Relationship Between the Loaded Pressure and Flow Rate of Packed Red Blood Cells and Various Infusion Solutions in Normal Infusion Lines and Catheters.

BACKGROUND: We investigated the relationship between the loaded pressure and flow rate in various catheters and the entire infusion line including the catheters, in several infusion solutions and packed red blood cells. METHODS: We connected the infusion line and catheter to the infusion solution and used an outer pressure bag or a compressor to pressurize the infusion solution bag to a pressure within the clinical (up to 450 mm Hg) or higher range (up to 1050 mm Hg). We approximated the relationship between the loaded pressure and flow rate in the entire infusion line including the catheter, versus the catheter alone, as a power function and compared the power numbers. RESULTS: In the clinical pressure range of normal saline, the power numbers of the entire infusion line for the 24-, 22-, 20-, and 18-gauge catheters were 0.76, 0.82, 0.81, and 0.86, respectively, while those for the catheter alone were 0.67, 0.63, 0.56, and 0.44, respectively. In the higher pressure range of normal saline, the power numbers of the entire infusion line for the 24-, 22-, 20-, and 18-gauge catheters were 0.68, 0.70, 0.71, and 0.73, respectively, while those for the catheter alone were 0.62, 0.61, 0.59, and 0.58, respectively. As the power number of the entire infusion line was closer to 1.00 than the values of the catheter, the relation between the loaded pressure and the flow rate was more linear in the entire infusion line than that in the catheter. Similar results were obtained using packed red blood cells and 40% glycerin mixture in normal saline. CONCLUSIONS: Regardless of the type of infusion solution or transfusion, the pressure-flow relationship in the catheter was nonlinear and not directly proportional. However, within the clinical pressure range (up to 450 mm Hg), the relationship between the flow rate and pressure in the entire infusion line was almost linear and proportional.

Combined Platelet and Erythrocyte Salvage: Evaluation of a New Filtration-based Autotransfusion Device.

BACKGROUND: The SAME device (i-SEP, France) is an innovative filtration-based autotransfusion device able to salvage and wash both red blood cells and platelets. This study evaluated the device performances using human whole blood with the hypothesis that the device will be able to salvage platelets while achieving a erythrocyte yield of 80% and removal ratios of 90% for heparin and 80% for major plasma proteins without inducing signification activation of salvaged cells. METHODS: Thirty healthy human whole blood units (median volume, 478 ml) were diluted, heparinized, and processed by the device in two consecutive treatment cycles. Samples from the collection reservoir and the concentrated blood were analyzed. Complete blood count was performed to measure blood cell recovery rates. Flow cytometry evaluated the activation state and function of platelets and leukocytes. Heparin and plasma proteins were measured to assess washing performance. RESULTS: The global erythrocyte yield was 88.1% (84.1 to 91.1%; median [25th to 75th]) with posttreatment hematocrits of 48.9% (44.8 to 51.4%) and 51.4% (48.4 to 53.2%) for the first and second cycles, respectively. Ektacytometry did not show evidence of erythrocyte alteration. Platelet recovery was 36.8% (26.3 to 43.4%), with posttreatment counts of 88 × 109/l (73 to 101 × 109/l) and 115 × 109/l (95 to 135 × 109/l) for the first and second cycles, respectively. Recovered platelets showed a low basal P-selectin expression at 10.8% (8.1 to 15.2%) and a strong response to thrombin-activating peptide. Leukocyte yield was 93.0% (90.1 to 95.7%) with no activation or cell death. Global removal ratios were 98.3% (97.8 to 98.9%), 98.2% (96.9 to 98.8%), and 88.3% (86.6 to 90.7%) for heparin, albumin, and fibrinogen, respectively. The processing times were 4.4 min (4.2 to 4.6 min) and 4.4 min (4.2 to 4.7 min) for the first and second cycles, respectively. CONCLUSIONS: This study demonstrated the performance of the SAME device. Platelets and red blood cells were salvaged without significant impact on cell integrity and function. In the meantime, leukocytes were not activated, and the washing quality of the device prevented reinfusion of high concentrations of heparin and plasma proteins.

Performance assessment of intravenous catheters for massive transfusion: A pragmatic in vitro study.

