Figure 7 - Monitoring the patient during transfusion
[Figure 7 resources: View large format, download as gif, pdf or Word™ document]
Standard intravenous cannulas are suitable for blood component infusion. All blood components can be slowly infused through small-bore cannulas or butterfly needles, e.g. 21 G. For rapid infusion, large-bore cannulas, e.g. 14 G, are needed. Many transfused patients have venous access established by the use of short-term or indwelling multi-lumen central lines. These are usually suitable for the transfusion of blood components. Where possible, one lumen should be reserved for administering blood components.
Red cells must be transfused through a sterile blood administration set with an integral screen filter (170−200 μm pore size). It is unnecessary to prime the blood administration set with saline. The infusion line should be changed at least every 12 hours and after completion of the prescribed blood transfusion. Platelets and plasma components may be administered through a normal blood administration set or through a platelet/cryoprecipitate administration set. Platelets should not be transfused through an administration set that has previously been used for red cells or other blood components as this may cause aggregation and retention of platelets in the line.
There are many manufacturers and types of infusion systems, so it is essential to be familiar with the equipment that is locally available and use it according to manufacturer’s instructions. It is essential to use the type of infusion set that is recommended for a particular type of pump.
Rapid infusion devices
Rapid infusion devices that are CE marked may be used when large volumes have to be infused rapidly. Typical devices can infuse from 6 l/hr up to 30 l/hr. Rapid infusers usually incorporate a blood-warming device.
Hypothermia impairs blood clotting. Studies in surgical patients have found an association between hypothermia at the end of surgery and an increased incidence of post-operative infections and myocardial ischaemia. Hypothermia during surgery should be avoided. Blood and other infused fluids should be warmed. Rapid infusion of cold fluids (> 100 ml/minute) has been reported to cause potentially lethal cardiac arrhythmias. Infusion through a central catheter terminating in or near the right atrium may increase the risk. Only CE-marked commercial blood warmers should be used and the manufacturer’s instructions must be strictly followed. Some blood warmers operate at up to 43°C but are safe provided they are used and serviced according to manufacturer’s instructions.
Blood must never be warmed in an uncontrolled way (e.g. in a microwave, in hot water, or on a radiator).
Drugs should not be added to any blood component pack. It is generally advised that an infusion line that is being used for blood should not be used to administer any drug. Dextrose solution (5%) can cause haemolysis and must not be mixed with blood components. Calcium-containing solutions may cause clotting of citrated blood. Use multi-lumen central lines. The topics of compatible IV fluids and co-administration of drugs and transfusion are under review by BCSH transfusion task force.
Blood administration equipment for neonatal and paediatric transfusion
see Equipment for paediatric transfusion