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

Abstract

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.

Effect of modern infusion pumps on RBC quality

“…The pumps' built‐in safety features mitigate occlusion or change in rates for agitated patients and children. Flexibility of providing faster infusion rates compared to gravity, notably in units with higher hematocrit and thus viscosity, can lead to higher satisfaction in outpatient transfusions 5 . It also minimizes the chances of the unit reaching its allowed 4‐h shelf life at room temperature, and therefore its unwanted discard.…”

“…The ability to provide faster infusion rates can also aid in rapid resuscitation of massive hemorrhage 2 . Logistics and workflow benefits of pumps include compatibility with peripherally inserted central catheters (PICCs) to minimize unnecessary venipuncture and reducing the cognitive load on nursing staff during overloaded shifts 5,6 . As transfusing blood products with infusion pumps is common, nurses also do not maintain competency or training to calculate the rate (mL/h) of gravity infusions by counting the number of drops in a period of time, a time‐consuming and an error‐prone process.…”

“…However, possible mechanical damage to red blood cells (RBCs) has been a concern 4 . Infusion pump mechanisms have improved over the years, and recent studies on the effects of modern infusion pumps on RBCs generally suggest their safe use 4,5,7–9 . However, there are still a few reports regarding the adverse impact of infusion pumps on RBC quality for transfusion 2,8 .…”

“…Flexibility of providing faster infusion rates compared to gravity, notably in units with higher hematocrit and thus viscosity, can lead to higher satisfaction in outpatient transfusions. 5 It also minimizes the chances of the unit reaching its allowed 4-h shelf life at room temperature, and therefore its unwanted discard. The ability to provide faster infusion rates can also aid in rapid resuscitation of massive hemorrhage.…”

“…4 Infusion pump mechanisms have improved over the years, and recent studies on the effects of modern infusion pumps on RBCs generally suggest their safe use. 4,5,[7][8][9] However, there are still a few reports regarding the adverse impact of infusion pumps on RBC quality for transfusion. 2,8 The mechanism of infusion pumps may have differential effects on RBC quality based on the aforementioned studies, with three common pump mechanisms currently in market: (1) piston pumps, where a specific volume of blood is sucked into a chamber and pushed forward with a diaphragm; (2) peristaltic pumps, which has a rotor that compresses the infusion line and pushes the blood forward with positive displacement; and (3) linear peristaltic (also called shuttle) pumps, where a set of independent fingers press the line sinusoidally.…”