BACKGROUND: Rapid infusion of warmed blood products is the cornerstone of trauma resuscitation and treatment of surgical and obstetric massive hemorrhage. Integral to optimizing this delivery is selection of an intravenous (IV) catheter and use of a rapid infusion device (RID). We investigated which IV catheter and RID system enabled the greatest infusion rate of blood products and the governing catheter characteristics. STUDY DESIGN AND METHODS: The maximum flow rates of nine IV catheters were measured while infusing a mixture of packed red blood cells and fresh frozen plasma at a 1:1 ratio using a RID with and without a patient line extension. To account for IV catheters that achieved the RID's maximum 1000 ml/min, the conductance of each infusion circuit configuration was calculated. RESULTS: IV catheters of 7-Fr caliber or higher reached the maximum pressurized flow rate. The 9-Fr multi-lumen access catheter (MAC) achieved the greatest conductance, over sevenfold greater than the 18 g peripheral catheter (4.6 vs. 0.6 ml/min/mmHg, p < .001). Conductance was positively correlated with internal radius (ß = 1.098, 95% CI 4.286-5.025, p < .001) and negatively correlated with length (ß= - 0.495, 95% CI -0.007 to 0.005, p < .001). Use of an extension line (ß= - 0.094, 95% CI -0.505 to -0.095, p = .005) was independently associated with reduced conductance in large caliber catheters. CONCLUSION: Short, large-diameter catheters provided the greatest infusion rates of massive transfusion blood products for the least pressure. For patients requiring the highest transfusion flow rates, extension tubing should be avoided when possible.

Implementation and evaluation of a major haemorrhage protocol in the Emergency Department Resuscitation Area in the University-affiliated Hospital of Brest (France).

Haemorrhagic shock is a rare occurrence in emergency medicine but it can be associated with significant mortality. The purpose of this study was to evaluate the impact of a major haemorrhage protocol on patient management in Emergency Department Resuscitation Area. METHODS: A single-centre study was conducted to compare two periods, before and after institution of a massive haemorrhage protocol including the use of massive transfusion orders and the availability of packed red blood cell concentrates prior to patient's admission. Two groups of patients (in both trauma and non-trauma settings) were defined: "before protocol" and "after protocol". The primary outcome was the median transfusion time for a unit of red blood cell concentrate. RESULTS: Forty patients were included: 22 for the "pre-protocol" group and 18 for the "post-protocol" group. The two groups were balanced with baseline characteristics. This study showed a significantly reduced median transfusion time for a unit of red blood cell concentrate from 20min pre-protocol to 9min post-protocol. The time between patient's admission and transfusion of the first red blood cell concentrate was reduced but non-significantly from 71min to 36min. CONCLUSION: The major haemorrhage protocol optimised patient management by reducing the median transfusion time for red blood cell concentrates.

Does the Use of an Infusion Pump for Red Blood Cells Increase Hemolysis?

Transfusions of red blood cells (RBCs) are frequently administered for a variety of clinical conditions. The use of an infusion pump has become common practice in nursing. Lack of evidence regarding hemolysis associated with transfusing older RBCs using an infusion pump led one 361-bed acute care suburban medical center to maintain its nursing policy to infuse all blood products by gravity. A combined simulated and clinical study was conducted with 25 units of RBCs. No significant hemolysis was demonstrated as measured by hemolysis index and serum potassium levels. As a result of this study, the nursing policy at the medical center was changed.

Indwelling ports for prophylactic RBC exchanges in sickle cell patients: Comparison of bard and vortex ports.

INTRODUCTION: Red blood cell exchange (RCE) procedures are commonly used for stroke prevention in sickle cell disease (SCD) patients. We compared two different dual lumen ports used for RCE because differences between the port and catheter design may lead to functional variance. METHODS: We reviewed the RCE parameters of SCD patients following implantable port placement encountered at a single institution. Five Vortex and four Bard ports were used and compared. Patients were followed for 1-24 exchange procedures over 3-26 months performed between 2013 and 2015. RESULTS: Nine patients underwent 124 RCE procedures with no failures. A total of 74 exchanges used Vortex ports with a mean flow rate of 45.2 mL/min while 50 exchanges used Bard ports with a mean flow rate of 42.1 mL/min which was a significant difference (P = .002). A total of 85 exchanges with tPA administration preprocedure had a mean flow rate of 43.8 mL/min while 39 exchanges without had a mean flow rate of 45.4 mL/min which was not a significant difference (P = .19). CONCLUSION: Both the Bard and Vortex ports functioned well during our study period with no treatment failures, no significant complications requiring removal or replacement, and adequate mean flow rates. While the difference in mean flow rates was statistically significant between Vortex and Bard ports, there may not be a practical difference in performance. There also does not appear to be a significant benefit in flow rates with preprocedure tPA. We conclude that both ports may be a satisfactory choice for vascular access in SCD patients expected to undergo regularly scheduled RCE.

