Hemolysis markers of blood administered in non-valved peripherally inserted central catheter*

Mendes, Maria Teresa de Melo; Jacinto, Amanda Karina de Lima; Kusahara, Denise Miyuki; Peterlini, Maria Angélica Sorgini; Pedreira, Mavilde da Luz Gonçalves; Avelar, Ariane Ferreira Machado

doi:10.1590/1982-0194201900020

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Acta Paulista de Enfermagem

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Original Article • Acta Paul Enferm. 32 (2) • Mar-Apr 2019 • https://doi.org/10.1590/1982-0194201900020 copy

Hemolysis markers of blood administered in non-valved peripherally inserted central catheter*

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective:

To evaluate the change in hemolysis markers in packed red blood cells, administered by gravity infusion in non-valved PICC lines, according to different sizes.

Methods:

Experimental study carried out in laboratory under controlled conditions of temperature and humidity. The sample had 36 blood aliquots from 10 packed red blood cells bags with A positive blood type; gravity infusion was used in six 3 French (Fr) PICC and in six 4Fr PICC, totaling 12 experiments divided in three moments: Basal, Free Flow and Controlled Flow. Degree of hemolysis, total and free hemoglobin values, lactic dehydrogenase and potassium were analyzed.

Results:

There was an average increase of free hemoglobin (p=0.01) and degree of hemolysis (p=0.01) after Free Flow infusion, with 0.04 average elevation of potassium (p<0.01) and decrease of total hemoglobin (p=0.01) in Controlled Flow. The packed red blood cells infused in 4Fr PICC had average elevation of degree of hemolysis (p=0.03) in Free Flow, and potassium (p=0.03) and degree of hemolysis (p=0.05) in the Controlled Flow. The 3Fr PICC had significant average increase in the degree of hemolysis (p=0.03) and free hemoglobin (p=0.01) after flow control.

Conclusion:

The 4Fr PICC were associated to higher changes in hemolysis markers. We infer that the larger size can provide a turbulent flow, contributing to a larger clash among red blood cells.

Keywords
Catheters; Vascular access devices; Hemolysis; Blood transfusion; Pediatric nursing

	Basal	Free flow	Mean difference (CI 95%)	p^* * Paired t-test;	Basal	Controlled flow	Mean difference (CI 95%)	p-value^* * Paired t-test;
HcT¹ 1 hematocrit; (%)	72.50 ±2.11	72.83 ±1.94	0.33 (- 0.40 to 1.06)	0.33	72.50 ±2.11	72.75 ±2.00	0.25 (-0.73 to 1.23)	0.58
Degree of hemolysis (%)	0.135 ±0.138	0.187 ±0.178	0.05 (0.01 to 0.09)	0.01	0.135 ±0.138	0.197 ±0.190	0.06 (0.02 to 0.09)	<0.01
THb² 2 total hemoglobin; (g/dL)	28.17 ±5.46	25.76 ±3.16	-2.40 (-4.75 to -0.05)	0.04	28.17 ±5.46	24.74 ±2.59	-3.42 (-5.91 to -0.92)	0.01
Potassium (mmol/L)	39.64 ±5.12	40.55 ±5.23	0.91 (-0.46 to 2.28)	0.17	39.64 ±5.12	40.90 ±5.27	1.26 (-0.02 to 2.55)	0.05
PFHb³ 3 free hemoglobin; (g/dL)	0.146 ±0.16	0.189 ±0.20	0.04 (0.01 to 0.07)	0.01	0.146 ±0.16	0.190 ±0.20	0.04 (0.01 to 0.07)	<0.01
LDH⁴ 4 lactate dehydrogenase isoenzymes (U/L)	888.2 ±404.4	1068.5 ±696.5	180.3 (-105.6 to 466.3)	0.19	888.2 ±404.4	1277.2 ±1206.8	389.0 (-254.7 to 1032.7)	0.21

