title: Blood transfusions using 27 gauge PICC lines: a retrospective clinical study on safety and feasibility.
abstract: BACKGROUND
  Blood transfusions are required by most extremely low birth weight (ELBW) infants, but sometimes an adequate peripheral venous access cannot be achieved. Under these circumstances, we used 27 Gauge (G) peripherally inserted central catheter (PICC) lines that are routinely inserted on the second day of life. Due to their narrow lumen, hemolysis of transfused erythrocytes was a major concern. We therefore performed a retrospective study in ELBW infants to analyze the incidence, safety and feasibility of PRBC transfusions via 27 G PICC lines.
  
  
  METHODS
  ELBW infants admitted from 08/2011-07/2012 were screened for packed red blood cell (PRBC) transfusions. Those applied via 27 G PICC lines were identified. For analysis of transfusion safety (hemolysis), hemoglobin and potassium levels as well as cardiovascular variables (invasive mean arterial blood pressure and heart rate) were evaluated before and after transfusion. For analysis of transfusion feasibility, catheter removal after transfusion and the reason for removal were recorded.
  
  
  RESULTS
  A total of 648 transfusions were applied in 110 ELBW infants. 27 infants (24%) received no transfusion. In 12/83 (14.5%) infants who received PRBCs, transfusions were applied using a 27 G PICC line (38/648, 5.9%). Patients who received PRBCs via the PICC line were smaller at birth (582 g [range 380-752 g] vs. 710 g [430-972 g]; 23+6 [23+1-27+6] vs. 26+0 [23+1-31+4]) and required a higher number of PRBC transfusions (n=13 vs. n=5) overall. Transfusion analysis showed an appropriate increase of blood hemoglobin levels and stable potassium levels as well as cardiovascular parameters. 4/38 of PICC lines were removed within 24 h after transfusion, one due to occlusion (15 h after transfusion).
  
  
  CONCLUSIONS
  We conclude that PRBC transfusions via 27 G PICC lines were feasible and performed without signs of hemolysis in ELBW infants. Our findings may help clinicians in the management of ELBW infants requiring transfusions if a peripheral venous access is not achievable.
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Repa
authors.affiliation: Department of Laboratory Medicine, Medical University Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Mayerhofer
authors.affiliation: Department of Blood Group Serology and Transfusion Medicine, Medical University Vienna, Austria.
authors.forename: N
authors.initials: N
authors.lastname: Worel
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria.
authors.forename: F
authors.initials: F
authors.lastname: Cardona
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria.
authors.forename: P
authors.initials: P
authors.lastname: Deindl
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Pollak
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria.
authors.forename: A
authors.initials: A
authors.lastname: Berger
authors.affiliation: Department of Pediatrics and Adolescent Medicine, Division of Neonatology, Pediatric Intensive Care and Neuropediatrics, Medical University Vienna, Austria.
authors.forename: N
authors.initials: N
authors.lastname: Haiden
mesh_terms: D001724:Birth Weight; D001794:Blood Pressure / Q000502:physiology; D002406:Catheterization, Peripheral / Q000295:instrumentation*; D020878:Device Removal; D004867:Equipment Design; D004869:Equipment Safety; D017707:Erythrocyte Transfusion / Q000295:instrumentation*; D005240:Feasibility Studies; D006339:Heart Rate / Q000502:physiology; D006452:Hemoglobinometry; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000097:blood / Q000628:therapy*; D011140:Polyurethanes; D011188:Potassium / Q000097:blood; D012189:Retrospective Studies
chemical_list: D011140:Polyurethanes; D011188:Potassium