Hemolysis risk after packed red blood cells transfusion with infusion pumps.

OBJECTIVE: To evaluate the hemolysis biomarkers of packed red blood cells transfused by two different linear peristaltic infusion pumps at two infusion rates. METHOD: An experimental and randomized study was designed simulating the clinical practice of transfusion. Two linear peristaltic infusion pumps from different manufactures were studied in triplicate at 100 mL/h and 300mL/h infusion rates. The chosen hemolysis biomarkers were total hemoglobin, free hemoglobin, hematocrit, potassium and degree of hemolysis. They were analyzed before and after each infusion. RESULTS: Potassium showed statistically significant variations in all scenarios of the experiment (P<0.010). In a separated analysis, potassium increased mainly at 300mL/h rate (P=0.021) and free hemoglobin had significant variation when comparing infusion pumps from different manufacturers (P=0.026). Although hematocrit, total hemoglobin and degree of hemolysis had increased after infusion, no statistically significance variations were identified. CONCLUSIONS: Hemolysis risk induced by a linear peristaltic infusion pump was identified by an increase in free hemoglobin and potassium markers. As the potassium biomarker is often increased in aged packed red blood cells, we do not recommend using them in this scenario. Additional studies should be performed about other markers and using larger samples in order to reinforce the transfusion practice in nursing.

Levels of Hemolysis Markers in Erythrocyte Concentrates Administered Using a Syringe Infusion Pump.

Syringe infusion pumps (SIPs) led to major advances in infusion therapy and were gradually applied to the transfusion of packed red blood cells (RBCs), raising questions about possible cell damage. The objectives of this study were to determine levels of hematocrit (%), total hemoglobin (g/dL), free hemoglobin (g/dL), lactate dehydrogenase (units/L), potassium (mmol/L), the degree of hemolysis (%) of RBCs infused by an SIP, and to investigate the influence of the infusion rate. The experimental study comprised 14 RBCs, 3 SIPs, and infusion rates of 5, 10, and 20 mL/h. The results showed total hemoglobin reduction (P = .003), and increased free hemoglobin and hemolysis (P <.001) were identified. The conclusion reached was that RBCs presented changes in free hemoglobin and degree of hemolysis.

Vascular access for red blood cell exchange.

Red blood cell exchange is the process of removing red blood cells from a patient and replacing them with donated blood using either automated or manual techniques. Red blood cell exchange is a well-recognized and effective therapy for many red blood cell-related diseases, especially sickle cell disease. However, decisions regarding the best methods for vascular access are not intuitive and must account for the patient's clinical condition, complication risks, and lifestyle, especially in the context of long-term vascular access. In this review, we discuss the recognized indications for red blood cell exchange, considerations for the selection of exchange modality and vascular access, and recommendations for the appropriate care and prevention of risks associated with vascular access.

Expediting red blood cell transfusions by syringing causes significant hemolysis.

BACKGROUND: Techniques commonly used to expedite blood transfusions include pneumatically pressurizing red blood cell (RBC) bags or manual syringing its contents. We compared these techniques on RBC hemolysis using a simulated transfusion model. STUDY DESIGN AND METHODS: Fifteen warmed RBC units that were 12.3 ± 4.3 (95% confidence interval [CI], 10.1-14.5) days old were each subjected to two experimental rapid transfusion techniques. RBCs from each technique were directed through 18- and 22-gauge cannulas attached to blood administration sets. One technique involved RBC bag pressurization to 300 mmHg. The other employed a 20-mL syringe to effect forceful, manual aspiration from the RBC bag followed by forceful, manual RBC injection. The control group was gravity driven without cannulas. Free hemoglobin (Hb) concentrations were measured and percent hemolysis was calculated. RESULTS: Free Hb concentrations and percent hemolysis (median [95% CI]) were similar in the control (0.05 [0.03-0.08] g/dL and 0.13% [0.09%-0.17%], respectively) and pressurized experiments (0.06 [0.05-0.09] g/dL; 0.14% [0.12%-0.22%]), respectively. Syringing resulted in 10-fold higher free Hb concentrations (0.55 [0.38-0.92] g/dL) and percent hemolysis (1.28% [1.03%-2.15%]) than when employing the control (p < 0.0001) or pressurization (p < 0.0001) techniques. Cannula sizes studied did not affect hemolysis. CONCLUSION: Forceful manual syringing caused significant hemolysis and high free Hb concentrations. Pressurizing RBC bags induced no more hemolysis than after gravity-facilitated transfusions. Syringing to expedite RBC transfusions should be avoided in favor of pneumatic RBC bag pressurization.

Quantitative assessment of haemolysis secondary to modern infusion pumps.

BACKGROUND: Although most studies have shown that little haemolysis is induced by infusion pumps, there are some notable exceptions. Only limited data are available on the actual infusion pumps that are most used in hospitals in Quebec and elsewhere, namely, the Infusomat® Space (peristaltic), Plum A+™ (piston) and Colleague® CXE (shuttle) pumps. METHODS: Haemolysis and potassium levels were compared before and after the use of the three different infusion pumps. Using 135 units of packed red blood cells (RBCs) aged from 10 to 28 days, 27 measurements were taken for each pump at various flow rates (30, 60, 150, 300 and 450 ml/h) and were compared with measurements taken before using the pumps. The range of flow rates was chosen to cover those of paediatric and adult transfusions. RESULTS: The shuttle- and piston-type pumps resulted in low haemolysis levels. The peristaltic-type pump produced significantly more haemolysis, which worsened at low flow rates, but the absolute value of haemolysis remained within the range recommended by the regulatory agencies in North America and Europe. Approximately two-thirds of the haemolysis produced by the peristaltic-type pump seemed to be secondary to the use of an antisiphon valve (ASV) on the transfusion line recommended by the manufacturer. Potassium levels did not increase with the use of the pumps. CONCLUSION: Modern infusion pumps widely used in hospitals in Quebec and elsewhere produce non-threatening levels of haemolysis during the transfusion of packed RBCs aged from 10 to 28 days. ASVs appear to induce additional haemolysis, and we do not recommend using them for blood transfusion.

Spectra Optia® for Automated Red Blood Cell Exchange in Patients with Sickle Cell Disease: A NICE Medical Technology Guidance.

The Spectra Optia® automated apheresis system, indicated for red blood cell exchange in people with sickle cell disease, underwent evaluation by the National Institute for Health and Care Excellence, which uses its Medical Technologies Advisory Committee to make recommendations. The company (Terumo Medical Corporation) produced a submission making a case for adoption of its technology, which was critiqued by the Newcastle and York external assessment centre. Thirty retrospective observational studies were identified in their clinical submission. The external assessment centre considered these were of low methodological and reporting quality. Most were single-armed studies, with only six studies providing comparative data. The available data showed that, compared with manual red blood cell exchange, Spectra Optia reduces the frequency of exchange procedures as well as their duration, but increases the requirement for donor blood. However, other clinical and patient benefits were equivocal because of an absence of robust clinical evidence. The company provided a de novo model to support the economic proposition of the technology, and reported that in most scenarios Spectra Optia was cost saving, primarily through reduced requirement of chelation therapy to manage iron overload. The external assessment centre considered that although the cost-saving potential of Spectra Optia was plausible, the model and its clinical inputs were not sufficiently robust to demonstrate this. However, taking the evidence together with expert and patient advice, the Medical Technologies Advisory Committee considered Spectra Optia was likely to save costs, provide important patient benefits, and reduce inequality, and gave the technology a positive recommendation in Medical Technology Guidance 28.

Hemodiafiltration-A Technique for Physiological Correction of Priming Solution in Pediatric Cardiac Surgery: An In Vitro Study.

