3 Changes to Preserving Autologous Tissue

Now is the time to review revisions to the Guideline for Autologous Tissue Management, which may require practice changes within the perioperative setting and other care areas. The revised guideline and materials that support implementation are now available in the 2020 edition of Guidelines for Perioperative Practice and online in the AORN Facility Reference Center.

New Evidence, New Practice Approaches

New recommendations provide new opportunities to review and refine the management of autologous tissue during various stages including handling, preparation, packaging, storage, and transportation, explains Julie Cahn, DNP, RN, CNOR, RN‐BC, ACNS‐CP, CNS‐CP, perioperative practice specialist and lead author of the guideline.

For example, a new section in the guideline called team communication clarifies tissue management across all phases of perioperative care, beginning with the preoperative briefing, during intraoperative hand-overs, and in the postoperative debriefing. Some actions include confirming the name of the tissue and how the tissue will be preserved.

“Teams can use the updated recommendations in the team communication section to refine a more comprehensive communication process for autologous tissue management that spans all perioperative phases of patient care,” Cahn says.

She highlights three specific updated sections of the guideline that interdisciplinary teams can compare against current practices to optimize safe tissue management:

1. Registering as a Tissue Establishment (see recommendation 1)

   Using manufacturing steps such as sterilization or other processing that changes tissue from the original form requires the facility to register with the FDA as a tissue establishment. According to the FDA, the only processing steps that allow autologous tissue to stay in the original form are cleaning, rinsing, sizing, and shaping. Facilities must also register with the FDA as a tissue establishment if they routinely distribute tissue. This information is now consolidated into one section in the guideline, as described in recommendation 1.



2. Storage (see recommendations 2¬–5)

   Now, an interdisciplinary team should determine the temperature range and the maximum storage duration for cranial bone flaps. When making the decision the team should consider the packaging method and patient-specific needs, as described in recommendation 2. 

   The maximum storage duration for cryopreserved parathyroid tissue is now an interdisciplinary team decision based on tissue viability and patient-specific needs, as discussed in recommendation 3.

   The storage temperature for skin should be 4° C (39.2° F), and the maximum storage duration for skin is now an interdisciplinary team decision, as described in recommendation 4.

   The storage temperature of vessels is between 2° C and 8° C (35.6° F and 46.4° F) and the maximum storage duration for vessels is 14 days, as discussed in recommendation 5.



3. Management (see recommendations 12, 14)

   Teams should review specifics of tissue that is nearing expiration or maximum storage duration, such as: determining patient status and condition of the packaging, discussing tissue details with the patient’s surgeon, and contacting the patient or patient’s legal representative for release of the tissue, as discussed in recommendation 12.

   New terminology specifying tissue records gives facilities more flexibility in the location of the information recorded on autologous tissue such as the patient health record or in a tissue log. The new verbiage is in alignment with federal regulations for registered tissue establishments, as discussed in recommendation 14.

Free Resources for Members

Guideline Essentials: Implement revised guideline implementation tools into your practice to help better manage autologous tissue to minimize microbial growth and reduce the risk for errors:

• Gap Analysis Tools: Tools to assess areas in which your facility may not be compliant with the guidelines.
• Policy & Procedure Templates: Ready-to-use customizable templates for developing your facility’s policies and procedures
• Competency Verification Tools: Ready-to-use customizable templates for verifying competency to meet facility requirements

Webinars

Autologous Tissue: Guideline Update 2020 Replay (1.0 CHs)

Implementing Best Practices for Autologous Tissue Management (1.0 CHs)

AORN Journal Articles

Back to Basics: Autologous Tissue (1.5 CHs)

A Team Approach to Improving Tissue Management