Feasibility of red blood cell transfusion through small bore central venous catheters used in neonates.
OBJECTIVE
To determine whether packed red blood cell transfusions through small-bore central venous catheters used in critically ill neonates results in significant hemolysis.


METHODS
In vitro experimental study using a mock transfusion setup incorporating a syringe pump, prestorage leukoreduced fresher, and older CPDA-1 red blood cell units and pressure transducer simulating neonatal transfusion through 1.9-Fr NeoPICC central venous catheter.


METHODS
Laboratory setting.


METHODS
None.


METHODS
None.


RESULTS
Spun hematocrit, plasma free hemoglobin (hemoglobin), lactate dehydrogenase, and potassium were analyzed pretransfusion, at various times during transfusion, and posttransfusion. Intraluminal pressures were measured using a TruWave Disposable Pressure Transducer. Using fresher (5-8 days old) and older (29-30 days old) CPDA-1 red blood cells, we compared 2 and 20 mL/hr flow rates. Statistical analysis was performed using repeated measures of analysis of variance to compare the differences in means between flow rates. Mean intraluminal pressures at the end of each experiment were significantly higher at 20 mL/hr flow rates (>360 mm Hg) in both fresher and older red blood cells than at 2 mL/hr (range, 61-70 mm Hg). Overall, potassium, lactate dehydrogenase, and plasma free hemoglobin concentrations were significantly higher for older red blood cells at either 2 or 20 mL/hr (p<.001). Both fresher and older red blood cells demonstrated higher potassium concentrations at 20 mL/hr (22.4%, p<.001;0.7%, p>.05, respectively); however, these increases were not clinically significant. Furthermore, lactate dehydrogenase, hematocrit, and plasma free hemoglobin differences seen at 2 and 20 mL/hr did not coincide with changes in potassium.


CONCLUSIONS
No clinically significant hemolysis was evidenced with red blood cell transfusion through small-bore central venous catheters when using fresher or older CPDA-1 red blood cells at 2 or 20 mL/hr.
Wong
Edward C C
EC
George Washington School of Medicine and Health Sciences, Department of Pediatrics and Laboratory Medicine, Children's National Medical Center, Washington, DC 20010, USA. ewong@cnmc.org
Schreiber
Seth
S
Criss
Valli R
VR
LaFleur
Bonnie
B
Rais-Bahrami
K
K
Short
Billie
B
Luban
Naomi L C
NL
D000704:Analysis of Variance; D001803:Blood Transfusion / Q000379:methods*; D002405:Catheterization, Central Venous / Q000009:adverse effects / Q000295:instrumentation*; D006461:Hemolysis; D006801:Humans; D066298:In Vitro Techniques; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D011188:Potassium / Q000097:blood
D011188:Potassium