Pediatric cardiopulmonary bypass (CPB) circuit invariably requires priming with packed red blood cells (PRBCs). Metabolic composition of stored PRBCs is unphysiological and becomes worse with increasing duration of storage. It is recommended to correct these abnormalities before initiation of CPB. We tested the hypothesis that hemodiafiltration of the prime with 0.45% saline is sufficient for reducing the metabolic load and reaching a physiologic state. In an in vitro study, 100 mL of blood each from 45 units of PRBCs stored for 3-20 days were used for priming the 45 neonatal CPB circuits. Based upon the method used for removal of excess crystalloid from the prime, circuits were divided into three groups. Group 1: Direct removal through manifold line. Group 2: Ultrafiltration of prime. Group 3: Hemodiafiltration of the prime. Blood gas analyses were obtained from the PRBCs and from the prime before and after removal of crystalloid. Both direct removal of crystalloid and ultrafiltration resulted in significant reduction in biochemical and metabolic load of blood (P < 0.001). However, the final composition of the prime was far from being physiological. Hemodiafiltration resulted in improvement of metabolic parameters to near physiological range (lactate: 33.8 ± 4.44 vs. 14 ± 2.53 mg/dL, pH: 7.05 ± 0.15 vs. 7.34 ± 0.06, bicarbonates: 4.83 ± 0.59 vs. 27.6 ± 2.94 meq/L; P < 0.001). Similarly, sodium (147.76 ± 12.73 vs. 144.6 ± 5.96 meq/L) and potassium (9.6 ± 2.83 vs. 4.23 ± 0.37 meq/L) also changed significantly (P < 0.001) to near physiologic range. Hemodiafiltraion of final prime is a simple, efficients and rapid method of correcting the biochemical parameters and reducing the metabolic load of stored PRBCs towards the physiological range before initiating the CPB.

Association between delivery methods for red blood cell transfusion and the risk of venous thromboembolism: a longitudinal study.

BACKGROUND: Mechanisms of red blood cell delivery and their contribution to the incidence of venous thromboembolism are not well understood in the clinical setting. We assessed whether red blood cell transfusion through peripherally inserted central catheters (PICCs) affects the risk of venous thromboembolism compared with transfusion through non-PICC devices. METHODS: We implemented a prospective study between Jan 1, 2013, and Sept 12, 2015, in patients (age ≥18 years) admitted to a general medicine ward or intensive care unit who received a PICC for any reason during clinical care in 47 hospitals in Michigan, USA, with a maximum follow-up of 70 days. The exposure of interest was route of red blood cell transfusion. The primary outcome was symptomatic, radiographically confirmed, deep-vein thrombosis in the arm or leg or pulmonary embolism. We used Cox proportional hazards regression for analyses. FINDINGS: Venous thromboembolism developed in 482 (5%) of 10 604 patients with PICCs. Of 788 patients who received a red blood cell transfusion through a multi-lumen PICC, 61 had venous thromboembolism. The adjusted hazard ratio (HR) for venous thromboembolism in all patients whose transfusions were administered through a multi-lumen PICC was 1·96 (95% CI 1·47-2·61; p<0·0001) compared with patients not receiving a transfusion, and was 1·79 (1·09-2·95; p=0·022) compared with patients transfused through a peripheral intravenous line. Compared with delivery through a peripheral intravenous line, venous thromboembolism risk was not elevated if transfusions were delivered through a single-lumen PICC (HR 0·98, 95% CI 0·44-2·14; p=0·95) or central venous catheter (1·50, 0·77-2·91; p=0·23). For every red blood cell unit transfused through a PICC, there was a significantly increased risk of venous thromboembolism (adjusted HR 1·24, 95% CI 1·01-1·52; p=0·037). Patients who received a transfusion through a PICC in the left arm were significantly more likely to develop a deep-vein thrombosis in the ipsilateral arm compared with the contralateral side (HR 23·44, 95% CI 2·96-185·83; p=0·0028). Similarly, patients transfused through a right-sided PICC were more likely to develop deep-vein thrombosis in the ipsilateral arm (HR 3·37, 95% CI 1·02-11·14; p=0·047). INTERPRETATION: Red blood cell delivery through a multi-lumen PICC is associated with a greater risk of thrombosis than transfusion through a peripheral intravenous catheter. Careful monitoring for venous thromboembolism when transfusing red blood cells through multi-lumen PICCs seems necessary. FUNDING: Blue Cross Blue Shield of Michigan and Blue Care Network, as part of the BCBSM Value Partnerships program.

Infusion pumps and red blood cell damage in transfusion therapy: an integrative revision of the academic literature.

