• Understanding of transfusion and intravenous therapy and fluid balance is necessary.

• Significant blood loss, related systemic hypoperfusion, and the associated decrease in oxygen-carrying capacity, with its impact on hypoxemia, often necessitate the replacement of blood with whole blood or packed cells. In appropriate patient populations (trauma, cardiovascular, or orthopedic surgical patients), autotransfusion should be considered as the need to replace blood becomes apparent.

• Autotransfusion is commonly used for trauma victims and for patients undergoing cardiovascular and orthopedic procedures; it reduces the need for banked blood transfusions with the inherent risks of transfusion reactions and disease transmission.

• A variety of autotransfusion devices are available. An autotransfusion system may be a standard water-seal chest drainage system (see Fig. 24-1, A), a separate autotransfusion setup, or a modified chest drainage autotransfusion system. In addition, continuous and intermittent systems are available. A continuous system has an intravenous line connected directly from the drainage unit collection chamber to the patient. An intermittent system uses a blood collection bag in-line between the chest tube and the collection chamber.

• Many disposable systems available today have the ability to act as a reservoir for autotransfusion if the need arises. To initiate autotransfusion, the autotransfusion bag is disconnected from the disposable system and connected to the saline solution–filled blood administration tubing. Nurses should gain familiarity with their institution’s autotransfusion system and policies.

• Indications for autotransfusion in the appropriate patient populations include active bleeding (greater than 100 mL/hr) and the accumulation of greater than 300 mL of drainage in the collection chamber.

• Contraindications to autotransfusion include the following: