Marcadores de hemólise em concentrados de hemácias administrados por bombas de infusão peristálticas lineares
Data
2015-09-30
Autores
Martins, Ana Maria Miranda 
Orientadores
Pedreira, Mavilde da Luz Goncalves Pedreira
Tipo
Dissertação de mestrado
Título da Revista
ISSN da Revista
Título de Volume
Resumo
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.
Introduction: Ministering hemocomponents through infusion pumps is not a fully supported practice in literature, due to erythrocytes mechanical hemolysis risk. Objectives: Determine the hemolysis level in packed red blood cells ministered by linear peristaltic infusion pumps in two different rates and manufactures. Method: This is an experimental study, done under controlled conditions and approved by our Research Ethics Committee. To determine sample volume, we estimated the volume needed to fulfill the extensors and infusion lines. Four packed red blood cells unities, all blood-center surplus, were used. Infusion pumps of two different manufactures (A and B) were used and experiments were done in triplicates, in a total of six. Infusion rates were selected to reproduce real situations of nursing practice, and were set at 100ml/h and 300ml/h. The combination of each equipment and its rate was randomized. Control and experimental samples were collected after infusion pump flow and potassium, hematocrit, hemoglobin and haemolysis level markers were analyzed. For analysis of continuous data, we used mean, standard deviation, minimum and maximum and median values. Analysis of Variance (ANOVA) was the method for markers distribution study, both to repeated measures and to different moments of study. Statistical significance for type I error was established on 5% or below. Results: Of the 180 markers analyses, potassium showed significant difference in the overall assessment of infusion pumps and speeds studied (p<0,01). When analyzed infusion rates, potassium increased in the experiments at 300mL/h (p=0,021). The free hemoglobin showed a tendency to increase at 100ml/h flow (p=0,068). On the equipment analysis, free hemoglobin showed an increase on infusion pump A (p=0,026) and potassium on B (p=0,022). Hematocrits markers, and total hemoglobin and degree of hemolysis showed no statistically significant increases in the experiments. However, the degree of hemolysis showed a value above that recommended by law between the experiment steps on the 300mL/ h flow. Conclusions: We identified hemolysis potential during the experiments, with a significant increase in free hemoglobin and potassium markers. Potassium increased mainly in infusion pump B and at the infusion rate of 300mL/h. Free hemoglobin level was high in the experiments with the infusion pump A, with an upward trend on 100mL/h flow. We consider that new studies, with other cell injury markers and more samples, are relevant for clinical nursing practice theoretical support.
Introduction: Ministering hemocomponents through infusion pumps is not a fully supported practice in literature, due to erythrocytes mechanical hemolysis risk. Objectives: Determine the hemolysis level in packed red blood cells ministered by linear peristaltic infusion pumps in two different rates and manufactures. Method: This is an experimental study, done under controlled conditions and approved by our Research Ethics Committee. To determine sample volume, we estimated the volume needed to fulfill the extensors and infusion lines. Four packed red blood cells unities, all blood-center surplus, were used. Infusion pumps of two different manufactures (A and B) were used and experiments were done in triplicates, in a total of six. Infusion rates were selected to reproduce real situations of nursing practice, and were set at 100ml/h and 300ml/h. The combination of each equipment and its rate was randomized. Control and experimental samples were collected after infusion pump flow and potassium, hematocrit, hemoglobin and haemolysis level markers were analyzed. For analysis of continuous data, we used mean, standard deviation, minimum and maximum and median values. Analysis of Variance (ANOVA) was the method for markers distribution study, both to repeated measures and to different moments of study. Statistical significance for type I error was established on 5% or below. Results: Of the 180 markers analyses, potassium showed significant difference in the overall assessment of infusion pumps and speeds studied (p<0,01). When analyzed infusion rates, potassium increased in the experiments at 300mL/h (p=0,021). The free hemoglobin showed a tendency to increase at 100ml/h flow (p=0,068). On the equipment analysis, free hemoglobin showed an increase on infusion pump A (p=0,026) and potassium on B (p=0,022). Hematocrits markers, and total hemoglobin and degree of hemolysis showed no statistically significant increases in the experiments. However, the degree of hemolysis showed a value above that recommended by law between the experiment steps on the 300mL/ h flow. Conclusions: We identified hemolysis potential during the experiments, with a significant increase in free hemoglobin and potassium markers. Potassium increased mainly in infusion pump B and at the infusion rate of 300mL/h. Free hemoglobin level was high in the experiments with the infusion pump A, with an upward trend on 100mL/h flow. We consider that new studies, with other cell injury markers and more samples, are relevant for clinical nursing practice theoretical support.
Descrição
Citação
MARTINS, Ana Maria Miranda. Marcadores de hemólise em concentrados de hemácias administrados por bombas de infusão peristálticas lineares. 2015. 125 f. Dissertação (Mestrado) - Escola Paulista de Enfermagem, Universidade Federal de São Paulo (UNIFESP), São Paulo, 2015.