RESUMEN

BACKGROUND: Critically ill patients frequently need blood transfusions. For safety, blood must be delivered via syringe infusion pumps, yet this can cause red cell damage and increase the rate of haemolysis. AIMS AND OBJECTIVES: To evaluate biochemical and haemolytic markers of red blood cells transfused in three different types of syringe infusion pumps at two different infusion rates (10 and 100 mL/h). DESIGN AND METHODS: A lab-based study using aliquots of 16 red blood cell bags was undertaken. Haemolysis markers (total haemoglobin [g/dL], haematocrit [%], free haemoglobin [g/dL], potassium [mmol/L], lactate dehydrogenase [U/L], osmolality [mOsm/kg], pH, degree of haemolysis [%]) were measured before and after red blood cell infusion and exposure. Three different syringe infusion pumps brands (A, B, and C) were compared at two different infusion rates (10 and 100 mL/h). RESULTS: Total haemoglobin fell significantly in all red blood cell units during manipulation (pre-infusion: 26.44 ± 5.74; post-exposure: 22.62 ± 4.00; P = .026). The degree of haemolysis significantly increased by 40% after manipulation of the red blood cells. Syringe infusion pump A caused a 3-fold increase in potassium levels (3.78 ± 6.10) when compared with B (-0.14 ± 1.46) and C (1.63 ± 1.98) (P = .015). This pump also produced the worst changes, with an increase in free haemoglobin (0.05 ± 0.05; P = .038) and more haemolysis (0.08 ± 0.07; P = .033). There were significant differences and an increase in the degree of haemolysis (P = .004) at the infusion rate of 100 mL/h. CONCLUSIONS: Syringe infusion pumps may cause significant red blood cell damage during infusion, with increases in free haemoglobin, potassium, and the degree of haemolysis. Some pump types, with a cassette mechanism, caused more damage. RELEVANCE TO CLINICAL PRACTICE: In many intensive care units, bedside nurses are able to consider infusion pump choice, and understanding the impact of different pump types on red blood cells during a transfusion provides the nurses with more information to enhance decision-making and improve the quality of the transfusion.

Asunto(s)

RESUMEN

This experimental randomized study compared the effects of macrodrop and microdrop blood transfusion sets on red blood cell (RBC) hemolysis. Twenty units of packed RBCs from different donors were infused through 48 infusion sets from 2 manufacturers at infusion rates of 10 and 100 mL/h. Pre- and postinfusion analysis was performed to determine total hemoglobin (g/dL), hematocrit (%), free hemoglobin (g/dL), potassium (mmol/L), haptoglobin (g/L), and degree of hemolysis (%). The results demonstrated that the level of free hemoglobin (P < .001) and degree of hemolysis (P < .001) increased postinfusion. A higher degree of hemolysis was noted when the RBCs were infused at a rate of 10 mL/h through a microdrop blood transfusion set.

Asunto(s)

RESUMEN

Hemólise extracorpórea pode ser identificada durante processos hemoterápicos. O enfermeiro é um dos profissionais responsáveis pela administração de hemocomponentes e controle de possíveis riscos, portanto deve apropriar-se de conhecimentos que respaldem a prática clínica. O objetivo foi identificar na literatura aspectos relacionados à hemólise em concentrados de hemácias decorrentes de administração de sangue por dispositivos de infusão intravenosa. Realizou-se Revisão Integrativa da Literatura. Incluídos artigos na língua inglesa, espanhola e portuguesa, sem delimitação da data, indexados em quatro bases de dados. Foram selecionadas 12 (100,0%) produções científicas, sendo que em sete (58,3%) foram analisadas bombas de infusão, em duas (16,7%) a manipulação de eritrócitos, em duas (16,7%) a hemólise com combinações de dispositivos e em uma (8,3%) cateter intravenoso. Os resultados de quatro (33,3%) destes estudos evidenciaram ocorrência de hemólise. Os estudos apontaram que pode ocorrer hemólise durante a passagem do componente por bombas de infusão e cateteres (AU).

Extracorporeal hemolysis may be identified during hemotherapy. The nurse is one of the professionals responsible for the administration of blood components and the control of possible risks, and must therefore acquire the knowledge which supports clinical practice. The objective was to identify, in the literature, aspects related to hemolysis in concentrates of red blood cells resulting from the administration of blood through intravenous infusion devices. An Integrative Review of the Literature was undertaken, including articles in the English, Spanish and Portuguese languages, without limitation of data, indexed in four databases. A total of 12 (100.0%) scientific productions were selected, of which seven (58.3%) analyzed infusion pumps, two (16.7%) the handling of erythrocytes, two (16.7%) hemolysis with combinations of devices, and one (8.3%), the intravenous catheter. The results of four (33.3%) of these studies evidenced the occurrence of hemolysis. The studies indicated that hemolysis can occur during the passage of the component through infusion pumps and catheters (AU).

Hemolisis extracorpórea puede ser identificada durante procesos hemoterápicos. El enfermero es uno de los profesionales responsables por la administración de hemocomponentes y control de posibles riesgos, por lo tanto debe apropriarse de conocimientos para garantizar la práctica clínica. El objetivo fue identificar en la literatura aspectos de la hemolisis en concentrados de hematíes decurrentes de administración de sangre por dispositivos de infusión intravenosa. Fue realizada revisión integrativa de la literatura. Se utilizaron artículos en lengua inglesa, española y portuguesa, sin delimitación de fecha, indexados en cuatro bases de datos. Fueron seleccionadas 12 (100,0%) producciones científicas, siendo que en siete (58,3%) fueron analizadas bombas de infusión, en dos (16,7%) la manipulación de eritrocitos, en dos (16,7%) la hemolisis con combinaciones de dispositivos y en una (8,3%) catéter intravenoso. Los resultados de cuatro (33,3%) de estos estudios evidenciaron ocurrencia de hemolisis. Los estudios apuntaron que puede ocurrir hemolisis durante la pasaje del componente por bombas de infusión y catéteres (AU).

Asunto(s)