	Basal	Free flow	Mean difference (CI 95%)	p^* * Paired-test;	Basal	Controlled flow	Mean difference (CI 95%)	p-value^* * Paired-test;
3 Fr
HcT¹ 1 hematocrit; (%)	71.50 ±1.97	72.33 ±2.06	0.83 (-0.71 to 2.37)	0.22	71.50 ±1.97	72.16 ±1.94	0.66 (-1.39 to 2.73)	0.44
Degree of hemolysis (%)	0.108 ±0.07	0.166 (± 0.14)	0.05 (-0.02 to 0.14)	0.14	0.108 ±0.07	0.158 ±0.10	0.50 (0.00 to 0.09)	0.03
THb² 2 total hemoglobin; (g/dL)	28.65 ±7.02	25.70 ±3.41	-2.94 (-7.50 to 1.61)	0.15	28.65 ±7.02	24.84 ±2.82	-3.81 (-9.09 to 1.46)	0.12
Potassium (mmol/L)	38.03 ±4.03	39.39 ±4.99	1.36 (-1.81 to 4.54)	0.32	38.03 ±4.03	39.96 ±5.06	1.93 (0.99 to 4.86)	0.15
PFHb³ 3 free hemoglobin; (g/dL)	0.115 ±0.10	0.161 ±0.15	0.04 (-0.01 to 0.10)	0.11	0.115 ±0.10	0.149 ±0.11	0.03 (0.00 to 0.05)	0.01
LDH⁴ 4 lactate dehydrogenase isoenzymes (U/L)	756.4 ±421.8	791.5 ±407.3	35.07 (-43.6 to 113.8)	0.30	756.4 ±421.8	779.8 ±414.9	23.3 (-148.4 to 195.2)	0.74
4 Fr
HcT (%)	73.50 ±1.87	73.33 ±1.86	-0.16 (-0.59 to 0.26)	0.36	73.50 ±1.87	73.33 ±2.06	-0.16 (-1.19 to 0.86)	0.69
Degree of hemolysis (%)	0.162 ±0.18	0.209 ±0.21	0.04 (0.00 to 0.86)	0.03	0.162 ±0.18	0.36 ±0.25	0.07 (0.00 to 0.15)	0.05
THb (g/dL)	27.68 ±3.97	25.82 ±3.22	-1.85 (-5.26 to 1.55)	0.22	27.68 ±3.97	24.65 ±2.61	-3.02 (-6.03 to -0.17)	0.04
Potassium (mmmol/L)	41.25 ±5.74	41.71 ±5.66	0.45 (-0.34 to 1.25)	0.20	41.25 ±5.74	41.85 ±5.78	0.59 (0.08 to 1.10)	0.03
PFHb (g/dL)	0.177 ±0.21	0.217 ±0.25	0.04 (-0.00 to 0.08)	0.06	0.177 ±0.21	0.231 ±0.26	0.05 (0.00 to 0.11)	0.07
LDH (U/L)	1019.9 ±374.4	1345.5 ±846.9	325.5 (-329.3 to 980.5)	0.25	1019.9 ±374.4	1774.6 ±1561	754.6 (-696.0 to 2205.3)	0.23

	3 Fr Median (min-max)	4 Fr Median (min-max)	_p ^* * Mann-Whitney;
HcT¹ 1 hematocrit; (%)	0.0 (-2.0 - 3.0)	0.0 (-2.0 - 1.0)	_p ^* * Mann-Whitney;	0.15
Degree of hemolysis (%)	0.03 (0.0 - 0.22)	0.03 (0.01 - 0.19)	0.77
THb² 2 total hemoglobin; (g/dL)	-1.39 (-9.94 - 1.60)	-1.54 (-8.24 - 1.01)	0.86
Potassium (mmol/L)	0.81 (-1.88 - 7.17)	0.39 (-0.48 - 1.51)	0.18
PFHb³ 3 free hemoglobin; (g/dL)	0.02 (0.0 - 0.16)	0.19 (0.01 - 0.15)	0.95
LDH⁴ 4 lactate dehydrogenase isoenzymes (U/L)	59.36 (-296.8 - 156.5)	55.31 (-37.78 - 3502.4)	0.50

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[1] Corresponding author Ariane Ferreira Machado Avelar, E-mail: ariane.machado@unifesp.br