Bomba de infusão por seringa para transfusão de concentrados de hemácias: análise dos níveis de marcadores de hemólise

• Ano de defesa: 2016
• Autor(a) principal: Gannam, Fernanda Figueiredo [UNIFESP]
• Tipo de documento: Dissertação
• Tipo de acesso: Acesso aberto
• Idioma: por
• Instituição de defesa: Universidade Federal de São Paulo (UNIFESP)
• Palavras-chave em Português: Infusion pumps; Syringes; Hemolysis; Erythrocytes; Erythrocyte transfusion; Neonatal nursing; Bombas de infusão; Seringas; Hemólise; Eritrócitos; Transfusão de eritrócitos; Enfermagem neonatal
• Link de acesso: https://sucupira.capes.gov.br/sucupira/public/consultas/coleta/trabalhoConclusao/viewTrabalhoConclusao.jsf?popup=true&id_trabalho=4621712; http://repositorio.unifesp.br/handle/11600/47070

Introduction: Syringe infusion pumps (SIP) were developed in the second half of the twentieth century, leading to major advances in intravenous therapy, and they were gradually applied to the transfusion of packed red blood cells (RBC), raising questions on possible cells damage. Objectives: Determining levels of hematocrit levels, total hemoglobin, free hemoglobin, lactate dehydrogenase (LDH), potassium and hemolysis percentage of RBC administered by SIP; investigating the influence of the infusion rate on hemolysis markers levels and describing the influence of RBC storage time, ambient temperature and humidity on hemolysis markers levels. Methods: Experimental study, conducted with 14 packed RBC, of which blood aliquots were filled into syringes. Three SIP of a same manufacture were randomly studied and infusion rates of 5 ml/h, 10 ml/h and 20 ml/h. The hemolysis markers analyzed were: hematocrit (%), total hemoglobin (g/dl), free hemoglobin (g/dl) LDH (U/l), potassium (mmol/l) and hemolysis degree (%). The variables were analyzed according to the average, standard deviation and median, applying the ANOVA or Friedman tests, drawning a linear correlation and coefficients according to Pearson or Spearman?s methods (p=0.05). Results: It was performed 324 hemolysis markers analyses. Among all the analyses that were performed on RBC before manipulation, after filling the syringe and after infusion by SIP, a decrease of total hemoglobin level (p=0.003) was identified with an increase of free hemoglobin level (p<0.001) and on the hemolysis percentage (p<0.001). The comparisons of infusion rates have shown an increase of free hemoglobin levels (5 ml/h: p=0.030; 10 ml/h: p=0.002; 20 ml/h: p=0.016) and hemolysis percentage (5 ml/h: p=0.006; 10 ml/h: p=0.002; 20 ml/h: p=0.009) in all the evaluated rates and there was a significant reduction of total hemoglobin at 10 ml/h (p=0.001). The variations in potassium concentration (p=0.030; p=0.030) and hematocrit (p=0.029; p=0.001) were correlated, respectively, to the ambient temperature and humidity, and temperature with LDH (p=0.008) variation. The RBC storage time was moderately correlated with changes on hemolysis degree (p<0.001), potassium levels (p=0.005) and free hemoglobin (p=0.009). Conclusion: RBC infused by SIP presented changes in free hemoglobin and hemolysis degree levels in all studied infusion rates, and a decrease of total hemoglobin at 10 ml/h. The blood aliquoting into syringes has created a significant increase in free hemoglobin level and the hemolysis degree, indicating occurrence of cell lysis during syringes filling. The increase in potassium concentration was directly proportional to the RBC storage time. In addition, it was identified a correlation between an increase in ambient temperature with an increase in potassium levels, hematocrit and LDH.