Navegando por Palavras-chave "Bombas de infusão"
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- ItemAcesso aberto (Open Access)Análise ex vivo do efeito do aquecimento de concentrados de glóbulos vermelhos e uso de diferentes dispositivos de infusão no nível de marcadores de hemólise(Universidade Federal de São Paulo (UNIFESP), 2018-12-20) Pires, Maria Paula de Oliveira [UNIFESP]; Pedreira, Mavilde da Luz Goncalves [UNIFESP]; Rickard, Claire Mihala; Peterlini, Maria Angélica Sorgini [UNIFESP]; http://lattes.cnpq.br/1599622257763420; http://lattes.cnpq.br/5901248667753975; http://lattes.cnpq.br/0669955447309650; Universidade Federal de São Paulo (UNIFESP)Introduction: Warming of red blood cell concentrates (RBC) before transfusion occurs especially in situations of massive transfusion, in order to avoid hypothermia and associated complications. Objectives: To describe the ex vivo effect of RBC warming on markers of hemolysis and infusion by manual and electronic devices. Materials and Methods: Ex vivo experimental research carried out after approval of ethical merit. The sample consisted of 90 RBC infusions, randomly, 45 simulations of infusions of warmed RBC, and 45 simulations of infusions of cold RBC, in three periods: before the intervention (Control), after immersion of the RBC in the water bath at 42º C (Warming), and after the warmed or cold RBC is infused by manual or electronic devices (Infusion) at a flow rate of 100 mL/h. Infusion devices were repeated nine times in each simulation by set drips systems (SD: 18; 20.0%), microdrips (MD: 18; 20.0%), linear peristaltic infusion pumps (PIP: 18; 20.0%), cassette infusion pumps (CIP: 18; 20.0%) and syringe infusion pumps (SIP: 18; 20.0%). RBC were analyzed according to hemolysis markers: hemoglobin concentration (g/dL), plasma free hemoglobin (g/dL), potassium (mmol/L) and lactate dehydrogenase, hemolysis degree (%), hematocrit (%) and total hemoglobin (U/L). In addition, the osmolality (mOsm/Kg) and pH were analyzed in the warmed RBC simulations. The data collection period was from March 2015 to February 2016. Statistical analysis was done using mean, standard deviation, standard error, median, interquartile range, minimum, maximum, tables, boxplot graphs, and the application of parametric test (t test), and non-parametric (Mann-Whitney). The software used for analysis was R 3.1.2, with significance level ≤ 0.05. Results: In the comparison between the Control and Warming stages, a significant reduction in total Hb level (p=0.002) and increase in free Hb levels (p<0.001), degree of hemolysis (p<0.001), and LDH (p<0.001). Infusion pumps presented significant changes in relation to manual devices, with increased values of free Hb (p<0.001), degree of hemolysis (p<0.001) and potassium (p<0.001). Infusion simulations with warmed RBC showed statistical differences when compared to infusion of cold RBC, with an increase in free Hb (p<0.001), degree of hemolysis (p<0.001) and LDH (p<0.001). Conclusion: Despite the variations identified in this study, hemolysis markers levels did not exceed those recommended in the literature for transfusion of RBC. The warming of RBC by immersion in a 42° C water bath and administration by infusion pumps caused a significant increase in markers of hemolysis capable of generating clinical complications in neonates, infants and unstable adults.
