Blood Management FAQs

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Blood Management Program

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What is used in place of blood?

There is no substitute for blood.  However, a host of strategies used individually or in concert have proven effective to overcome the need for blood transfusion in many medical situations. These include pharmaceuticals, techniques, and devices that minimize blood loss and maximize blood volume.

What strategies and techniques are used to avoid a blood transfusion?

Before Surgery

During Surgery

  •  Anesthesia Techniques
  • Cell salvage
  • Volume expanders
  • Hemostatic drug therapy
  • Hemodilution
  • Meticulous surgical techniques
  • Minimally invasive surgery such as the cyberknife, aneurysm microsurgery (coiling), and the da Vinci robotic surgery technology
  • Tissue adhesives and sealants 
  • Electrocautery

After Surgery

  • Anemia management
  • Minimal blood draws  
  • Monitor and arrest bleeding
  • Cell salvage
  • Reduce oxygen consumption
  • Appropriate fluid administration

Non-Surgical Patient

  • Hemostatic drug therapy
  • Blood cell stimulating drugs
  • Nutritional support
  • Minimal blood draws
  • Reduce oxygen consumption (rest)
  • Appropriate oxygen administration

What effect can nutritional supplements have on my surgery?

It is very important for every patient to inform their doctor about any medications, nutritional supplements, or herbs they take.  Many (e.g., garlic, ginger, ginseng, feverfew, flax seed, fish oil, dong quai, kava, licorice, saw palmetto, St. John's wort, omega 3, valerian, etc.) can cause bleeding or other serious complications (stroke, heart failure, seizure, coma) during surgery.

Additional information about herbs and supplements can be found at MedlinePlus®

What provisions are available to manage the care of my minor child/dependent without a blood transfusion?

In the hospital, talk to your child's nurse or doctor at your earliest opportunity to let them know your wishes.  It is important to keep the lines of communication open to avoid a blood transfusion. 

Patients under 18 years of age may be enrolled in the Pediatric Bloodless Program. Please contact Blood Management for more information or a referral to a participating physician, or call 206 320-8094. 

What are some important considerations frequently overlooked on a Durable Power of Attorney for Health Care (DPA)?

It is very important that you follow the instructions for completing your Advance Directive/Durable Power of Attorney for Health Care in accordance with the laws of your state.  Please review your Washington State Advance Directive/Durable Power of Attorney for Health Care with these points in mind:

  • Choices must be initialed, rather than checked or marked with an "X".
  • Appoint two (or more) agents. If your first appointed agent is unavailable, unable, or unwilling to serve, the alternate agent will serve with the same power and authority. Please write all agent contact information clearly and completely.
  • Tell your agents the kinds of decisions you want made on your behalf, and make sure each of them understands and respects your wishes.
  • Your agent must be 18 years of age or older and cannot be your physician, the physician's employees, or an employee of your hospital or nursing home unless he/she is also your spouse, state registered domestic partner, adult child or brother or sister.1
  • If your DPA addresses end-of-life decisions, sign it in front of two witnesses who are not your agent, not related to you by blood or marriage and who are not entitled to a portion of your estate. Also, your physician, the physician's employees and employees of your hospital or nursing home cannot be witnesses. 
  • Your DPA is a legal document. Only you may make changes verbally or in writing at any time. All written changes need to be dated at the time of the change. If you do change your DPA, be sure to replace all copies (previously placed with physician, hospital, agents, etc.) with the current version.

What if I have not completed a Durable Power of Attorney for Health Care (DPA)?

In an emergent situation where you are unconscious and there is no advance directive/DPA, emergency personnel could be faced with the responsibility to administer a blood transfusion (see implied consent).

Please be responsible to complete and carry your DPA with you at all times.

If you are planning a surgery or procedure at Swedish Medical Center, you may contact Blood Management to complete the "Refusal of Blood Products". Your choices will be documented at Swedish Medical Center. However, enrollment in the Bloodless Program at Swedish Medical Center does not take the place of a DPA.  Please see the Glossary for more information on DPAs.

Why should I travel to a hospital with an established bloodless program if I have other facilities closer to me?

Routine medical care can quickly develop into a situation that requires immediate and specialized treatment. Swedish is equipped and prepared to employ the strategies that make bloodless medicine and surgery possible. When you are enrolled in the Bloodless Program, the health care team can quickly care for you without blood transfusion. Each member of the hospital team knows his/her role in managing your care without the use of blood, whether they are the anesthesiologist, pharmacist, surgeon, or admitting clerk. The net result is greater safety, quality care, and respect for you. We think this is an excellent reason to travel to Swedish for Bloodless Program care.

1EHB 1175
2Revised Code of Washington 70.122.030