Administration of blood products
through the Alaris SE pump
®
(Models 7100 and 7200)
Rodney A. Hasler, ME
Sr. Clinical Study Specialist
Note: This white paper was published prior to the release of models 7130 and 7230. However, this white paper also
applies to these models as the mechanisms are identical.
Summary
Studies have been performed by an independent
There is a great deal of variation in transfusion practices
laboratory to screen for potential pump-induced
among institutions. Infusion pumps do not completely
hemolysis with the Alaris SE pump. These studies
automate transfusion, and are not intended to replace the
indicate no clinically significant hemolysis is induced by
nurse or other professionals in monitoring the process. For
delivering blood products with an Alaris SE pump and
example, red cells tend to clump and settle in the blood bag
model 72980 blood administration set or model 72023
prior to entering the tubing. The bag still must be mixed
administration set. Additionally, there did not appear to
occasionally to resuspend the cells, as is common transfusion
be any substantial adherence of platelets to the infusion
practice with or without pump-assisted administration.
set, nor was there significant release of cytosolic LDH due
to membrane damage.
Table 1: Factors affecting hemolysis during blood
Pump assisted transfusion has become common practice.
product transfusions
The convenience, improvement in flow rate control and
Type of blood component
volume control afforded by infusion pumps make them
an attractive alternative to pressure sleeve or gravity
Age of the blood product
infusion of blood products.
Viscosity
When IV infusion pumps are used to infuse blood
Storage conditions (temperature, preservatives,
products, the concern most often expressed is whether
container material)
passage through the pump mechanism contributes
Handling (agitation, kneading to re-suspend
significantly to hemolysis of red blood cells. Many factors
may affect hemolysis during transfusion (see Table 1).
settled cells)
Because the influence of any combination of these
External pressure applied to the blood bag
factors may converge on a given transfusion event, it
In-line blood filters (pore size, filter material, degree
has been difficult for clinicians to establish guidelines
to which clots occlude surface area)
that define acceptable cell damage. For example, FDA
guidelines for the evaluation of shelf life require posttransfusion survival of red cells to be only 75% of the
cells initially present when the unit was drawn.1 In many
instances the relationship between the amount of blood
product infused and the resulting clinical response is not
known. Of course the clinical condition of the patient
will determine individual tolerance to infusion of red cell
breakdown products.
Interaction between blood components and fluid path
surfaces or materials
Type of mechanical infusion device, if any
Infusion rate
Needle or catheter gauge
Methods
Results
P.D. Mintz, MD, Associate Professor of Pathology and
None of the assays for red cell damage displayed clinically
Internal Medicine, and G. Anderson, SBB (ASCP),
significant differences over their appropriate control. For
University of Virginia Health Sciences Center, performed
the MCV, LDH, K+ and free hemoglobin, there were no
studies in 1994 on the Alaris SE pump model 7100 with
significant differences by examination among sample means.
model 72980 blood administration set and model 72023
There was one instance in which the LDH rose by 1,000 U/L
administration set.
and the K+ rose 12 mmol/L from the unit control to the test
2
Four units of red blood cells (adenine-saline added, AS1)
and four pools of platelets per set were pumped in a
laboratory setting. Testing was performed at or near the
blood products’ outdate. To detect any red cell damage,
mean corpuscular volume (MCV) was measured on
each sample and RBC histograms were printed. Cell-free
conditions. Since both of these parameters were measured on
the same instrument and the corresponding free hemoglobin
did not increase, this isolated event is most likely a technical
error in the testing (such as a dilution error). The platelet
concentration, MPV and LDH release reflect no significant
differences between the sample means by observation.
supernatants were prepared by double centrifugation and
Conclusion
were measured for free hemoglobin, lactose dehydrogenase
The Alaris SE pump with Guardrails ® software has the same
(LDH) and potassium (K+). The hematocrit of each sample
was determined in order to have some measure of the
viscosity of the blood being pumped. Samples for each test
run was collected under the five conditions in Table 2.
Pooled platelets were also tested by sampling at the five
conditions listed in Table 2. Platelet concentration, mean
platelet volume (MPV) and percent LDH release were used
as markers for platelet loss and membrane disruption.
pumping mechanism, and therefore the same effect on blood
and blood hemolysis. Dr. Mintz and Mr. Anderson concluded
that the Alaris SE pump, when used with model 72980 blood
administration set or model 72023 administration set, did not
induce any clinically significant hemolysis. Additionally, there
did not appear to be any substantial adherence of platelets to
the infusion set, nor was there significant release of cytosolic
LDH due to membrane damage.2
Discussion
Table 2: Sampling conditions red blood cells and
pooled platelets2
1. Directly from unit
2. After passage through the filter and administration
set by gravity alone (no pre-priming)
3. After 20 mL of blood/platelets had been pumped
at 999 mL/hr without a needle attached
4. After 100 mL of blood (or 50 mL of platelets)
If, upon review of the study methods presented, a hospital
considers its practice to be significantly different, it is
recommended that the institution consider performing tests
for hemolysis on a small series of outdated (worst case) blood
components with the complete setup and under conditions
of flow rate, etc., anticipated in clinical use in the facility. The
term “blood products” is not intended to be all inclusive.
Special applications, such as the delivery of T-cells with the
had been pumped at 999 mL/hr with a 19g
Alaris SE pump, are considered unique and have not presently
needle attached
been studied.
5. With needle attached as unit finished
References
1 Walker LH. Technical manual 11th Edition. Arlington, VA: American Association of
Blood Banks, 1993.
2 Anderson GT. Evaluation of the IVAC Signature Edition Infusion Pump to Deliver Red
Blood Cells and Platelets. Transfusion, 1994, 34: 664.
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