Navegando por Palavras-chave "Security of the patient"

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    Análise ex vivo do efeito do aquecimento de concentrados de glóbulos vermelhos e uso de diferentes dispositivos de infusão no nível de marcadores de hemólise
    (Universidade Federal de São Paulo (UNIFESP), 2018-12-20) Pires, Maria Paula de Oliveira [UNIFESP]; Pedreira, Mavilde da Luz Goncalves [UNIFESP]; Rickard, Claire Mihala; Peterlini, Maria Angélica Sorgini [UNIFESP]; http://lattes.cnpq.br/1599622257763420; http://lattes.cnpq.br/5901248667753975; http://lattes.cnpq.br/0669955447309650; Universidade Federal de São Paulo (UNIFESP)
    Introduction: Warming of red blood cell concentrates (RBC) before transfusion occurs especially in situations of massive transfusion, in order to avoid hypothermia and associated complications. Objectives: To describe the ex vivo effect of RBC warming on markers of hemolysis and infusion by manual and electronic devices. Materials and Methods: Ex vivo experimental research carried out after approval of ethical merit. The sample consisted of 90 RBC infusions, randomly, 45 simulations of infusions of warmed RBC, and 45 simulations of infusions of cold RBC, in three periods: before the intervention (Control), after immersion of the RBC in the water bath at 42º C (Warming), and after the warmed or cold RBC is infused by manual or electronic devices (Infusion) at a flow rate of 100 mL/h. Infusion devices were repeated nine times in each simulation by set drips systems (SD: 18; 20.0%), microdrips (MD: 18; 20.0%), linear peristaltic infusion pumps (PIP: 18; 20.0%), cassette infusion pumps (CIP: 18; 20.0%) and syringe infusion pumps (SIP: 18; 20.0%). RBC were analyzed according to hemolysis markers: hemoglobin concentration (g/dL), plasma free hemoglobin (g/dL), potassium (mmol/L) and lactate dehydrogenase, hemolysis degree (%), hematocrit (%) and total hemoglobin (U/L). In addition, the osmolality (mOsm/Kg) and pH were analyzed in the warmed RBC simulations. The data collection period was from March 2015 to February 2016. Statistical analysis was done using mean, standard deviation, standard error, median, interquartile range, minimum, maximum, tables, boxplot graphs, and the application of parametric test (t test), and non-parametric (Mann-Whitney). The software used for analysis was R 3.1.2, with significance level ≤ 0.05. Results: In the comparison between the Control and Warming stages, a significant reduction in total Hb level (p=0.002) and increase in free Hb levels (p<0.001), degree of hemolysis (p<0.001), and LDH (p<0.001). Infusion pumps presented significant changes in relation to manual devices, with increased values of free Hb (p<0.001), degree of hemolysis (p<0.001) and potassium (p<0.001). Infusion simulations with warmed RBC showed statistical differences when compared to infusion of cold RBC, with an increase in free Hb (p<0.001), degree of hemolysis (p<0.001) and LDH (p<0.001). Conclusion: Despite the variations identified in this study, hemolysis markers levels did not exceed those recommended in the literature for transfusion of RBC. The warming of RBC by immersion in a 42° C water bath and administration by infusion pumps caused a significant increase in markers of hemolysis capable of generating clinical complications in neonates, infants and unstable adults.