OBJECTIVES: to obtain information from scientific literature concerning infusion pumps used in administering erythrocyte (red blood cells) and to evaluate the implications in the practical use of this equipment by nurses when conducting transfusions. METHOD: an integrative revision of the following scientific databases: Pubmed/Medline, Scopus, the Virtual Library for Health, SciELO, Web of Science and Cochrane. The following descriptors were used: "infusion pumps", "blood transfusion", "transfused erythrocyte" and "hemolyis". There were no restrictions on the scope of the initial data and it was finalized in December 2014. 17 articles were identified in accordance with the inclusion and exclusion criteria. RESULTS: all of the publications included in the studies were experimental in vitro and covered the use of infusion pumps in transfusion therapy. A summary of the data was presented in a synoptic chart and an analysis of it generated the following categories: cellular damage and the infusion mechanism. CONCLUSION: infusion pumps can be harmful to erythrocytes based on the infusion mechanism that is used, as the linear peristaltic pump is more likely to cause hemolysis. Cellular damage is related to the plasmatic liberation of markers that largely dominate free hemoglobin and potassium. We reiterate the need for further research and technological investments to guide the development of protocols that promote safe practices and that can contribute to future clinical studies. OBJETIVOS: identificar na literatura a produção científica acerca dos efeitos de bomba de infusão na administração de hemácias e avaliar as implicações do uso desses equipamentos na prática transfusional de enfermagem. MÉTODO: revisão integrativa de literatura nas bases de dados Pubmed/Medline, Scopus, Biblioteca Virtual em Saúde, SciELO, Web of Science e Cochrane, utilizando os descritores "bombas de infusão", "transfusão de sangue", "transfusão de eritrócitos" e "hemólise". A data inicial não foi delimitada e a final foi dezembro de 2014. Foram identificados 17 artigos de acordo com os critérios de inclusão e exclusão. RESULTADOS: Todas as publicações incluídas eram estudos experimentais in vitro e abordavam o uso de bombas de infusão na terapêutica transfusional. A síntese dos dados foi apresentada em quadro sinóptico e a análise gerou duas categorias relevantes: lesão celular e mecanismo de infusão. CONCLUSÃO: bombas de infusão podem ser deletérias às hemácias de acordo o mecanismo de infusão, sendo que as peristálticas lineares foram mais predisponentes à hemólise. A lesão celular foi relacionada à liberação plasmática de marcadores, predominando a hemoglobina livre e potássio. Reitera-se a necessidade de pesquisas adicionais e investimentos tecnológicos para nortear o desenvolvimento de protocolos que promovam prática segura e que subsidiem futuros estudos clínicos. OBJETIVOS: identificar en la literatura la producción científica acerca de los efectos de la bomba de transfusión en la administración de glóbulos rojos y evaluar las implicaciones del uso de esos equipos en la práctica transfusional de enfermería. MÉTODO: revisión integradora de literatura en las bases de datos Pubmed/Medline, Scopus, Biblioteca Virtual en Salud, SciELO, Web of Science y Cochrane, utilizando los descriptores "bombas de infusión", "transfusión de sangre", "transfusión de eritrocitos" y "hemolisis". La fecha inicial no fue delimitada y la final fue en diciembre de 2014. Fueron identificados 17 artículos de acuerdo con los criterios de inclusión y exclusión. RESULTADOS: todas las publicaciones incluidas eran estudios experimentales in vitro y abordaban el uso de bombas de infusión en la terapéutica transfusional. La síntesis de los datos se presenta en un cuadro sinóptico y el análisis generó dos categorías relevantes: lesión celular y mecanismo de transfusión. CONCLUSIÓN: las bombas de infusión pueden ser perjudiciales para los glóbulos rojos de acuerdo el mecanismo de transfusión, siendo que las peristálticas lineares fueron más predisponentes para la hemolisis. La lesión celular fue relacionada a la liberación plasmática de marcadores, predominando la hemoglobina libre y el potasio. Se reitera la necesidad de realizar investigaciones adicionales e inversiones tecnológicas que puedan orientar el desarrollo de protocolos que promuevan la práctica segura y que ayuden a futuros estudios clínicos.

Comparative evaluation of the depletion-red cell exchange program with the Spectra Optia and the isovolemic hemodilution-red cell exchange method with the COBE Spectra in sickle cell disease patients.

