Department of Nursing, Paulista University, Sao Paulo, Brazil.
Paulista Nursing School, Universidade Federal de São Paulo - UNIFESP, Sao Paulo, Brazil.
Nurs Crit Care. 2022 Mar;27(2):267-274. doi: 10.1111/nicc.12561. Epub 2020 Oct 23.
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.
To evaluate biochemical and haemolytic markers of red blood cells transfused in three different types of syringe infusion pumps at two different infusion rates (10 and 100 mL/h).
A lab-based study using aliquots of 16 red blood cell 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 cell infusion and exposure. Three different syringe infusion pumps brands (A, B, and C) were compared at two different infusion rates (10 and 100 mL/h).
Total haemoglobin fell significantly in all red blood cell units during manipulation (pre-infusion: 26.44 ± 5.74; post-exposure: 22.62 ± 4.00; P = .026). The degree of haemolysis significantly increased by 40% after manipulation of the red blood cells. Syringe infusion pump A caused a 3-fold increase in potassium levels (3.78 ± 6.10) when compared with B (-0.14 ± 1.46) and C (1.63 ± 1.98) (P = .015). This pump also produced the worst changes, with an increase in free haemoglobin (0.05 ± 0.05; P = .038) and more haemolysis (0.08 ± 0.07; P = .033). There were significant differences and an increase in the degree of haemolysis (P = .004) at the infusion rate of 100 mL/h.
Syringe infusion pumps may cause significant red blood cell damage during infusion, with increases in free haemoglobin, potassium, and the degree of haemolysis. Some pump types, with a cassette mechanism, caused more damage.
In many intensive care units, bedside nurses are able to consider infusion pump choice, and understanding the impact of different pump types on red blood cells during a transfusion provides the nurses with more information to enhance decision-making and improve the quality of the transfusion.
危重症患者经常需要输血。为了安全起见，血液必须通过注射器输注泵输送，但这可能会导致红细胞损伤并增加溶血率。
评估三种不同类型的注射器输注泵以两种不同的输注速度（10 和 100 mL/h）输注时对红细胞的生化和溶血标志物的影响。
使用 16 袋红细胞样本进行了基于实验室的研究。在输注和暴露前后测量溶血标志物（总血红蛋白[g/dL]、红细胞压积[%]、游离血红蛋白[g/dL]、钾[mmol/L]、乳酸脱氢酶[U/L]、渗透压[mOsm/kg]、pH 值、溶血程度[%]）。比较了三种不同的注射器输注泵品牌（A、B 和 C）在两种不同的输注速度（10 和 100 mL/h）下的效果。
在操作过程中，所有红细胞单位的总血红蛋白均显著下降（输注前：26.44 ± 5.74；输注后：22.62 ± 4.00；P =.026）。红细胞操作后溶血程度显著增加了 40%。与 B（-0.14 ± 1.46）和 C（1.63 ± 1.98）相比，注射器输注泵 A 导致钾水平升高了 3 倍（3.78 ± 6.10）（P =.015）。该泵还产生了最严重的变化，游离血红蛋白增加（0.05 ± 0.05；P =.038）和溶血程度增加（0.08 ± 0.07；P =.033）。在输注速度为 100 mL/h 时，溶血程度有显著差异和增加（P =.004）。
在输注过程中，注射器输注泵可能会导致红细胞严重受损，导致游离血红蛋白、钾和溶血程度增加。一些具有盒式机制的泵类型造成的损害更大。
在许多重症监护病房，床边护士可以考虑选择输注泵，了解不同泵类型在输血过程中对红细胞的影响，为护士提供更多信息，以增强决策能力并提高输血质量。
