Safety and feasibility of platelet transfusion through long catheters in the neonatal intensive care unit: an in vitro study

OBJECTIVE

To assess the safety and feasibility of platelet transfusion through small-bore long lines used in the neonatal intensive care unit (NICU), including double-lumen umbilical venous catheters (UVCs) and 24 G and 28 G peripherally inserted central catheters (PICCs).

DESIGN

Prospective in vitro controlled study.

SETTING

Blood transfusion service laboratory.

METHODS

In vitro platelet transfusions were set up as per NICU practice. Transfusion line pressure was monitored. Post-transfusion swirling, presence of aggregates, pH analysis and automated cell count in vitro activation response by flow cytometry assessing CD62P expression were assessed.

MAIN OUTCOME MEASURES

All transfusions completed successfully. The rate of infusion was reduced in 5 of 16 transfusions through 28 G lines due to 'pressure high' alarms. There was no difference in swirling values or transfusion aggregate formation, CD62P expression levels, platelet count, platelet distribution width, mean platelet volume, plateletcrit or platelet to large cell ratio across transfusions post-transfusion.

CONCLUSIONS

This study showed that in vitro platelet transfusion performed through 24 G and 28 G neonatal PICC lines and double-lumen UVCs is non-inferior to 24 G short cannulas, using outcome measures of platelet clumping, platelet activation and line occlusion. This suggests that where available these lines can be used if necessary for platelet transfusion.

The impact of donor biological variation on the quality and function of cold-stored platelets

BACKGROUND AND OBJECTIVES

Room temperature-stored platelets (RTPs) maximize platelet viability but limit shelf life. The aims of this study were to investigate the impact of donor variability on cold-stored platelets (CSPs) and RTP, to determine whether RTP quality markers are appropriate for CSP.

MATERIALS AND METHODS

Double platelet donations (n = 10) were collected from consented regular male donors stored in 100% plasma. A full blood count, donor age, weight, height and body mass index (BMI) were collected at the time of donation. Platelet donations were split equally into two bags, and assigned to non-agitated CSP or agitated RTP. The quality and function of platelets were assessed throughout the standard 7 days of storage and at expiry (day 8). Non-parametric statistical analyses were used to analyse results given the small sample size.

RESULTS

As expected, there were significant differences between CSP and RTP throughout storage including a reduction in CSP concentration as well as a loss of swirling. Furthermore, a significant increase in CSP exhibiting activation and apoptotic markers was observed. Platelet concentrations were further impacted by donor BMI, and donors with the highest BMI (>29) had the lowest platelet concentration and activation response at the end of CSP storage.

CONCLUSION

Platelet quality and functionality play a vital role in transfusion outcomes; however, blood components are inherently variable. This study demonstrated, for the first time, the specific impact of donor BMI on CSP quality and function and highlights the requirement for novel quality markers for assessing CSPs.

174 DEVELOPING THE ROLE OF THE OLDER PERSONS ADVANCED NURSE PRACTITIONER

Background

Advanced Nurse Practitioners (ANP) for Older Persons have advanced clinical skills and work with the Multidisciplinary Team, patients and carers. They practice with a high degree of autonomy under the clinical governance of a Geriatrician. These new roles have been developed in line with the emergence of clinical care pathways and an ageing population. Many are in the area of frailty assessment in the Emergency Department setting. This audit examined the development of the role of Older Persons ANP in a level three hospital.

Methods

Inclusion and exclusion criteria for ANP caseload were developed. ANP referral pathways were established. Referrals and interventions were captured by Audit. Data collection was both quantitative and qualitative

Results

Referrals to the ANP are generated in ED using a Variable Indicator of Placement (VIP) score and via consults from medical teams. 245 inpatients aged over 75 years were seen in 2021. Half referrals were generated by VIP and the other half by consult. Clinical Frailty Scale (CFS) of patients ranged from 4 to 9 but were predominantly 6,7 and 8. The ANP undertook a comprehensive geriatric assessment for these patients. Interventions included medication adjustment, social assessment and specialist advice to the MDT. The ANP “pulls the story together” (Cowley, 2016) providing a holistic link between all parties. Ongoing support is provided in an outpatient setting.

Conclusion

The ANP is well placed to lead holistic care for older people in conjunction with the MDT. In this level three hospital, the ANP role has made a significant impact on the wards as part of the wider specialist geriatric team. This is novel in that many hospitals to date have placed the role in the ED. Variables such as impact on patient outcome, length of stay, readmission rates and service quality are worthy of exploration as the service progresses.

181 FIGHTING BACK AGAINST FRAILTY—THE INTRODUCTION OF A DEDICATED FRAILTY HUB

Background

Quarantine, lockdowns and mandatory isolation have slowed the transmission of Covid-19. However, these public health measures have amplified frailty in our vulnerable older person population by increasing social disconnection, reducing exercise and access to early interventions. In response to this increasingly dependent older population we introduced a ‘frailty hub’ in our hospital. This hub allowed early access to a geriatric review as well as a broader multidisciplinary team intervention.

Methods

We performed a cross sectional review of our new hub which was introduced in our tertiary centre to priortise care of the older person.We analysed attendees from February to June 2021 (20 weeks of data).

Results

There were 121 new patient reviews and 127 follow up consultations.Commonly requested reason for referral was medical assessment (30%), cognitive assessments (30%) and falls(28%). Referral sources were analysed and included consultant referrals (11% n = 13), GP referrals (55% n = 67), multidisciplinary team referrals (6% n = 7) and emergency department referrals (26% n = 32). The average age of those review was 79 years (range 59 years to 99 years). Of all patients 65% were reviewed by physiotherapist, 45% were seen by an occupational therapist, 10% were seen by a speech and language therapist or dietician. 85% had a medication changes. 95% had a follow up review with either a geriatrician or advanced nurse practitioner.

Conclusion

Innovation is required to appropriately target our most vulnerable frail adults.The pandemic has had a detrimental effect on some older adult’s function.Our hub is targeting this group and optimising their care.These are our preliminary findings, we plan on doing further analysis.

Spatial localization and properties of pacemaker potentials in the canine rectoanal region

The present study investigated the spatial organization of electrical activity in the canine rectoanal region and its relationship to motility patterns. Contraction and resting membrane potential (E(m)) were measured from strips of circular muscle isolated 0.5-8 cm from the anal verge. Rapid frequency [25 cycles/min (cpm)] E(m) oscillations (MPOs, 12 mV amplitude) were present across the thickness of the internal anal sphincter (IAS; 0.5 cm) and E(m) was constant (-52 mV). Between the IAS and the proximal rectum an 18 mV gradient in E(m) developed across the muscle thickness with the submucosal edge at -70 mV and MPOs were replaced with slow waves (20 mV amplitude, 6 cpm). Slow waves were of greatest amplitude at the submucosal edge. Nifedipine (1 micro M) abolished MPOs but not slow waves. Contractile frequency changes were commensurate with the changes in pacemaker frequency. Our results suggest that changing motility patterns in the rectoanal region are associated with differences in the characteristics of pacemaker potentials as well as differences in the sites from which these potentials emanate.