BACKGROUND: This study aims to compare in patients with sickle cell disease (SCD), the technical performance and packed red blood cell unit consumption between the automated depletion/Red Blood Cell exchange (RBCx) program (Spectra Optia Apheresis System) with the isovolemic hemodilution (IHD)/RBCx procedure (COBE Spectra Apheresis System) in a routine clinical setting. METHODS: We retrospectively reviewed the data of 23 patients treated between October 2010 and August 2013 who underwent repeated RBCx on both apheresis systems for preventive indications. Each patient was their own control and had undergone two procedures on each system, totaling 46 sessions per group. On Spectra Optia, we performed the automated depletion/RBCx program. For COBE Spectra, we used a modified IHD/RBCx protocol. All patients had an initial 250 mL depletion offset by a 5% albumin prior to the exchange procedure, for the respective device, with leucodepleted Rh/Kell compatible and cross-matched RBC packs. RESULTS: All procedures were well tolerated except three mild febrile nonhemolytic reactions. Postprocedure hemoglobin S (HbS), fraction of cells remaining (FCR), procedure duration and processed blood and anticoagulant volumes were comparable in the two groups. However, the RBCx volume was significantly higher for the Spectra Optia group (+71 mL, P = 0.01), with no significant difference in the number of RBC units used. CONCLUSIONS: Technical performance and packed RBC unit consumption were not compromised when switching from the COBE Spectra IHD/RBCx protocol to the depletion/RBCx protocol on the Spectra Optia. Tolerability was equal for both protocols. J. Clin. Apheresis 31:429-433, 2016. © 2015 Wiley Periodicals, Inc.

Infusion pumps and red blood cell damage in transfusion therapy: an integrative revision of the academic literature / Bombas de infusão e lesão celular em hemácias na terapia transfusional: revisão integrativa da literatura / Bombas de infusión y lesión celular en glóbulos rojos en la terapia transfusional: revisión integradora de la literatura

ABSTRACT Objectives: to obtain information from scientific literature concerning infusion pumps used in administering erythrocyte (red blood cells) and to evaluate the implications in the practical use of this equipment by nurses when conducting transfusions. Method: an integrative revision of the following scientific databases: Pubmed/Medline, Scopus, the Virtual Library for Health, SciELO, Web of Science and Cochrane. The following descriptors were used: "infusion pumps", "blood transfusion", "transfused erythrocyte" and "hemolyis". There were no restrictions on the scope of the initial data and it was finalized in December 2014. 17 articles were identified in accordance with the inclusion and exclusion criteria. Results: all of the publications included in the studies were experimental in vitro and covered the use of infusion pumps in transfusion therapy. A summary of the data was presented in a synoptic chart and an analysis of it generated the following categories: cellular damage and the infusion mechanism. Conclusion: infusion pumps can be harmful to erythrocytes based on the infusion mechanism that is used, as the linear peristaltic pump is more likely to cause hemolysis. Cellular damage is related to the plasmatic liberation of markers that largely dominate free hemoglobin and potassium. We reiterate the need for further research and technological investments to guide the development of protocols that promote safe practices and that can contribute to future clinical studies.

RESUMO Objetivos: identificar na literatura a produção científica acerca dos efeitos de bomba de infusão na administração de hemácias e avaliar as implicações do uso desses equipamentos na prática transfusional de enfermagem. Método: revisão integrativa de literatura nas bases de dados Pubmed/Medline, Scopus, Biblioteca Virtual em Saúde, SciELO, Web of Science e Cochrane, utilizando os descritores "bombas de infusão", "transfusão de sangue", "transfusão de eritrócitos" e "hemólise". A data inicial não foi delimitada e a final foi dezembro de 2014. Foram identificados 17 artigos de acordo com os critérios de inclusão e exclusão. Resultados: Todas as publicações incluídas eram estudos experimentais in vitro e abordavam o uso de bombas de infusão na terapêutica transfusional. A síntese dos dados foi apresentada em quadro sinóptico e a análise gerou duas categorias relevantes: lesão celular e mecanismo de infusão. Conclusão: bombas de infusão podem ser deletérias às hemácias de acordo o mecanismo de infusão, sendo que as peristálticas lineares foram mais predisponentes à hemólise. A lesão celular foi relacionada à liberação plasmática de marcadores, predominando a hemoglobina livre e potássio. Reitera-se a necessidade de pesquisas adicionais e investimentos tecnológicos para nortear o desenvolvimento de protocolos que promovam prática segura e que subsidiem futuros estudos clínicos.

