Reducing Waste Associated With Bloodline Setups
Background
Financial & Environmental Impacts
Department of Anesthesiology, Weill Cornell Medicine, New York-Presbyterian Hospital, New York, NY
Dale Tager, MD, MBA, Mary Carter Mullen, MD, Julian Rowe, MD
Mentors: Patricia Mack, MD, Deirdre C. Kelleher, MD
Staff: Aaron Weinberg, Diego Bauza, Michelle Tiangco
Conclusions
• Our standard institutional practice for all neurosurgical cases included a
blood line setup, however, blood transfusions remain rare.
• Warmed IV fluids do not contribute substantially to patient temperature
management, raising core temperature by only ~1/2 degree with likely
no clinical benefit.1
• Warmed IV fluids not indicated below flow rates of 35cc/min
• Only indicated for large volume blood transfusion
• Calculate financial cost of current bloodline setup and alternative
solutions (basic IV tubing or short extension tubing "leash")
• Calculate environmental burden of current bloodline setup and
alternative solutions by weighing all components (except fluid bags)
including outer packaging.
• Review PACU temperature data from fluid warmer cartridge shortage
(compared to time with universal use) for any noticeable effects
• Calculate recent transfusion rates for neurosurgical cases
• Informally survey clinicians for comfort with alternative "standards"
1Bindu, Barkha; Bindra, Ashish; Rath, Girija. Temperature management under general anesthesia: Compulsion or option. Journal of
Anaesthesiology Clinical Pharmacology 33(3):p 306-316, Jul–Sep 2017. | DOI: 10.4103/joacp.JOACP_334_16
Projected Annual Cost Savings
Warmer Shortage
Feb – Oct 23
Blood Warmer Basic IV Tubing Leash Only
Monthly Cost $3848.34 $2027.40 $228.78
Annual Cost $46,180.08 $24,328.80 $2745.36
Projected Annual Savings $21,851.28 $43,434.72
Blood Warmer Basic IV Tubing Leash Only
Plastic waste 510 kg 186 kg 38 kg
CO2 emissions
(converted from kg of waste) 1325 – 1738 kg CO2e 482 – 632 kg CO2e 99 – 129 kg CO2e
Projected CO2e Annual
Savings 843 – 1106 kg CO2e 1226 – 1609 kg CO2e
Projected Annual Weight and CO2 emissions
• Less than 3% of adult neurosurgery patients received blood products
• There was no detectable pattern (surgeon, case type) to predict when blood was needed Use of blood warmer over leash when blood is not given is:
16x the cost, 13x the weight, 13x the CO2 emissions
Unmeasured Savings:
o CO2 emissions from transporting supplies to the hospital
o Labor & space saved from having to keep greater stock of supplies
o Labor, cost, and CO2e from transporting & disposing of supplies
o Universally message that the “leash” is the new “Cornell standard”
for 2nd IVs in neuro cases (via email, setup guidelines, in-person
conference presentation, trainee "bootcamp")
o Investigate other areas of bloodline waste:
▪ Robotics
▪ Hysterectomy and major gynecological procedures
▪ Prostatectomies and major urologic procedures
▪ Orthopedics
o Review purchasing records to determine procurement decrease
Universal use of blood setups in neurosurgical procedures with low
transfusion rates can be wasteful, resulting in financial loss, time waste,
and excess carbon emissions.
Historic Temperature Data
Next Steps
No detectable difference in PACU temperatures when
warmers used in transfusions only (Feb-Oct 2023)
• Reduce unnecessary bloodline setups in adult neurological surgery
cases by 15% over 1 year
• Determine safety and savings of making fluid conservation practices
standard.
Components of Bloodline Setups
Blood Setup: Primed
blood Y-tubing, fluid
warming cassette
with ranger,
stopcock, extension
tubing, fluid bag
Unused Set up: No
blood was transfused
Problem
Objective
Methods