Blood Transfusions Using 27 Gauge PICC Lines: A Retrospective Clinical Study on Safety and Feasibility

Abstract

Background:

Blood transfusions are required by most extremely low birth weight (ELBW) infants, but sometimes an adequate peripheral venous access cannot be achieved. Under these circumstances, we used 27 Gauge (G) peripherally inserted central catheter (PICC) lines that are routinely inserted on the second day of life. Due to their narrow lumen, hemolysis of transfused erythrocytes was a major concern. We therefore performed a retrospective study in ELBW infants to analyze the incidence, safety and feasibility of PRBC transfusions via 27 G PICC lines.

Methods:

ELBW infants admitted from 08/2011–07/2012 were screened for packed red blood cell (PRBC) transfusions. Those applied via 27 G PICC lines were identified. For analysis of transfusion safety (hemolysis), hemoglobin and potassium levels as well as cardiovascular variables (invasive mean arterial blood pressure and heart rate) were evaluated before and after transfusion. For analysis of transfusion feasibility, catheter removal after transfusion and the reason for removal were recorded.

Results:

A total of 648 transfusions were applied in 110 ELBW infants. 27 infants (24%) received no transfusion. In 12/83 (14.5%) infants who received PRBCs, transfusions were applied using a 27 G PICC line (38/648, 5.9%). Patients who received PRBCs via the PICC line were smaller at birth (582 g [range 380–752 g] vs. 710 g [430–972 g]; 23+6 [23+1-27+6] vs. 26+0 [23+1-31+4]) and required a higher number of PRBC transfusions (n=13 vs. n=5) overall. Transfusion analysis showed an appropriate increase of blood hemoglobin levels and stable potassium levels as well as cardiovascular parameters. 4/38 of PICC lines were removed within 24 h after transfusion, one due to occlusion (15 h after transfusion).

Conclusions:

We conclude that PRBC transfusions via 27 G PICC lines were feasible and performed without signs of hemolysis in ELBW infants. Our findings may help clinicians in the management of ELBW infants requiring transfusions if a peripheral venous access is not achievable.

Zusammenfassung

Hintergrund:

Frühgeborene mit extrem niedrigem Geburtsgewicht (ELBW) benötigen oft Bluttransfusionen. In dieser Studie wurden 27-Gauge(G)-peripher-inserierbare zentrale Kathe­ter (PICC) bei mangelnder Verfügbarkeit anderer Zugänge für die Applikation von Transfusionen verwendet. Sicherheit und Machbarkeit wurden retrospektiv überprüft.

Methodik:

Bluttransfusionen über 27-G-PICCs bei ELBW-Kindern (08/11–07/12) wurden auf Sicherheit (Hämoglobinanstieg, Kaliumspiegel, Herzfrequenz und Blutdruck vor und nach Transfusion) und Machbarkeit (Katheterokklusion) analysiert.

Ergebnisse:

83 von 110 ELBW-Kindern (75,5%) erhielten 648 Bluttransfusionen. Bei 14,5% (12/83) wurden dafür auch 27-G-PICCs verwendet (38/648; 5,9%). Diese Kinder waren kleiner bei Geburt (582 g [380–752 g] vs. 710 g [430–972 g]; 23+6 [23+1-27+6] vs. 26+0 [23+1-31+4] und erhielten mehr Transfusionen (13 vs. 5). Die Analyse zeigte einen adäquaten Hämoglobinanstieg ohne Hämolysehinweis (Kalium und kardiovaskuläre Parameter stabil). Bei 4/38 Transfusionen wurden die PICC-Kathe­ter entfernt, in einem Fall aufgrund von Katheterokklusion (15 h nach Transfusion).

Schlussfolgerung:

27-G-PICCs wurden ohne Hinweis auf relevante Hämolyse für Bluttransfusionen bei ELBW-Kindern verwendet. Diese Er­kenntnisse können bei der Behandlung von ELBW-Kindern mit Transfusionsbedarf von Nutzen sein.

Key words

preterm infants - extremely low birth weight infants - catheter - red blood cell transfusion - hemolysis - safety

Schlüsselwörter

Frühgeburt - extrem niedriges ­Geburtsgewicht - Katheter - Bluttransfusion - Hämolyse - Sicherheit

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