RESUMEN Objetivos: identificar en la literatura la producción científica acerca de los efectos de la bomba de transfusión en la administración de glóbulos rojos y evaluar las implicaciones del uso de esos equipos en la práctica transfusional de enfermería. Método: revisión integradora de literatura en las bases de datos Pubmed/Medline, Scopus, Biblioteca Virtual en Salud, SciELO, Web of Science y Cochrane, utilizando los descriptores "bombas de infusión", "transfusión de sangre", "transfusión de eritrocitos" y "hemolisis". La fecha inicial no fue delimitada y la final fue en diciembre de 2014. Fueron identificados 17 artículos de acuerdo con los criterios de inclusión y exclusión. Resultados: todas las publicaciones incluidas eran estudios experimentales in vitro y abordaban el uso de bombas de infusión en la terapéutica transfusional. La síntesis de los datos se presenta en un cuadro sinóptico y el análisis generó dos categorías relevantes: lesión celular y mecanismo de transfusión. Conclusión: las bombas de infusión pueden ser perjudiciales para los glóbulos rojos de acuerdo el mecanismo de transfusión, siendo que las peristálticas lineares fueron más predisponentes para la hemolisis. La lesión celular fue relacionada a la liberación plasmática de marcadores, predominando la hemoglobina libre y el potasio. Se reitera la necesidad de realizar investigaciones adicionales e inversiones tecnológicas que puedan orientar el desarrollo de protocolos que promuevan la práctica segura y que ayuden a futuros estudios clínicos.

Use of a dual lumen port for automated red cell exchange in adults with sickle cell disease.

Red cell exchange (RCE) is a common procedure in adults with sickle cell disease (SCD). Implantable dual lumen Vortex (DLV) ports can be used for RCE in patients with poor peripheral venous access. We performed a retrospective cohort study of RCE procedures performed in adults with SCD. The main objective of the study was to compare the inlet speed, duration of procedures and rate of complications performed through DLV ports to those performed through temporary central venous and peripheral catheters. Twenty-nine adults with SCD underwent a total of 318 RCE procedures. Twenty adults had DLV ports placed and 218 procedures were performed using DLV ports. Mean length of follow-up after DLV port placement was 397 ± 263 days. Six DLV ports were removed due to infection and 1 for malfunction after a mean of 171 ± 120 days. Compared to temporary central venous and peripheral catheters, DLV port procedures had a greater rate of procedural complications, a longer duration, and a lower inlet speed (all P < 0.01). When accounting for the maximum allowable inlet speed to avoid citrate toxicity, 40% of DLV port procedures were greater than 10% below maximum speed, compared to 7 and 14% of procedures performed through temporary central venous and peripheral catheters (P < 0.0001). In conclusion, DLV ports can be used for RCE in adults with SCD, albeit with more procedural complications and longer duration. The smaller internal diameter and longer catheter of DLV ports compared to temporary central venous catheters likely accounts for the differences noted.

Characterization of the cation-binding capacity of a potassium-adsorption filter used in red blood cell transfusion.

A K(+) -adsorption filter was developed to exchange K(+) in the supernatant of stored irradiated red blood cells with Na(+) . To date, however, the filter's adsorption capacity for K(+) has not been fully evaluated. Therefore, we characterized the cation-binding capacity of this filter. Artificial solutions containing various cations were continuously passed through the filter in 30 mL of sodium polystyrene sulfonate at 10 mL/min using an infusion pump at room temperature. The cation concentrations were measured before and during filtration. When a single solution containing K(+) , Li(+) , H(+) , Mg(2+) , Ca(2+) , or Al(3+) was continuously passed through the filter, the filter adsorbed K(+) and the other cations in exchange for Na(+) in direct proportion to the valence number. The order of affinity for cation adsorption to the filter was Ca(2+) >Mg(2+) >K(+) >H(+) >Li(+) . In K(+) -saturated conditions, the filter also adsorbed Na(+) . After complete adsorption of these cations on the filter, their concentration in the effluent increased in a sigmoidal manner over time. Cations that were bound to the filter were released if a second cation was passed through the filter, despite the different affinities of the two cations. The ability of the filter to bind cations, especially K(+) , should be helpful when it is used for red blood cell transfusion at the bedside. The filter may also be useful to gain a better understanding of the pharmacological properties of sodium polystyrene sulfonate.