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    Marcadores de hemólise de concentrados de hemácias administrados in vitro por cateter central de inserção periférica: influência da velocidade de infusão, tempo de armazenamento e calibre do cateter
    (Universidade Federal de São Paulo (UNIFESP), 2019-09-26) Souza, Adja Havreluk Paiva De [UNIFESP]; Avelar, Ariane Ferreira Machado [UNIFESP]; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The use of the central peripheral insertion catheter (CCIP) is expanding and can be used even for the administration of blood components. In hospital practice, the use of CCIP is common, but the use of these devices for transfusion therapy is not yet fully supported in the literature, due to the risk of hemolysis due to the mechanical action generated on erythrocytes. Objectives: To identify changes in the levels of hemolysis markers after infusion of red blood cells (RBC) in peristaltic infusion pump by central catheter of peripheral valve insertion, according to time of storage of the blood component bag, infusion rate, and catheter caliber. Method: Experimental study carried out in laboratory under controlled temperature and humidity conditions. The data collection took place after approval of the ethical merit of the research (opinion nº 3.231.723). Concentrated positive A-type RBC concentrates were collected from CPDA-1 provided by the nonprofit Charity Blood Collection Association (COLSAN). RBC concentrates with storage time greater than and less than 14 days were randomly administered in 6 units of 5French (FR) CCIP and 6 4FR units of carbotane, with a PASV (Pressure Activated Safety Valve) valve, 60 cm in length, at speeds 50 and 100ml / h per linear peristaltic pump. Aliquots were analyzed in three moments: A1: - Aliquot of the RBC bag (directly from the packed red blood cells), A2- Aliquot after filling of the system by free flow of the infusion system and A3- Aliquot after controlled infusion. The hemolytic markers analyzed were hemolysis (%), hematocrit - Ht (%), total hemoglobin - Hbt (g / dl), free hemoglobin - Hbl (g / dl), potassium - K lactate dehydrogenase - LDH (U / L). Data were analyzed according to descriptive and inferential statistics, using the T-student, Kruskal-Wallis or Mann-Whitney tests (p <0.05). Results: 48 experiments were performed, and 144 aliquots of red blood cell concentrates were analyzed from the three moments studied. In relation to the infusion rates studied, there was a trend towards an increase in the median values (minimum and maximum) at a rate of 50 ml / h between Hbt A1-A3 moments [of 23,18 (15,70 / 32,49 ) g / dl for 23.99 (16.45 / 30.75 g / dl), Hbl [from 0.11 (0.04 / 0.23) g / dl to 0.12 (0.00 / , 24) g / dl], Ht [from 74.00 (68.00 / 80.00)% to 75.00 (70.00 / 84.00)%], K [ / 39.95) mmol / l for 26.45 (0.10 / 41.63) mmol / l] and LDH [from 1036.16 (0.00 / 2997.85) U / L to 1083.38 (137 , 61 / 5847.29) U / L] and only Ht [from 74.00 (68.00 / 80.00) g / dl to 75.00 (68.00 / 80.00) g / dl] LDH 787.91 [((5.40 / 4600.65) U / L for 835.13 (0.00 / 2879.12) U / L] in 100 ml / hr; and reduction in markers of hemolysis [from 0.13 (0.04 / 0.44)% to 0.12 (0.00 / 0.37)%] at 50ml / h and at 100ml / h Hbt [from 23, 26 (17.10 / 32.50) g / dl to 22.96 (16.48 / 31.53) g / dl] and K xvi [24.95 (0.10 / 41.91) mmol / l for 24.22 (0.05 / 41.16) mmol / l]. With regard to the storage time, there was an upward trend in Hbt, Ht and LDH values in pockets of less than 14 days, and of Ht, K and LDH in pockets with more than 14 days of storage. The tendency to decrease was observed in the markers: Hbl, degree of hemolysis and K in pockets stored for less than 14 days; and in Hbt, Hbl and degree of hemolysis in the pockets with more than 14 days. As for the caliber of the catheters, the same tendency of increase in the values of the Hbt, Ht and LDH markers was observed in both calibers, and opposite tendencies in the K, in which in 4FR there was increase and in 5FR reduction. When comparing the A3 moments, a significant difference was identified between the storage times of the pockets in all the markers, with the exception of Hbt; between gauges, except Hbl; and only in the comparison of infusion rates did not identify significant influence on the markers. Conclusion: The storage time of the pockets greater than 14 days and the caliber 4 Fr of the CCIP valve significantly influenced the levels of Hb t, potassium and LDH. No influence of the infusion rates studied on hemolysis markers was identified. The levels of hemolysis markers identified after the experimental conditions imposed do not contraindicate the administration of CH, according to the recommendations of the competent organs.