CBBS: Does new evidence exist on the safety of using automatic IV infusion pumps for red cell transfusions?

Does new evidence exist on the safety of using automatic IV infusion pumps for red cell transfusions?

A Canadian colleague reports that her hospital has been using automatic IV infusion pumps for years without any problems and that she is aware of the previous e-network discussion entitled 'Using automatic IV infusion pumps for the transfusion of red cells'. Now her province in Canada is trying to come up with guidelines and some of her colleagues are concerned over the safe use of these pumps as blood transfusion devices. The inquiring colleague wonders about any new evidence that might sway opinions.

The following responses were received.

ADDENDA June 7, 2003

1. A colleague in Virginia reports that her hospital has been using pumps for blood transfusions without any apparent problems. Interestingly, however, she implies that they have not done validation studies on these pumps before placing them into use for the purpose of blood product transfusions. She comments (verbatim) "I would, however, like in time to run some free hemoglobin studies on pre- and post-transfusion samples from the unit of blood to see if there are significant changes. No one has reported any untoward reactions from pump use."

ADDENDA June 11, 2003

2. Jan Wilson, the blood bank QA supervisor at Long Beach Memorial Medical Center (attribution used with permission) reports that in 1999, her facility performed a validation on their IV pumps for use with blood products. Briefly, the plan was:

They used 3 units of RBCs ....CPDA1 (for high hct) and Adsol units, all approximately 5 days before outdate when tested.
They compared each unit transfused through a Sigma pump fit with Sigma tubing, and a Sigma pump fit with Baxter tubing.
They removed 50mL from each unit for a baseline plasma hemoglobin.
They divided the rest of each unit in half and transfused one half through the Sigma-Sigma set up, and the other through the Sigma-Baxter set up, using the same infusion rates for each pair.
They removed aliquots from each (baseline, Sigma-Sigma and Sigma-Baxter) and ran plasma hemoglobins on them.

Here is a summary of their findings: “Neither Sigma-Sigma nor Sigma-Baxter pump-tubing systems showed any evidence of hemolysis with Adsol units. Both Sigma-Sigma and Sigma-Baxter pump-tubing set ups showed slight hemolysis with CPDA1 units; however, the level of hemolysis was not clinically significant and was equivalent for both systems.” As a consequence of their validation, they have used the Sigma-Baxter pump-blood administration set up since 1999 with no reported problems.

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Ira A. Shulman, MD
CBBS e-Network Forum Editor & Moderator

Posted: June 3, 2003

Addenda: June 7 & 11, 2003

Links Removed: Sept. 22 & Oct. 20, 2003

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