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

Pardo, L; Sorgini Peterlini, M; Tume, LN; Pedreira, M

Abstract

Background: Critically ill patients frequently need blood transfusions. For safety, blood must be delivered via syringe infusion pumps, yet this can cause red cell damage and increase the rate of haemolysis.
Aims and objectives: To evaluate biochemical and haemolytic markers of red blood cells transfused in three different, common type of syringe infusion pumps with two different infusion rates (10 and 100 ml/h).
Methods: A lab-based study using aliquots of 16 red blood cells bags was undertaken. Haemolysis markers (total haemoglobin(g/dl), haematocrit(%), free haemoglobin(g/dl), potassium(mmol/L), lactate dehydrogenase(U/L), osmolality(mOsm/kg), pH, degree of haemolysis(%)) were measured before and after red blood cells infusion and exposure. Three different syringe infusion pumps brands (A, B and C) were compared with two different infusion rates (10 and 100 ml/h).
Results: The total haemoglobin fell significantly in all red blood cells units during manipulation (Pre-infusion: 26.44±5.74; Post-exposure: 22.62±4.00; p=0.026). The degree of haemolysis significantly increased by 40% after manipulation of the red blood cells. Syringe infusion pump A caused a threefold increase in potassium levels (3.78±6.10) when compared to B (-0.14±1.46) and C (1.63± 1.98) (p=0.015). This pump also produced the worst changes, with an increase in free haemoglobin (0.05±0.05; p=0.038) and more haemolysis (0.08±0.07; p=0.033). There were significant differences and an increase in the degree of haemolysis (p=0.004) in the infusion rate of 100 mL/h.
Conclusions: Syringe infusion pumps may cause significant red blood cell damage during infusion, with increases in free haemoglobin, potassium and the degree of haemolysis. Some pumps types, with a cassette mechanism, caused more damage.
Relevance to clinical practice: In many ICUs, bedside nurses are able to consider infusion pump choice and understanding the impact of different pump types on RBC during a transfusion provides the nurses with more information to enhance decision-making and improve the quality of the transfusion.

• Journal Article Type: Article
• Acceptance Date: Sep 23, 2020
• Online Publication Date: Oct 23, 2020
• Publication Date: Oct 23, 2020
• Deposit Date: Nov 3, 2020
• Publicly Available Date: Oct 23, 2021
• Journal: Nursing in Critical Care
• Print ISSN: 1362-1017
• Electronic ISSN: 1478-5153
• Publisher: Wiley
• DOI: https://doi.org/10.1111/nicc.12561
• Publisher URL: https://doi.org/10.1111/nicc.12561
• Related Public URLs: http://onlinelibrary.wiley.com/journal/10.1111/(ISSN)1478-5153
• Additional Information: Access Information : This is the peer reviewed version of the following article: Pardo, LP, Peterlini, MAS, Tume, LN, Pedreira, MLG. Impact of different syringe pumps on red cells during paediatric simulated transfusion. Nurs Crit Care. 2020, which has been published in final form at https://doi.org/10.1111/nicc.12561. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions.; Projects : Influence of different syringe pumps and infusion rates on red cells during paediatric simulated transfusion; Grant Number: 308281/2015-2