalpel / harmonic scalpel
• Cell salvage
• Hypotensive Anesthesia
• Proper Patient Positioning
• Synthetic Erythropoietin – EPO
• Pulse Oximetry
• Volume expanders
• Blood Substitutes
• Hyperoxic Ventilation
• Minimally Invasive Surgery
• Multi Staged Operation
• Cautery –
- Argon beam coagulator
- Harmonic Scalpel /Ultrasonic Scalpel
- Laser surgery
• Prompt surgery
• Hyperbaric Oxygen Therapy
• Tissue adhesives
• Hematopoietic agents
The use of these special procedures, scalpels and medicines require specialized training. As can be seen a comprehensive Bloodless Medicine and Surgery Program is professional, serious, highly dedicated to its purpose and all inclusive.
How does a Bloodless Surgery and Medicine Program differ from standard Minimally Invasive Surgery (MIS)?
Although standard minimally invasive surgery – sometimes called laparoscopic surgery - may reduce or eliminate the use of blood products by their minimally invasive nature as opposed to open surgery, they are generally not referred to as Bloodless Surgery.
It is possible that a patient may undergo a minimally invasive procedure and encounter severe blood loss. MIS can cause serious internal bleeding. The surgeon, though performing a ‘bloodless surgery’, may not be properly trained to handle the problem and thus feel impelled to order a blood transfusion (unless he happens to be a Bloodless Surgeon as well and is in a surgical theatre that has the necessary devises, staff and products needed to handle the situation). A patient may have entered the hospital for a ‘bloodless surgical procedure’ with the mistaken idea that he is being operated on by a Bloodless Surgeon in a Bloodless Hospital.
Since there may be some in the general public that think of minimally invasive surgery as bloodless, that is never requiring a homologous blood transfusion, MyBlood capitalizes the phrase bloodless surgery as Bloodless Surgery when it is used in the sense described on the page What is Bloodless Surgery?, to distinguish Bloodless Surgery from MIS.
And as can be seen from the previous subheading a Bloodless Surgery Program is highly technical, extremely detailed and comprehensive. A standard MIS program will lack almost all of the tools and training required in a Bloodless Surgery Program by far.
Opting for Bloodless Surgery
Choosing Bloodless Surgery is a personal choice. MyBlood is dedicated to offering as much information as possible to help you make that choice. Remember, you will not be choosing to undergo an experimental operation. The procedures are sound, proven and safe. You will be joining millions of others who have chosen to accept Bloodless Surgery as an intelligent and safe decision. Over 100,000 surgeons worldwide are prepared to help you.
"It's the wave of the future." But it's here now,
"It's a growing trend across the country," Dr. Gabriel Alvarez says from Baptist Hospital, one of the few bloodless surgery centers in South Florida. He adds this transfusion-free surgeries lead to fewer complications, less inflammation, better results, and quicker recoveries even during major surgeries--like cardiac bypass.
"It definitely shows better outcomes for the patients," Dr. Alvarez says. Plus blood banks are constantly short on supply. "Some hospitals have actually had to cancel surgery due to a lack or availability of blood and blood products," he said.
Mr. De Le Pena said he's living proof -- Bloodless medicine has benefits.
Choosing a Bloodless Surgery Program
How does a patient choose one Bloodless Program over another? Some localities have more than one hospital that offers Bloodless Surgery. Investigate. Visit the hospitals. Take your time. Take a tour of the hospital. Talk to the staff, don’t just read brochures or look at websites. If possible, talk to patients that are currently under the care of the hospital.
"Few of the technologies used in bloodless medicine are new." -David Shook, BusinessWeek Online
"Non-acceptance of blood products is not a 'death wish." -Kay Williams, C.R.N.P., Director, Center for Bloodless Medicine and Surgery, Pennsylvania Hospital
“Avoid transfusion regardless of the level of preoperative anemia."
"Allogeneic blood transfusion should be avoided whenever possible, not only because of associated risks but also because transfusion has not been proven to improve postoperative outcomes.”