Intra-aortal blood transfusion

It is used in sudden clinical death, massive bleeding resulting from thoracic surgeries. Intra-aortal blood transfusion can be done with the help of a catheter inserted into the aorta through one of the peripheral arteries (often the femoral, rarely brachial) by means of a puncture or section. In the case of intra-arterial transfusion this is done under pressure and with the use of the same type of systems.

Intra-osseous transfusion

This method is only used when it is not possible to transfuse blood through other means (e.g. in severe widespread burns). Blood is transfused into the sternum, the iliac crest and the heel bone.

Puncture of the sternum is done with the patient lying supine. It is punctured under local anaesthesia into the shaft or body of the sternum. It is Kassirsky's needle that is used for this puncture. The operation site is cleansed. Injection is strictly made in the midline, passing through the skin, subcutaneous tissues; the initial resistance is at the bony lamella of the sternum, which is overcome with some effort. A specific feeling of the needle indicates that it has reached the bone marrow. The mandrin is removed and a syringe is used to aspirate the bone marrow. The appearance of the latter in the syringe indicates that the needle is positioned correctly, 3-5 ml of 1-2% novocain (procaine) are then injected into the bone marrow and the transfusion system is attached.

The iliac crest is punctured in the centre of the posterior third since in this area the spongy layer of bone has a loose structure that makes it easier to transfuse.

Flow of blood should be as slow as 5-30 drops/ minute, the transfusion of 250 ml of blood, therefore, takes 2-3 hours. To accelerate the flow, raise the bottle or increase the pressure in the bottle by injecting air under pressure up to 220 mm Hg.

THE PROCEDURE OF BLOOD TRANSFUSION

Blood transfusion is a serious operation which consists in transplantation of human living tissues. This method of treatment is widespread in clinical practice. Health care professionals of different specialities perform blood transfusion: surgeons, obstetrician and gynaecologists, traumatologists, internists, etc. Up-to-date scientific advancements, especially those in transfusiology, help prevent the complications associated with blood transfusion, which can sometimes even lead to death. These complications occur because of the errors that are committed in the process, which result from inadequate knowledge of the essentials of transfusion or violation of whichever step of the procedure. These include the inappropriate decisions as to the indications or contraindications for blood transfusion, errors in blood group and Rh typing, misinterpretation of the results of compatibility tests, etc. Observing the rules and regulations and following the steps of the procedure are bound to lead to successful blood transfusion.

Indications for blood transfusion. As blood transfusion is a serious intervention for each patient, it must always be justified. If it is possible to avoid the procedure or the benefits expected from blood transfusion are unlikely, the procedure should always be avoided. The indications for blood transfusion depend on the effect it is supposed to achieve: replacement of deficient blood volume or its components; improvement of the clotting properties of blood in case of bleeding disorders. Blood transfusion is absolutely indicated for acute blood loss, shock, bleeding, severe anaemia, major traumatic operations, including those with heartlung bypass. Diseases of blood, pyogenic infections and severe intoxication are all indications for transfusing blood or its components.

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