Can an infusion set VS a blood transfusion set be used for infusion?

The blood transfusion set is a special infusion device designed to adapt to blood and its products, and is not suitable for infusion.

Case number one

The patient, Uncle Gao, male, 79 years old, was diagnosed with chronic myelogenous leukemia with coronary heart disease arrhythmia. Anemia appearance, hemoglobin 5.1g/L, after admission to the hospital, complete related examinations, blood transfusion treatment, nitroglycerin expansion, Danhong improve microcirculation and Shenqi to strengthen the immune system and other treatments, see the doctor's order for details. On the second day of admission, the responsible nurse Xiaoxue considered the patient to have a blood transfusion when transfusing the patient. In order to save the trouble of replacing the blood transfusion set and save the cost of the infusion set for the patient, she directly infused the patient with the blood transfusion set. At about 10 o'clock, when the head nurse visited the ward, he found that Danhong injection was infused intravenously with a blood transfusion set. So, tell the nurse Xiaoxue Chinese patent medicine can not use blood transfusion set.

Case two

Netizen asks (@优优): During my internship in Gastroenterology, the teacher told me that blood transfusion sets cannot be used for infusion. But when I transferred to the Department of Hematology, the teachers used the blood transfusion device to change the liquid to the patient after the patient finished the blood transfusion. I asked the teacher and the teacher said that the patient can save the hospitalization fee. I am very dissatisfied with this reason. I don’t know if you guys know why. If you use a blood transfusion device for infusion, will it have any effect? ​​For example, filtering out a large number of liquid medicine molecules, affecting the therapeutic effect of the drug?

Netizens answered:

@xinghailanghua520: I haven't seen that there is a clear stipulation that infusion is not allowed. In the past, our hospital used to directly follow the infusion.

@最烦想名: The blood transfusion device can transfuse blood cells and plasma proteins, and it will not filter out such large molecules. It should not filter out a large number of liquid medicine molecules in the infusion?

@xiaojiaan: The blood transfusion device does not have such a precise filter membrane. Some impurities in the liquid, such as glass fragments produced when we break the ampoules, cannot be filtered out by the blood transfusion device. These impurities are dangerous to enter the human body.

Parsing

01Types of infusion sets and filter pore size

There are basically three types of infusion sets in clinical use: one is a normal PVC infusion set with a filter pore size of 15um; the other is a precision infusion set containing PVC with a filter pore size of 3um, 5um, or even smaller; the other is no The TPE infusion set containing PVC plasticizer has a filter pore size of 15um, which can prevent the adsorption of emulsions, oils such as nitroglycerin, bufenide injection and certain chemotherapeutics.

02Material and filter aperture of blood transfusion set

At present, 90% of domestic infusion set pipes and blood transfusion funnel are made of polyvinyl chloride PVC, and the filter pore size is 170um～260um. If the pore size is too small, it is easy to be blocked by the micro-polymers of platelets and white blood cells in the blood cells, which affects the effective filtration area.

03Characteristics of concentrated red blood cells

The diameter of a single red blood cell is 6-9 microns. However, concentrated red blood cells remove most of the plasma, platelets and white blood cells, and the concentration of red blood cells increases, and many red blood cells are often glued together. Therefore, the viscosity of concentrated red blood cells is greater than that of whole blood, and the fluency is only 60% of whole blood.

04Requirements for infusion sets during infusion of various drugs

(1) Infusion of proprietary Chinese medicines: In the preparation process of proprietary Chinese medicines, there are impurities due to the lack of purification technology, or the powder injection is not fully dissolved, resulting in an increase in the number of particles. Therefore, a precision infusion device with a drug filter device should be used for infusion. , It is better that the filter pore size is 2.2～5μm and the drug adsorption is less than 28.6%.

(2) Nutrients: As mentioned in the 2016 INS filter clause in the United States, use a 0.2 micron filter to filter non-fat parenteral nutrition, use a 1.2 micron filter to filter fat-containing emulsions, and replace the filter every 24 hours Device.

05 Infusion particulate pollution and filter

As mentioned in the 2016 US INS filter clause, constantly updated research evidence suggests that particulate matter (such as rubber, glass, latex) has an effect on capillary endothelial cells, and tiny bubbles in the liquid may cause brain and lung ischemia; and particle retention And the use of filters that eliminate the air function can prevent potential damage from air/particulate matter (such as heart deformities that shunt right to left).

Infusion particles are non-metabolic particles that exist in the liquid, and their diameters are mostly 1-15 microns, and a few can be 50-300 microns. Larger particles can cause local blood vessel blockage or insufficient blood supply, tissue hypoxia, and cause veins. Inflammation and edema, granuloma, and even promote the formation of tumors. Insoluble particles can also cause allergic reactions and pyrogen-like reactions.

06The adsorption effect of PVC material on drugs

PVC material has strong adsorption to some alcohol-soluble and fat-soluble drugs, which makes prescription medication inaccurate and affects the therapeutic effect. These drugs mainly include paclitaxel, nitroglycerin injection, isosorbide mononitrate injection, nimodipine, clonazepam, diazepam, chlorpromazine, urokinase, insulin, fat emulsion, brucea oil, ligustrazine , Amiodarone, fentanyl, tinidazole, turmeric oil, etc.

Summarize

To sum up, in view of the PVC material of the blood transfusion set and the larger filter mesh, it is indicated that the blood transfusion set is a special infusion device designed to adapt to blood and its products, and it is not suitable for infusion.