I read the article "Blood Conservation Strategies in Cardiovascular Surgery" by Maglish Ehrman and Moore1 with interest. The authors made a glaring omission by not addressing the role of postoperative autotransfusion of shed mediastinal blood in a comprehensive blood conservation program. This approach to transfusion safety in cardiac surgical patients entered the mainstream in the 1980s when chest drain manufacturers introduced disposable systems that were easy to use at the bedside. Today, there are 3 options for reinfusion of shed mediastinal blood: continuous reinfusion in which intravenous tubing is connected to the collection chamber and to an infusion site, creating a continuous loop; an inline collection bag placed between the patient drainage tubing and the chest drain where blood is collected, after which the bag is removed and hung on an intravenous pole for reinfusion; and a separate blood bag that can remove shed blood from the collection chamber for reinfusion.

Reports on reinfusion of shed mediastinal blood have shown a reduction in allogenic transfusions by as much as 50% with no significant contamination, derangements of laboratory measures of clotting function, or postoperative complications.2-5 This is clearly a viable strategy for reducing patients' exposure to donor blood and the hazards of blood-borne infection, allergic, and hemolytic reactions, while providing higher quality blood without the loss of platelets and 2,3-DPG that occurs with blood storage.

Patricia Carroll, RN, BC, CEN, Ret, MS

Community Health Care Consultant, Nurse's Notebook, LLC, Meridew, Conn, [email protected]

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