To the Editor:--Orthotopic liver transplantation (OLT) is an effective treatment for end-stage liver disease. The procedure is fraught with the risk of massive intraoperative blood loss and severe coagulopathy requiring the anesthesiologist's efficient use of time to correct the acute blood loss, coagulopathy, and hemodynamic and metabolic derangements that are present. Several devices facilitate the rapid administration of warm fluids and blood products. Cryoprecipitate usually is given separate from the rapid infusion system (RIS) to prevent dilution of the cryoprecipitate in the reservoir of the RIS, which may be filled with a mixture of crystalloid, packed erythrocytes, and fresh frozen plasma.
Our regional American Red Cross provides the blood bank with cryoprecipitate with an approximate volume of 10–15 ml in a 300-ml bag. Transfusing multiple bags (i.e., 5–10 units) of cryoprecipitate one after another is labor-intensive and inefficient. Also, one may risk a needlestick injury and its sequelae when attempting to aspirate the contents of multiple bags into one large syringe.
We describe a device for effectively transferring cryoprecipitate for bolus infusion. After appropriately identifying each bag of cryoprecipitate, one bag is retained as a reservoir, and subsequent bags are used for transfer of their small volume of cryoprecipitate into the 300-ml reservoir bag. This is achieved through a large-bore blood priming catheter. Using two sterile Blood Bag Spike "Quickie Prime" 1/4 x 1/16 x 3-inch catheters (Surgimedics, Woodlands, TX) connected by one sterile 1/4 x 1/4-inch straight luer lock connector (Cobe Cardiovascular, Arvada, CO), we composed a rapid transfer catheter (Figure 1) that facilitates the pooling of cryoprecipitate into one infusion bag. The components are sterile, and the luer lock port allows a needleless syringe aspiration to obtain residual cryoprecipitate from the transfer bag. We emphasize that it is important to observe the use of sterile technique throughout the pooling process and that the cryoprecipitate transfer device should be used for only one set of pooled products (i.e., 5–10 units). Once pooled, the cryoprecipitate can be transfused using a standard blood infusion set.
We believe that pooling the cryoprecipitate units into a reservoir bag using our device provides an efficient method for transfer and administration, simplifying the effort of cryoprecipitate administration to the patient and decreasing the risk of needlestick injury to the anesthesiologist. This device also can be used in procedures when severe coagulopathy may require the administration of multiple units of cryoprecipitate.
Barbara J. Roberts, M.D., Assistant Professor of Anesthesiology, Director, Transplantation Anesthesia Service.
Nilda E. Salaman, M.D., Assistant Professor of Anesthesiology, Department of Anesthesiology, Howard University Hospital, 2041 Georgia Avenue NW, Washington, DC 20060.