Using the App

Cell Salvage Simulator

Premium tool. This is an embedded simulator inside the Patient Blood Management module at /patient-blood-management — open that page and find the Cell Salvage Simulator card. It is not a standalone entry on the /training-dashboard hub.

Cell salvage is a key part of Patient Blood Management (PBM). This simulator covers the BMS / Transfusion Practitioner role in supporting cell salvage during major surgery.

What it does

• Simulates an intraoperative cell-salvage scenario (cardiac, orthopaedic, vascular, obstetric)
• Walks you through the device set-up for the case
• Tests collection vs processing decisions during the case
• Drills the wash / re-infusion protocol
• Handles adverse events — contamination, irrigation fluid in the bowl, equipment failure

Indications

Common indications for cell salvage:

• Cardiac surgery — CABG, valve surgery, aortic surgery
• Orthopaedic — revision arthroplasty, spinal surgery, complex trauma
• Vascular — aortic aneurysm repair, complex peripheral vascular
• Obstetric — caesarean section in high-risk cases (placenta praevia / accreta)
• Major trauma — selected cases
• Hepatic / urological — selected cases

Contraindications

• Frank contamination with bowel content or infected fluid (relative — leukocyte filters can mitigate)
• Cytotoxic drugs in the field
• Antibiotics not licensed for IV use in the field
• Antiseptic solutions (chlorhexidine, betadine) in the field — wash thoroughly or discard
• Haemostatic agents (some) — check manufacturer guidance
• Sickle cell disease — risk of haemolysis (relative)

The wash cycle

The simulator covers the standard wash:

1. Suction collection — at the appropriate vacuum (usually 100-150 mmHg) to minimise haemolysis
2. Reservoir collection with anticoagulant (heparin or citrate)
3. Volume threshold — typically 500-1000 mL collected before processing
4. Processing — centrifugation to concentrate RBCs
5. Wash with 0.9% saline (volume per manufacturer)
6. Resulting product — concentrated washed RBCs at Hct ~50-70%
7. Re-infusion within 4 h of processing (per manufacturer IFU)

Documentation

Each cell-salvage case must be documented:

• Indication
• Volume collected and re-infused
• Wash details
• Any adverse events
• Operator (BMS or Transfusion Practitioner) identity
• Linked to the patient record

Standards alignment

• NICE TA428 / IPG144 on intraoperative cell salvage (current)
• AAGBI / Association of Anaesthetists cell salvage guidance
• UK Cell Salvage Action Group (UKCSAG) standards
• BBTS cell salvage guidance
• MHRA for device-related issues

Bands and competency mapping

• Band 5 — assist in case set-up
• Band 6 — independent case management; train operating-theatre staff
• Band 7 — service-wide PBM lead; audit cell-salvage outcomes

Pair with the broader Transfusion Specialty article (article 30) and Major Haemorrhage Simulation (article 40) — cell salvage is part of the PBM toolkit alongside the MHP.