- ItemAcesso aberto (Open Access)Bomba de infusão por seringa para transfusão de concentrados de hemácias: análise dos níveis de marcadores de hemólise(Universidade Federal de São Paulo (UNIFESP), 2016-12-21) Gannam, Fernanda Figueiredo [UNIFESP]; Pedreira, Mavilde da Luz Goncalves [UNIFESP]; http://lattes.cnpq.br/5901248667753975; http://lattes.cnpq.br/7966962702628127; Universidade Federal de São Paulo (UNIFESP)Introduction: Syringe infusion pumps (SIP) were developed in the second half of the twentieth century, leading to major advances in intravenous therapy, and they were gradually applied to the transfusion of packed red blood cells (RBC), raising questions on possible cells damage. Objectives: Determining levels of hematocrit levels, total hemoglobin, free hemoglobin, lactate dehydrogenase (LDH), potassium and hemolysis percentage of RBC administered by SIP; investigating the influence of the infusion rate on hemolysis markers levels and describing the influence of RBC storage time, ambient temperature and humidity on hemolysis markers levels. Methods: Experimental study, conducted with 14 packed RBC, of which blood aliquots were filled into syringes. Three SIP of a same manufacture were randomly studied and infusion rates of 5 ml/h, 10 ml/h and 20 ml/h. The hemolysis markers analyzed were: hematocrit (%), total hemoglobin (g/dl), free hemoglobin (g/dl) LDH (U/l), potassium (mmol/l) and hemolysis degree (%). The variables were analyzed according to the average, standard deviation and median, applying the ANOVA or Friedman tests, drawning a linear correlation and coefficients according to Pearson or Spearman?s methods (p=0.05). Results: It was performed 324 hemolysis markers analyses. Among all the analyses that were performed on RBC before manipulation, after filling the syringe and after infusion by SIP, a decrease of total hemoglobin level (p=0.003) was identified with an increase of free hemoglobin level (p<0.001) and on the hemolysis percentage (p<0.001). The comparisons of infusion rates have shown an increase of free hemoglobin levels (5 ml/h: p=0.030; 10 ml/h: p=0.002; 20 ml/h: p=0.016) and hemolysis percentage (5 ml/h: p=0.006; 10 ml/h: p=0.002; 20 ml/h: p=0.009) in all the evaluated rates and there was a significant reduction of total hemoglobin at 10 ml/h (p=0.001). The variations in potassium concentration (p=0.030; p=0.030) and hematocrit (p=0.029; p=0.001) were correlated, respectively, to the ambient temperature and humidity, and temperature with LDH (p=0.008) variation. The RBC storage time was moderately correlated with changes on hemolysis degree (p<0.001), potassium levels (p=0.005) and free hemoglobin (p=0.009). Conclusion: RBC infused by SIP presented changes in free hemoglobin and hemolysis degree levels in all studied infusion rates, and a decrease of total hemoglobin at 10 ml/h. The blood aliquoting into syringes has created a significant increase in free hemoglobin level and the hemolysis degree, indicating occurrence of cell lysis during syringes filling. The increase in potassium concentration was directly proportional to the RBC storage time. In addition, it was identified a correlation between an increase in ambient temperature with an increase in potassium levels, hematocrit and LDH.
- ItemAcesso aberto (Open Access)Marcadores de hemólise em concentrados de hemácias administrados por bombas de infusão peristálticas lineares(Universidade Federal de São Paulo (UNIFESP), 2015-09-30) Martins, Ana Maria Miranda [UNIFESP]; Pedreira, Mavilde da Luz Goncalves Pedreira [UNIFESP]; Peterlini, Maria Angélica Sorgini [UNIFESP]; http://lattes.cnpq.br/1599622257763420; http://lattes.cnpq.br/5901248667753975; http://lattes.cnpq.br/2077514190370554; Universidade Federal de São Paulo (UNIFESP)Introdução: A administração de hemocomponentes por bombas de infusão não é prática totalmente respaldada na literatura, devido ao risco de hemólise pela ação mecânica gerada nos eritrócitos. Objetivos: Determinar e analisar o nível de marcadores de hemólise em concentrados de hemácias administrados por bombas de infusão peristálticas lineares em duas velocidades de infusão. Método: Estudo experimental, com coleta dos dados realizada em laboratório sob condições controladas e após aprovação do Comitê de Ética em Pesquisa. Para o cálculo da amostra, foi feita a estimativa de volume de sangue necessário para o preenchimento dos equipos, dos extensores, para simulação da prática transfusional nas velocidades estudadas e para as análises laboratoriais de cada etapa do experimento. Totalizaram-se quatro unidades de concentrados de hemácias excedentes de estoque fornecidas por um hemocentro. Foram selecionadas bombas de infusão de dois fabricantes, denominadas como A e B, analisadas em triplicata, totalizando seis equipamentos. Para seleção das velocidades de infusão foram mimetizadas situações da prática clínica de enfermagem na terapia transfusional, definidas em 100mL/h e 300mL/h. Houve randomização dos equipamentos, de acordo com as velocidades de infusão. Coletaram-se amostras de controle e experimentais para análise dos marcadores: potássio, hematócrito, hemoglobina total, hemoglobina livre