Mechanical hemolysis in pediatric patients associated with rapid transfusion and one‐way valve

Gniadek, Thomas J.; Richtsfeld, Martina; Pulkrabek, Shelley; Hansen, Kayla R.; Barnett, Susan L.; Joyner, N. T.; Kinney, Stephanie; Zantek, Nicole D.; Azakie, Anthony; Cohn, Claudia S.

doi:10.1111/trf.14554

Cited by 4 publications

(7 citation statements)

References 14 publications

(19 reference statements)

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“…25 In a study on mechanical hemolysis in pediatric patients, during rapid manual transfusion with the use of a valved device, greater resistance was associated with increased hemolysis. 11 Thus, it can be inferred that the valve could also cause random movements in the fluid and probably a variation in infusion rate, resulting in a higher mean rate and, consequently, increasing Reynolds number. 23 The Reynolds number is used to evaluate the type of flow, whether laminar or turbulent.…”

Section: Resultsmentioning

confidence: 99%

“…Studies have shown changes in hemolysis markers attributed to catheter type and size, in addition to infusion rate, infusion equipment used, and the physical properties of PRBCs, such as time in storage. 3,[5][6][7][8][9][10][11][12] Thus, the guiding question of this study was: can the inherent advantages of PICCs with a proximal valve, such as lower rates of occlusion and infection, be extended to the nonoccurrence of significant changes in hemolysis markers? This study hypothesized that the size and gauge of PICCs with proximal valves and the infusion rate influence hemolysis markers of RBC concentrates transfused by the gravity method.…”

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confidence: 99%

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Influence of Peripherally Inserted Central Catheters With Proximal Valves on Red Blood Cell Hemolysis During Transfusion

Jacinto

Mendes

Kusahara

et al. 2022

Journal of Infusion Nursing

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The aim of this study was to verify the occurrence of hemolysis after infusion of packed red blood cells (PRBCs) in 12 peripherally inserted central catheters (PICCs) with a proximal valve, according to size and infusion rate. This was an experimental in vitro study performed under laboratory-controlled conditions, and the sample was composed of 12 PICCs with proximal valves (3F and 4F catheter). Twelve type A+ aliquots from 10 PRBCs were analyzed preinfusion and postinfusion according to PICC size and infusion rate. Hemolysis markers, total hemoglobin (g/dL), hematocrit (%), free hemoglobin (g/dL), potassium (mmol/L), lactate dehydrogenase (U/L), and rate of hemolysis (%) were studied. Data were analyzed using analysis of variance and Bonferroni multiple comparison tests. After the infusions in 3F PICCs, an increase was seen in rate of hemolysis (P = .003) and free hemoglobin (P = .014), in addition to a reduction in total hemoglobin (P = .002), with significant influence of minimum and maximum flow rates on the rate of hemolysis. The study finding indicated that the smaller catheter size and the infusion rate influenced variations in some hemolysis markers, but the alterations observed in the hemolysis markers would not contraindicate the infusion of PRBCs by 3F and 4F PICCs with proximal valves.

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Section: Resultsmentioning

confidence: 99%

mentioning

confidence: 99%

Influence of Peripherally Inserted Central Catheters With Proximal Valves on Red Blood Cell Hemolysis During Transfusion

Jacinto

Mendes

Kusahara

et al. 2022

Journal of Infusion Nursing

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“…This may have important clinical implications for neonates and children because of their smaller body size and rapid increase in haemolysis rate per kilogram of weight. 22 Children's kidneys are more immature, with a lower rate of glomerular filtration, and as a result, they may be predisposed to more complications than those of adults. 23,24 In our study, free haemoglobin levels also significantly increased across the four sampling points, and this may cause deleterious effects in critically ill neonates and children.…”

Section: Discussionmentioning

confidence: 99%

“…However, our study has shown that differences related to the mechanism of delivery may exist, which could reduce the degree of haemolysis. This may have important clinical implications for neonates and children because of their smaller body size and rapid increase in haemolysis rate per kilogram of weight 22 . Children's kidneys are more immature, with a lower rate of glomerular filtration, and as a result, they may be predisposed to more complications than those of adults 23,24 …”

Section: Discussionmentioning

confidence: 99%

Impact of different syringe pumps on red cells during paediatric simulated transfusion

Pardo

Peterlini

Tume

2020

Nursing in Critical Care

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Waiver of the donor's free and informed consent form was requested, as blood donation is a voluntary and altruistic act. Every donor signs a consent provided by law, in which he agrees that his blood can be used for therapeutic purposes, examinations and laboratory tests required by law and current technical standards. Therefore, it was not possible to identify the donor's origin, as the blood units did not contain the donor's identification and, thus, the donor's image and privacy were protected.

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“…Hospira Plum 360 (ICU Medical), CareFusion Alaris PC model 8015 with pump module 8100 (BD) and Infusomat Space (B.Braun) were directly provided by the manufacturers. Syringe pumps, used for small volume transfusions (<50 mL), 12 were not part of this study.…”

Section: Methodsmentioning

confidence: 99%

Effect of modern infusion pumps on RBC quality

et al. 2022

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Background: Mechanical stress on red blood cells is associated with using infusion pumps for blood administration. Current standards in North America leave it to healthcare facilities to consult with manufacturers about infusion pump safety for transfusion; studies on various pumps and red blood cell (RBC) conditions are scarce. Study design and methods: RBC units were pumped through four infusion pumps on d22 (22 days postcollection), d40, d28 after gamma irradiation on d14 (I14d28), and d22 after irradiation on d21 (I21d22). For each experiment, three units were pooled and split among four bags. Samples were collected at gravity and after pumping at clinical nonemergency rates. Hemolysis %, microvesicles, potassium, lactate dehydrogenase, mechanical fragility index levels, and morphology evaluations were performed (n = 5-6).Results: Hemolysis levels of Piston and Linear Peristaltic pump samples were not different from hemolysis of corresponding gravity samples. Peristaltic samples had significantly higher hemolysis compared to gravity, and other pumps, however, maximum mean difference was limited to 0.05%. Pumping at 50 mL/h resulted in the highest hemolysis level. Change in hemolysis % due to pumping was significantly higher in d40 and I21d22 units. No combination of pumps and RBCs conditions led to hemolysis >0.8%. Besides hemolysis, lactate dehydrogenase release was the only marker that demonstrated some differences between infusions via pump versus gravity. Conclusion:The pump design affects the degree of hemolysis. However, for all tested pumps and RBC conditions, this increase was minimal. Hemolysis measurement on d40 and I21d22 at 50 mL/h were concluded to be appropriate parameters for pump evaluation.

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Mechanical hemolysis in pediatric patients associated with rapid transfusion and one‐way valve

Abstract: Mechanical hemolysis should be considered when investigating possible hemolytic transfusion reactions, especially with high rates of transfusion and use of a valve. During rapid manual transfusion with the valve, greater resistance was associated with increased hemolysis.

Cited by 4 publications

References 14 publications

Influence of Peripherally Inserted Central Catheters With Proximal Valves on Red Blood Cell Hemolysis During Transfusion

Influence of Peripherally Inserted Central Catheters With Proximal Valves on Red Blood Cell Hemolysis During Transfusion

Impact of different syringe pumps on red cells during paediatric simulated transfusion

Effect of modern infusion pumps on RBC quality

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