Direct re-transfusion of autologous blood (ADR) is a technique applied both intra- and postoperatively. Critical assessment reveals that this technique cannot fulfill expectations, particularly with respect to homologous blood avoidance. Undesired compounds delivered with such autologous re-transfusion systems result in – potentially lethal – complications. ADR is rarely indicated, provides blood of low quality, and produces hidden cost.

The systems/filters assessed in this study do not improve quality of blood drained from the surgical field. Retransfusion of such blood can not be recommended.

This study evaluated electric nerve stimulation as a nerve location tool. After eliciting motor response in 43 patients undergoing shoulder surgery, the needle tip's position, distance from the closest nerve, and spread of saline were evaluated using ultrasound imaging. The needle's tip resided 1 to 4 mm from the closest nerve in 21, in direct contact with it in 7, and 6 to 18 mm away in 15 patients. In 21 patients, subsequent saline dissection did not reach the brachial plexus. Thus, the success rate of electric nerve stimulation for correct needle-nerve distance identification was 48.8%, with correct fluid spread reached in only 51.2% of patients.

Elimination of ''Undesired Components'' by Automated Autotransfusion Background: Usefulness and efficacy of automated autotransfusion in the process of recovering autologous, washed erythrocytes are well documented. The primary advantage compared to direct autotransfusion systems results from a more or less effective elimination of undesired components of wound and drainage blood. Material and Methods: The autotransfusion device Sequestra 1000( (Medtronic) was investigated. Assessed were haemoglobin (Hb), haematocrit (Hct), thrombocytes (PLT), free Hb (f-Hb), β-thromboglobulin (β-TG), elastase, lactate dehydrogenase (LDH), thrombin-antithrombin-III complex (TAT), plasmin-antiplasmin complex (PAP), fibrin degradation products (FDP) and the complement C3 in wound blood as well as in the autologous erythrocyte concentrate. Results: The wound blood showed, in comparison to normal as well as, low levels of Hb (6.2 mmol/l), Hct (0.28) and PLT (91 G/l), whereas indicators of cell decomposition (f-Hb:778 µmol/l, β-TG: >429 IU/ml and LDH: 98 µmol/l s^–1) were increased. There was an increased concentration of Hb in the washed autologous erythrocyte concentrate, and undesired components were decreased. Conclusion: With automated autotransfusion, the plasmatic factors can be separated and removed. The quality of an automated system is demonstrated by the elimination rates of the purification process. The elimination rates showed a removal of undesired wound blood components greater than 80%.