Safety of Red Blood Cell Transfusion Using Small Central Lines in Neonates: An in vitro Non-inferiority Study

Abstract

Aim: This study aimed to investigate the safety of transfusing red blood cell concentrates (RBCCs) through small [24 gauge (24G)] and extra-small [28 gauge [28G)] peripherally inserted central catheters (PICCs), according to guidelines of transfusion practice in Switzerland.Methods: We performed a non-inferiority in vitro study to assess the safety of transfusing RBCC for 4 h at a 4 ml/h speed through 24G silicone and 28G polyurethane PICC lines, compared with a peripheral 24G short catheter. The primary endpoint was hemolysis percentage. Secondary endpoints were catheter occlusion, inline pressure, and potassium and lactate values.Results: For the primary outcome, hemolysis values were not statistically different among catheter groups (0.06% variation, p = 0.95) or over time (2.75% variation, p = 0.72). The highest hemolysis values in both 24G and 28G PICCs were below the non-inferiority predefined margin. We did not observe catheter occlusion. Inline pressure varied between catheters but followed the same pattern of rapid increase followed by stabilization. Potassium and lactate measurements were not statistically different among tested catheters (0.139% variation, p = 0.98 for potassium and 0.062%, p = 0.96 for lactates).Conclusions: This study shows that RBCC transfusion performed in vitro through 24G silicone and 28G polyurethane PICC lines is feasible without detectable hemolysis or pressure concerns. Also, it adds that, concerning hemolysis, transfusion of RBCC in small and extra-small PICC lines is non-inferior to peripheral short 24G catheters. Clinical prospective assessment in preterm infants is needed to confirm these data further.

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

“…These results were similar to those identified by researchers who simulated transfusion with a nonvalved 1F PICC 30 cm in length 19. Another study did not show statistically different hemolysis values between 1F and 2F PICCs 3. Currently, the Infusion Nurses Society does not have specific standards of practice on central VAD size for pediatric or neonatal blood transfusions.…”

“…Considering the quality standards of blood banks, those values would not contraindicate the transfusion of PRBCs using a PICC. Another study showed that PRBC transfusion performed in vitro through 24-gauge silicone and 28-gauge polyurethane PICCs was feasible without detectable hemolysis 3…”

“…19 Another study did not show statistically different hemolysis values between 1F and 2F PICCs. 3 Currently, the Infusion Nurses Society does not have specific standards of practice on central VAD size for pediatric or neonatal blood transfusions. However, it is mentioned in Standard 44, Blood Sampling, that there is a higher incidence of hemolysis when blood samples are collected using small-gauge catheters.…”

Peripherally inserted central catheter obstruction in packed red blood cell transfusions in neonates

“…In this case, there was a concomitant infusion of pRBC to TPN, which constitutes a risk factor (10) . In an experimental study conducted in a university hospital in Geneva, whose objective was to demonstrate the safety of pRBC transfusions through PICC 1 and 2 Fr, compared with transfusions through the peripheral venous catheter, no statistically significant differences were found between the control and experimental groups and no evidence of obstruction (11) . The authors highlight the need to develop prospective studies that evaluate different variables, so that the catheter caliber may not be identified as the only interfering factor in the obstruction of the catheter, with the need for deepening of the topic.…”

“…A retrospective study, whose objective was to assess the occurrence of obstruction after the administration of red blood cells in preterm NB through 1Fr PICC, identified the incidence of catheter obstruction of 2.6% of transfusion cases (10) . Another study, which compared transfusions of packed red blood cells (pRBCs) using PICC 1 and 2 Fr and peripheral venous catheter, found no evidence of obstruction (11) .…”