Needleless Connectors Substantially Reduce Flow of Crystalloid and Red Blood Cells During Rapid Infusion

Lehn, Robert A.; Gross, Jeffrey B.; McIsaac, Joseph H.; Gipson, Keith E.

doi:10.1213/ane.0000000000000630

Cited by 11 publications

(12 citation statements)

References 8 publications

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“…As the differences in flow resistance between the four fluid warmers are relatively small, pressurising fluids through any of the devices will provide flow rates of 300–500 mL/min of crystalloids or 150–250 mL/min of packed red blood cells. 8 …”

Section: Discussionmentioning

confidence: 99%

Comparison of the performance of battery-operated fluid warmers

et al. 2018

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ObjectivesWarming intravenous fluids is essential to prevent hypothermia in patients with trauma, especially when large volumes are administered. Prehospital and transport settings require fluid warmers to be small, energy efficient and independent of external power supply. We compared the warming properties and resistance to flow of currently available battery-operated fluid warmers.MethodsFluid warming was evaluated at 50, 100 and 200 mL/min at a constant input temperature of 20°C and 10°C using a cardiopulmonary bypass roller pump and cooler. Output temperature was continuously recorded.ResultsPerformance of fluid warmers varied with flows and input temperatures. At an input temperature of 20°C and flow of 50 mL/min, the Buddy Lite, enFlow, Thermal Angel and Warrior warmed 3.4, 2.4, 1 and 3.6 L to over 35°C, respectively. However, at an input temperature of 10°C and flow of 200 mL/min, the Buddy Lite failed to warm, the enFlow warmed 3.3 L to 25.7°C, the Thermal Angel warmed 1.5 L to 20.9°C and the Warrior warmed 3.4 L to 34.4°C (p<0.0001).ConclusionWe found significant differences between the fluid warmers: the use of the Buddy Lite should be limited to moderate input temperature and low flow rates. The use of the Thermal Angel is limited to low volumes due to battery capacity and low output temperature at extreme conditions. The Warrior provides the best warming performance at high infusion rates, as well as low input temperatures, and was able to warm the largest volumes in these conditions.

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Section: Discussionmentioning

confidence: 99%

Comparison of the performance of battery-operated fluid warmers

et al. 2018

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“…There are many factors that can contribute to increased resistance across a system in clinical practice including patient-specific blood composition, use of extension tubing, stopcocks, drip chambers, and fluid warmers [1,6]. Resistance to flow can be determined by Poiseuille's Law: =8 nlp 4 where R = resistance, n = viscosity, l = length, and r = radius, and any of these variables may be modified to alter resistance.…”

Section: Discussionmentioning

confidence: 99%

“…Large-bore IV cannulae are critical to administering IV fluids and blood products during resuscitation and treatment of hemorrhage. Although catheter flow rates for rapid transfusion of crystalloid solutions and red blood cell (RBC) transfusions are well defined [1], strategies to safely increase the speed of RBC transfusions are lacking.…”

Section: Introductionmentioning

confidence: 99%

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Rapid Blood Transfusion: The Importance of Hemodilution and Needleless Connectors

Burbridge

Panigrahi

Stone

et al. 2021

Cureus

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Introduction: Large-bore cannulas are critical to administering IV fluids and blood products during resuscitation and treatment of hemorrhage. Although catheter flow rates for crystalloid solutions are well defined, rapid administration of blood products is poorly characterized. In this in vitro study, we examined the effects of hemodilution and needleless connectors on red blood cell (RBC) flow rates. Methods: To determine RBC flow rates through large-bore cannulae, a crystalloid solution (Normosol®, Hospira, Lake Forest, IL) or RBC units were warmed and delivered under pressure (360 mmHg) using a Level 1 H-1200 Fast Flow Fluid Warmer (Smiths Medical, St. Paul, MN). Flow rates for crystalloid, packed RBCs and diluted RBCs were determined using a stopwatch. Additionally, the effect of the MaxPlus® clear needleless connector (CareFusion, San Diego, CA) was measured in all three infusion groups. Results: Flow rates for undiluted RBC units were 53% slower than crystalloid solution (220 mL/min vs. 463 mL/min; p=0.0003), however, when RBC units were diluted to a hematocrit of ~30% flow rate improved to 369 mL/min (p=0.005). The addition of the MaxPlus® needleless connector reduced flow of crystalloid solution by 47% (245 mL/min; p=0.0001), undiluted RBCs by 64% (78 mL/min; p=0.01), and diluted RBCs by 51% (180 mL/min; p=0.00003). Compared to undiluted RBC units, hemodilution increased RBC delivery rate through a MaxPlus® connector by 130% (p=0.004) and by 68% (p=0.02) when the catheter was directly connected to the Level 1 tubing (MaxPlus® excluded). Conclusion: In settings requiring rapid transfusion of RBC units, needleless connectors should not be used and hemodilution should be considered in order to decrease the time required to deliver an equivalent red cell mass.

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“…Needle-free IV connector devices Needle-free devices are not recommended when drugs must be administered at high flow rates, especially with large-caliber catheters [20,21].…”

Section: Bidirectional Valvesmentioning

confidence: 99%