Transfusions via hand-held syringes and small-gauge needles as risk factors for hyperkalemia

Michal A MILLER; Annette J SCHLUETER

doi:10.1111/j.1537-2995.2004.00653.x

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Transfusions via hand-held syringes and small-gauge needles as risk factors for hyperkalemia

Journal article

Peer reviewed

Transfusions via hand-held syringes and small-gauge needles as risk factors for hyperkalemia

Michal A MILLER and Annette J SCHLUETER

Transfusion (Philadelphia, Pa.), Vol.44(3), pp.373-381

2004

DOI: 10.1111/j.1537-2995.2004.00653.x

PMID: 14996194

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Abstract

Background: Pediatric emergency RBC transfusions are often infused rapidly through 22-gauge (ga) or smaller needles or catheters using hand-held syringes. Data relating needle size, unit age, and infusion rate are needed to assess the risk of hemolysis and hyperkalemia in this setting. Study design and methods: Multiple simulated transfusions were performed during storage of RBC units. Aliquots from five units were rapidly passed through needles (18, 20, 22-25 ga) using a hand-held syringe. Resulting plasma Hb and K+ concentrations were measured. Free Hb levels were used as a measure of needle-associated hemolysis (NAH). Results: Passage through 18-ga and 20-ga needles caused no hemolysis, but rapid passage through 23-ga, 24-ga, and 25-ga did. RBCs stored less than 7 days showed significant K+ release with 23- to 25-ga needles. The greatest needle-associated K+ release was 10 mEq per L, on Day 5. Due to high K+ concentrations resulting from spontaneous efflux, K+ release from NAH was not detectable after 2 or more weeks of storage. Conclusions: Rapidly transfusing RBCs using hand-held syringes through 23-ga or smaller needles can cause hemolysis. In RBCs stored 2 weeks or more, NAH does not measurably increase K+ concentrations above that present from storage-related efflux. During rapid transfusions, RBC storage time is the primary risk factor for transfusion-associated hyperkalemia.

Biological and medical sciences

Medical sciences

Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy

Blood. Blood and plasma substitutes. Blood products. Blood cells. Blood typing. Plasmapheresis. Apheresis

Transfusions. Complications. Transfusion reactions. Cell and gene therapy

Details

Title: Subtitle: Transfusions via hand-held syringes and small-gauge needles as risk factors for hyperkalemia
Creators: Michal A MILLER - Departments of Pathology and Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, United States
Annette J SCHLUETER - Departments of Pathology and Pediatrics, University of Iowa College of Medicine, Iowa City, Iowa, United States
Resource Type: Journal article
Publication Details: Transfusion (Philadelphia, Pa.), Vol.44(3), pp.373-381
Publisher: Blackwell Publishing; Oxford
DOI: 10.1111/j.1537-2995.2004.00653.x
PMID: 14996194
ISSN: 0041-1132
eISSN: 1537-2995
Language: English
Date published: 2004
Academic Unit: Pathology
Record Identifier: 9984047698102771

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