Bloodless surgery programs are being instituted because of increasing public concerns about blood transfusions and the need to accommodate some patients' religious beliefs. Patients' desires to forego transfusion must be identified during the preoperative screening process and subsequently reflected on the surgical consent. Patients are managed preoperatively with erythropoietin and dietary supplements. The surgical team employs a variety of intraoperative and postoperative blood conservation techniques to help avoid the need for transfusion. A retrospective review of congenital cardiac procedures in a blood conservation program confirmed that bloodless cardiac surgery is effective.

Some surgical procedures can be performed more safely outside the OR. One procedure commonly performed within the neonatal intensive care unit (NICU) is patent ductus arteriosus (PDA) ligation. Staff members at one tertiary care facility assessed current management and delivery of bedside PDA ligation surgery and identified several problem areas, including communication issues regarding patient and unit readiness, design of instrument sets, and organization and transportation of surgical supplies. Implementing solutions to these problems resulted in a decrease in the amount of time the surgical team spent in the NICU and more efficient surgical procedures.

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