as someone once said to me "if air bubbles were that dangerous, there would not be a live junkie in the world" (and yes, I do understand the difference between the arterial and venous sides of the system).

discuss............

... not to mention neonate "junkies"!

Hi, We have seemed to solve some of the problems re air in line etc......
when air in line or air bubble alarm is alarming , prime the line as per usual.... if the problem is still there and there is no visable signs etc of air and it still keeps alarming... reset the pump with new volumes etc (as your setting it up for a new patient) then the pump should then be ok. been told its to do with the memory data for the previous alarm setings. obviously not all pumps will mend itself , if the alarm is still there then ok it is faulty and needs attending to.
Was told this by Braun and my medical electronics manager .

Hi,
I'm experiencing the same problem, lots of small bubbles post the pump and causing endless accumulation alarms.
Blood is from fridge, no heating performed, one unit delivered in 1 hour.
As previous discussion outlines, the rising temp of blood releases gas but should the set not remove the gas via maybe a double bubble trap.
I have repeated excercise with Baxter Colleague - no problems encountered, obviously not as sensitive as the BBRaun but there were no bubbles forming to cause an alarm.
Any solutions, suggestions, help appreciated.
Thanks,
Noel

BBraun admit that there is a micro-bubble problem with cold blood. As it warms up micro-bubbles are formed and these exceed the alarm limit. It is possible to raise the accumulation alarm limit.

The bubble trap will remove bubbles but these micro-bubbles come from disolved gas so will not be removed by the trap.

One problem is that these are micro-bubbles and you will not see them so it seems the air-in-line is going off incorrectly. So the staff often report a faulty pump.

The solution is for the staff to let the blood reach room temperature before infusing it - as they should do but most often do not.


RoJo

I can't help but wonder how the patient feels about (reacts to) that?

Surely blood needs to be warmed before infusion?

There is also the issue with the Air in line on the Braun pumps, which is caused by weakened plastic coating which effected a batch at the time - email me for more information.

Thanks for your replies!

Just a few comments:
Out accumulation alarm has been increased to max - 3.8
The bubbles which form in our sets are easy to see- could not be mistaken.
In relation to temperature, I have done a bit of reading on this, our hospital policy does not advise to warm the blood unless
•Patients with high titres of cold agglutinins
•Patients receiving massive transfusions at/in excess of 50ml/kg/hr

I have also read a number of UK guidelines and the same is indicated. It looks like one of the big risks with blood transfusions is bacteria, therefore increasing the blood temp could let to bacteria growth?? I have included a few comments from guidelines below.

I would be very interested in info related to a issue with the plastic coating, I will make contact for info.
Thanks,
Noel


Red cells
1. Complete the transfusion of the unit
within four hours after it is removed from
controlled temperature storage (CTS).
2. A red cell unit that has been out of CTS
for longer than 30 minutes should not
be accepted back into stock by the
blood bank, unless there is a validated
local procedure to ensure that any unit
returned to blood bank stock is suitable
for transfusion.
3. Red cell units must not be warmed
other than in an approved device, nor
left in sunshine or near a heat source.
Rationale
Once it is out of CTS, the risk of bacterial
proliferation increases with time,
especially in a warm ambient temperature.
Even a short period of exposure to high
temperature may be deleterious.

Blood should be transfused within four hours of its removal from storage (there is a risk of bacterial proliferation and red call metabolism if the blood reaches an ambient temperature for a sustained period of time) (RCN 2005)

the reason for the alarms is that the b-braun pumps accumilated air alarm counts bubbles down to 0.1 micro litres all other manufactuers i contacted state they count bubbles down to 0.45 micro litres. when i was shown the eu requirements for air it states all bubbles less than 0.45 mico litres can be ignored. when i mentioned counting bubbles down to 0.1 microlitres they all said this would cause nonsense alarms. our cancer department got so frustrated with the brauns they chucked them out and went back to baxter.