Can't blood transfusion set be used for infusion? Don't use it anymore!

In clinical infusion, nurses often ask questions, can both the infusion set and the blood transfusion set be used for infusion? In response to this problem, we will jointly investigate.

Case study

The patient Xiao Mou, male, 58 years old, was admitted to the hospital as the chief complaint with frequent blood in his stool for 4 months. After completing all the examinations, under general anesthesia for radical resection of sigmoid colon cancer. Due to the high blood loss during the operation, follow the doctor’s instructions for blood transfusion. After the blood transfusion, the nurse Xiaojin saves the trouble of replacing the infusion set and helps the patient to reduce the cost of the infusion set. , So he directly infused the patient with a blood transfusion set, which was stopped in time by the nurse Xiao Wang who was also on duty, and the infusion treatment was restarted after replacing the infusion set.

Through this case, let’s analyze, why is it inappropriate to use a blood transfusion set for infusion?

At present, 90% of the domestic blood transfusion tube and blood transfusion funnel are made of polyvinyl chloride PVC, and the filter pore size is 170μm～260μm. 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. The diameter of infusion particles is mostly 1～15μm, and a few can be 50～300μm. They are non-metabolic particle impurities in the liquid. Larger particles can cause local blood vessel blockage or insufficient blood supply, tissue hypoxia, and promote phlebitis. And edema, granuloma, and even promote the formation of tumors, insoluble particles can also cause allergic reactions and pyrogen-like reactions.

However, particles larger than 10μm in the liquid medicine account for only about 1%, and particles smaller than 10μm account for about 98%. The larger filter pore size of the blood transfusion set cannot filter these infusion particles, so it is not suitable for infusion. The filter membrane selected for the precision filtration infusion set is a nuclear pore membrane with a double-layer filter medium, high filtration accuracy, and strict pore size classification. The appropriate pore size can be selected according to clinical needs: 5μm, 3μm, 2μm, 1.2μm, 0.2μm . It can effectively filter the infusion particles to ensure the safety of the patient's infusion.

1

Types of infusion set and filter aperture

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.

2

Material and filter aperture of blood transfusion set

At present, 90% of domestic infusion set tubing and blood transfusion funnel are made of polyvinyl chloride PVC, and the filter pore size is 170 um ~ 260 um. 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.

3

Features 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.

4

Requirement of infusion set for 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.

5

Infusion particulate contamination and filters

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.

6

The 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.

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.