e grau de hemólise. Para análise dos dados, as variáveis contínuas foram descritas por meio da média, desvio-padrão, valores mínimo e máximo e mediana. A distribuição dos marcadores foi estudada por meio da análise de variância (ANOVA) para medidas repetidas e empregaram-se testes de comparações múltiplas entre os momentos do estudo. Foram considerados achados estatisticamente significativos aqueles com probabilidade de erro tipo I inferior ou igual a 5%. Resultados: Das 180 análises dos marcadores estudados, o potássio apresentou alterações significativas na avaliação geral das bombas de infusão e velocidades estudadas (p<0,01). Quando analisadas as velocidades de infusão, o potássio aumentou nos experimentos a 300mL/h (p=0,021). A hemoglobina livre apresentou tendência de elevação em fluxo de 100mL/h (p=0,068). Na análise dos equipamentos, a hemoglobina livre apresentou aumento no experimento com a bomba de infusão A (p=0,026) e o potássio com a B (p=0,022). Os marcadores hematócrito, hemoglobina total e grau de hemólise não apresentaram incrementos estatisticamente significantes nos experimentos. Entretanto, o grau de hemólise apresentou valor acima do recomendado pela legislação vigente entre as etapas do experimento com o fluxo de 300mL/h. Conclusões: Identificou-se potencial para hemólise durante os experimentos, com incremento significante dos marcadores hemoglobina livre e potássio. O potássio aumentou, predominantemente na bomba de infusão B e no fluxo de 300mL/h. O nível de hemoglobina livre mostrou-se elevado nos experimentos com a bomba de infusão A, com tendência de aumento no fluxo de 100mL/h. Considera-se que a realização de novos estudos com outros marcadores de lesão celular e com maior número de amostras sejam relevantes para fundamentação da prática clínica de enfermagem na administração de concentrados de hemácias.
- ItemAcesso aberto (Open Access)Utilização de bombas de infusão no transporte terrestre inter-hospitalar(Universidade Federal de São Paulo (UNIFESP), 2018-12-20) Herrera, Jenny Del Carmen Arcentales [UNIFESP]; Kusahara, Denise Miyuki [UNIFESP]; http://lattes.cnpq.br/2666393667209812; http://lattes.cnpq.br/1560373861616487; Universidade Federal de São Paulo (UNIFESP)Introduction: Interhospital patient transportation is a frequent activity when the need for treatment supersedes the assistance capacity of the hospital. The use of Infusion Pumps (IP) to infuse drugs is a common method of intravenous therapy inside ambulances. The proposed problem is whether the equipment frequently used and tested inside the hospitals are adequate for ground transportation of patients. Objective: To verify the performance, alarm triggering, volume differences and the influence of transportation physical conditions of the IP. Setting and method: experimental study performed through infusion simulations using fluorometric, volumetric and syringe IPs, during interhospital transportation by basic and advance file support ambulances of the prehospital service in Vale do Ribeira Sao Paulo. 54 experiments were performed, 18 using fluorometric IPs, 18 using volumetric IPs, and 18 using IPs by syringe. The equipment was tested at three different flows (1ml/h, 5ml/h and 50ml/h). Researched variables: measured, registered and expected volumes; type and number of alarm triggering; and ground transportation conditions such as speed, temperature, humidity, trepidation and length. For variance analysis tests OneWay ANOVA e KruskalWallis were applied. The exact tests of Fischer or Quiquadrado were adopted to analyze the categoric variables. The significance level was established at 5%. Results: average of the transportation conditions: speed 146,31 ±79,89 km, time 128,72 ±72,20 min., maximum speed of 116,24 ±10,73 Km/h, maximum trepidation 6,65 ±0,94 in the Ritcher scale, temperature of 24,41 ±4,38 ºC and humidity of 76,25 ±8,39% inside the cabin. Average of the volumes: measured volume 32,18 ±49,98 mL; Expected volume 34,47 ±51,20 mL and Registered volume 31,50 ±48,31 mL. Fluorometric pumps had the highest alarm triggering (50%), followed by the syringe pumps (38,9%) and volumetric pumps (22,2%). The free flow alarm was dominant in the fluorometric pumps and air in the line and obstruction alarms were more common in volumetric and syringe pumps. The volume analysis demonstrated that, in all three types of IP, the expected volume of infusions was higher than the actual volume infused and registered by the IP. The trepidation had the highest correlation with the difference among volumes, Expected, Measured and Registered and the error percentage was a minimum of 2,80% and maximum of 25,93%. Conclusion: The three types of IPs presented performance alterations and the highest frequency of free flow alarm was in the fluorometric ones, specially at a infusion speed of 50mL. The expected volume was higher than the infused volume in all three types of tested IP. There were interferences in the IPs performance when they were subjected to the physical conditions of transportation, specially trepidation and the error percentage was higher than the one defined by the Brazilian Agency of Technical Rules (ABNT).