How often should a red blood cell administration set be changed while a patient is being transfused? A commentary and review of the literature

Abstract

Current recommendations vary with regard to the frequency of change of a red blood cell (RBC) administration set. A full review was undertaken to evaluate the recommendations for how often a RBC administration set should be changed while a patient is being transfused. Comprehensive searches of Medline, Embase, Cinahl, the Cochrane Library, handsearching of transfusion journals, guidelines and websites and contact with administration set manufacturers identified 32 relevant papers: 11 clinical updates; 11 guidelines; 5 manufacturer data sheets; 3 standards; 1 Department of Health report and 1 expert opinion. Recommendations varied widely across papers. There was no pattern in recommendation by paper type, date or country of origin. Recommendations were based on change of RBC administration set either after a given number of hours or number of RBC units. The recommendations varied widely and ranged from 4 to 48 h and from 'every unit' to 'several units'. The most frequent recommendations were change of RBC administration set after 12 h or 4 units. Methodological quality of the included papers is poor. There is no formal evidence base on which to support current recommendations or challenge the current British Committee for Standards in Haematology guideline. Targeted research aimed at establishing an evidence base may be warranted and would need to document other variables that can impact frequency of change, including type of filter, age of blood and duration of RBC transfusion.

Comparison of Safety and Effectiveness of Two Different Transfusion Rates in Children With Severe Anemia

“…2 Nevertheless, some groups such as Finnish Medical Society state in their guidelines that a transfusion of RBCs should last no longer than 6 hours. 6 In many centers, red blood cells are packed in smaller aliquots for pediatric usage. However, in our center, pediatric packs are not available and thus, adult type packs are used instead.…”

The administration of blood components: a British Society for Haematology Guideline

“…All blood components should be administered through a CE‐marked transfusion set. The administration set should be changed at least every 12 h or in accordance with manufacturer's instructions (Blest et al, ). Red blood cells and plasma may be transfused using the same administration set.…”

Improving the evidence base for transfusion medicine: the work of the UK Systematic Review Initiative

“…Recent systematic reviews have gone beyond the territory of conventional clinical trials to identify any evidence to underpin the guidance covering steps in the hospital blood transfusion process, e.g. the frequency of change of a blood administration set (Blest et al , 2008) and the effect of pretransfusion checking by one vs. two persons (Watson et al , 2008).…”

“…Systematic review of interventions usually only takes their evidence from RCTs. In two of our completed systematic reviews (Blest et al , 2008; Watson et al , 2008), we have widened the inclusion criteria beyond RCTs because in these areas of transfusion practice, no RCTs have been undertaken. Furthermore, we know that evidence is available from alternative data sources (e.g.…”