Problems in transfusion

Hi,
Most infants have problems finding the veins and Hassan too is no exception. But the problem we had this time was unacceptable.I will just detail the procedure the hospital follows. First they pass the blood from the bag through a leukocyte reduction filter(on our demand). Then in a very crude way they fill a syringe, opening and closing the vent all the time to release trapped air, spilling blood everywhere... The syringe is then fitted in some sort of a machine. Seconds after infusion starts the machine stops beeping a message - LINE OCCLUSION. The doc said this was because packed RBC`S are thick. The rate of infusion was so slow that only 50ml was infused in three hours. As the transfusion period should not exceed 6 hours a RMO came and instructed the nurse to inject 10 ml every 15 mins directly via the cannula. Hassan was already very tired as the machines constant beeping didn`t allow him to sleep and he wasn`t enjoying the nurses constant company. Ultimately a nurse from neo natal ward was contacted as she was an expert in handling that useless apparatus. The machine continued its beeping but she managed to control the infusion rate and finally 2 hours later it was done. Even she said the same thing that this was because packed RBC`s are thick .

P.S- The set connecting the syringe was changed thrice. They kept flushing Hassan with normal saline.

Since all thal receive packed RBC`s do they have any problems . The sister said since a leukocyte reduction filter was used they couldn`t use the normal infusion sets. Since our insurance is booked in that hospital we go there although we did try another place before but that was even worse.
Regards
MAHA

Hi Maha,

That indeed seems like a pretty complicated procedure and equipment for a simple blood transfusion!

Further more doesn't all that use of the syringe break up the RBCs rendering them useless???

We use a simple transfusion set that works by the earth's gravity. No pumps and electricity involved. They just hook the pipe up to the bag which hangs overhead, simple!

Yes i agree with Sajid, we also, use simple transfusion set, no machines involved,and 400 ml of blood is usually infused in 2 or 2 and a half hours,and once in a blue moon it happens that infusion gets slow due to thick RBC'S, but not that slow.

ZAINI.

Same here for my daughter. In her first couple of transfusions the packed cell was kept in a paediatric container for better measurement and making the transfusion process slightly slower.  After that she has been getting transfusion directly from the blood bag using a blood set. No other filters /pumps have ever been used.

Generally the transfusion time is calculated  by 5 ml of packed cell per kg of body weight per hour. However, now a days a  3 way canula is used on top of the IV channel. So that Desferral can also be infused slowly along with blood in the IV.

For paediatric patients generally the channel making part depends on the efficiency of the concerned Nurse. It is better to get the channel done only from specialist paediatric nurses.

We do use filter,

ZAINI.

Hi Zaini
What kind of a filter do you use? Is it a leukocyte reduction filter or is it just a blood filter? The nurse said they had to use that machine if a leukocyte reduction filter was used.
Regards
MAHA

Hi Maha,

Yes, we use leukocyte reduction filter , and with out any machine.

ZAINI.

Hi Zaini
Thanks for the info. We have worked out with our insurance to consult even in hospitals which they haven`t listed. So hopefully I don`t have to see that doc, those nurses and that horrible apparatus again.
Thankyou once again
MAHA

Here in Australia, transfusion rule had changed once and the equipment at the hospital had changed once in 3 years too. I used to have to beg the nurse to increase transfusion rate because my son got inpatient after 3.5 hours being restrained. Then a year ago, the rule change and the nurse said that no blood pack would be allowed to be hung for more than 2 hours. There were times when I had to request for the rate to be lowered because my son's arm would swell and he would cry in agony. So, I am always glad when transfusion went smoothly from month to month.