Itried to edit that last post and it jumped to the top...?
Anyway, sorry if I'm beating this one to death but I've been informed that one of our educators is saying that small guage catheters cause hemolysis.
AABB states http://portal.aabb.org/apps/docs/053013_samp.pdf
The lumen of needles or catheters used for blood transfusion should be large enough to allow appropriate flow rates without damaging the vein. There are no strict guidelines limiting the size of the catheter or needles used for transfusion. An 18-gauge catheter provides good flow rates for cellular components without excessive discomfort to the patient, but patients with small veins require much smaller catheters.High-pressure flow through needles or catheters with a small lumen may damage red cells (8-10) unless the transfusion component is sufficiently diluted.(10) Undiluted preparations of red cells flow very slowly through a 23-gauge needle, but dilution with saline to increase the flow rate may cause unwanted volume expansion. Even in patients with cardiac disease or volume expansion, transfusions should be able to be given safely within 4 hours. For rare patients unable to tolerate a transfusion within 4 hours, local policy should be developed regarding whether to split units or to discard the unused portion. Specific models of infusion pumps have been approved for use in blood transfusion. These pumps maintain a constant delivery of blood, and studies have indicated no significant evidence of hemolysis as the needle size varies. (11)
WOW your fast Angelo!!! I see you beat me to it.
Peter Marino R.N. BSN CRNI VA-BC Hospital based staff R.N. with no affiliation to any product or health care company.
The Technical Manual states: "an 18gauge needle provides good flow rates for cellular components without excessive discomfort to the patient, but patients with small veins require much smaller needles. High-pressure flow through needles or catheters with a small lumen may damage red cells unless the transfusion component is sufficiently diluted. Undiluted preparations of red cells flow very slowly through a 23 gauge needle, but dilution with saline to increase the flow rate may cause unwanted volume expansion. If the flow rate will make the infusion process longer than 4 hours per unit, it is desirable to separate the units into aliquots, and keep part under refrigeration in the blood bank while the first portion is transfused. Infusion pumps have also been used to maintain a constant delivery of blood, and studies have indicated no significant evidence of hemolysis as the needle size varies."
What specifically does AABB say?
Frelich R.& Ellis, MH did not use 24G cath's in the paper sited
"RBC transfusions were performed sequentially via 16-, 18-, 20-, and 22-gauge cannulas with the application of a pneumatic pressure device at pressures of 150 and 300 mmHg."
[quote=angeloaguila] I found the Technical Manual of AABB 14th Edition and I just want to share the reference that was used related to this issue: Frelich R. Ellis, MH. The Effect of External Pressure, Catheter Gauge and Storage time on Hemolysis in RBC Transfusion 2001; 41 799-802.[/quote]
Thanks to everyone who responded. Lynn, you will never seize to amaze me with your knowledge and expertise!
I found the Technical Manual of AABB 14th Edition and I just want to share the reference that was used related to this issue:
Frelich R. Ellis, MH. The Effect of External Pressure, Catheter Gauge and Storage time on Hemolysis in RBC Transfusion 2001; 41 799-802.
I think this is taken from the Technical Manual published by the American Association for Blood Banks. Check with your blood bank to see if they have this reference.
Also check with the pump manufacturers for their information on infusing blood. This must be listed in their product instructions and each pump is different. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Office Phone 770-358-7861
Thank you Jerry, I have also seen positive results of PRBC's given via pump with a 24Ga. cath. I really want to know the specific pressures that supposedly cause hemolysis mentioned in the article. The Author sites, Nursing 97 August 34-41: Blood transfusion--keeping your patient safe. Fitzpatrick L, Fitzpatrick T
Which states; "You could use a needle as small as 22 gauge for an adult; however, the flow rate may be slow. (Small needles won't cause hemolysis of RBCs unless you apply pressure to increase the infusion rate.) "
I don't see any mention of specific pressure values. Too ambiguous for evidense based nursing IMO.
I can tell you from personal experience that 24 gauge catheters work great. I worked for a home infusion company for two years, infusing IVIG via gravity. These are large molecules, but I used 24 gauge catheters almost exclusively, with no problems.
At this facility we use pumps to infuse everything. I have infused a number of units of blood via 24 gauge catheters, at rates from 200-400ml/hour with no evidence of hemolysis. Hemoglobin and hematocrit always rise predictably.
Jerry Bartholomew RN, BSN, CRNI
VA Medical Center, Spokane, WA
Jerry Bartholomew RN, MSN, CRNI
Unfortunitly the recent article in JAVA; "A Comprehensive review of Blood transfusion Therapy" Does not go into great detail about "smaller" guage catheter selection.
From the article:
" It may be necessary to use a 23 gauge cannula in some situations,e.g, pediatric patients or adults whose larger veins are unaccessible. However, one must recognize that highpressure flow through a small lumen cannula may damage red cells, unless the transfused component is sufficiently diluted with sodium chloride injection, USP 0.9% (NS)"
Can someone please define what is considered "highpressure flow". All our PRBC's are given via a pump. I had always thought that that hemolysis occurs from citrate not from lumen/catheter size?
I was also taught not to dilute PRBC's with the NS bag. Time to look into that educational thought.
Is there a specific protocol for transfusing PRBC's through a 24 guage peripheral catheter?
If you are not transfusing at a high rate and not using pressure to transfuse, a 24 gauge can be used. This goes against the "nursing myth" that a 20 gauge is necessary for a transfusion. Ask any NICU nurse about the size of the catheter used for transfusions. Of course, they are not using pressure to transfuse at a high rate.
A recent article in JAVA describes transfusion rates and catheter sizes.