Trauma Anesthesia Group, Royal London Hospital, London, UK.
Department of Anesthesia and Perioperative Care, Zuckerberg San Francisco General Hospital and Trauma Center, University of California San Francisco, San Francisco, California, USA.
Transfusion. 2021 Jun;61(6):1721-1728. doi: 10.1111/trf.16399. Epub 2021 Apr 13.
Rapid infusion of warmed blood products is the cornerstone of trauma resuscitation and treatment of surgical and obstetric massive hemorrhage. Integral to optimizing this delivery is selection of an intravenous (IV) catheter and use of a rapid infusion device (RID). We investigated which IV catheter and RID system enabled the greatest infusion rate of blood products and the governing catheter characteristics.
The maximum flow rates of nine IV catheters were measured while infusing a mixture of packed red blood cells and fresh frozen plasma at a 1:1 ratio using a RID with and without a patient line extension. To account for IV catheters that achieved the RID's maximum 1000 ml/min, the conductance of each infusion circuit configuration was calculated.
IV catheters of 7-Fr caliber or higher reached the maximum pressurized flow rate. The 9-Fr multi-lumen access catheter (MAC) achieved the greatest conductance, over sevenfold greater than the 18 g peripheral catheter (4.6 vs. 0.6 ml/min/mmHg, p < .001). Conductance was positively correlated with internal radius (β = 1.098, 95% CI 4.286-5.025, p < .001) and negatively correlated with length (β= - 0.495, 95% CI -0.007 to 0.005, p < .001). Use of an extension line (β= - 0.094, 95% CI -0.505 to -0.095, p = .005) was independently associated with reduced conductance in large caliber catheters.
Short, large-diameter catheters provided the greatest infusion rates of massive transfusion blood products for the least pressure. For patients requiring the highest transfusion flow rates, extension tubing should be avoided when possible.
快速输注加热的血液制品是创伤复苏和治疗外科及产科大出血的基石。优化这种输送的关键是选择静脉（IV）导管和使用快速输注装置（RID）。我们研究了哪种 IV 导管和 RID 系统能够实现最大的血液制品输注率以及控制导管的特性。
在使用 RID 输注红细胞和新鲜冷冻血浆 1:1 混合物时，测量了九种 IV 导管的最大流速，并在有和没有患者管路延长线的情况下进行测量。为了考虑达到 RID 最大 1000ml/min 的 IV 导管，计算了每种输注回路配置的电导率。
7-Fr 口径或更大的 IV 导管达到了最大加压流速。9Fr 多腔接入导管（MAC）实现了最大的电导率，比 18g 外周导管高出七倍以上（4.6 比 0.6ml/min/mmHg，p<.001）。电导率与内半径呈正相关（β=1.098，95%置信区间 4.286-5.025，p<.001），与长度呈负相关（β=-0.495，95%置信区间-0.007 至 0.005，p<.001）。使用延长线（β=-0.094，95%置信区间-0.505 至-0.095，p=.005）与大口径导管电导率降低独立相关。
短而大直径的导管在压力最小的情况下提供了最大的大量输血血液制品输注率。对于需要最高输血流速的患者，应尽可能避免使用延长管。
