Bourne C, Cabelguenne D, David J-S, Rioufol C, Piriou V
Service de pharmacie, secteur dispositifs médicaux, centre hospitalier Lyon-Sud, hospices civils de Lyon, 165, chemin du Grand-Revoyet, 69495 Pierre-Bénite cedex, France.
Ann Fr Anesth Reanim. 2012 Jun;31(6):537-42. doi: 10.1016/j.annfar.2012.01.031. Epub 2012 Mar 29.
An assessment of practices and available medical devices during the treatment of a massive haemorrhage has been realised in the shock unit of our hospital.
Parameters influencing transfusion flow rate have been identified. Medical devices and equipment to accelerate the flow rate were analyzed on the basis of manufacturers' data and users opinion in relation with their practices.
The system, from blood bags to venous access, influences flow rate: red blood cell viscosity, catheter and pressure gradient. Three types of acceleration systems are available: accelerated transfusion set, pressure cuff with a gravity blood IV set and fast-flow fluid warmers. Their benefits and disadvantages are presented and discussed.
Maximum flow rates noted by manufacturers are not the real values because some parameters such as venous catheter diameter (limitative factor) and the red blood cell viscosity (diluted or not) are not considered. The choice of an infusion system is mainly based on the technical capacities (flow rate fluctuations, pressure gradient on blood bags, warming, air purging), practical modalities of use (medical devices and assembly) and cost. The pressure cuff with transfusion gravity set should be limited to non-critical situations or during the assembly of the fast flow fluid warmers (but no warming fluids, no air embolism prevention). The accelerated transfusion set is not the best option for a shock unit because it needs an operator permanently. The fast-flow fluid warmers are recommended for all types of massive haemorrhages, they are more secure but they require a long time to be assembled.
我们医院的休克治疗单元对大量出血治疗过程中的操作和可用医疗设备进行了评估。
确定了影响输血流速的参数。根据制造商数据和用户关于其操作的意见，对加速流速的医疗设备和器材进行了分析。
从血袋到静脉通路的系统会影响流速：红细胞粘度、导管和压力梯度。有三种类型的加速系统：加速输血装置、带重力输液器的压力袖带和快速输液加温器。介绍并讨论了它们的优缺点。
制造商标注的最大流速并非实际值，因为未考虑一些参数，如静脉导管直径（限制因素）和红细胞粘度（是否稀释）。输液系统的选择主要基于技术能力（流速波动、血袋上的压力梯度、加温、排气）、实际使用方式（医疗设备和组装）以及成本。带输血重力装置的压力袖带应限于非危急情况或在组装快速输液加温器期间使用（但不能加温液体，不能预防空气栓塞）。加速输血装置对休克治疗单元而言并非最佳选择，因为它需要有操作人员随时在场。快速输液加温器推荐用于所有类型的大量出血情况，它们更安全，但组装需要较长时间。
