Filter size for neonates

[Jody]

Hello all,

I am looking for references related to appropriate filter size for neonatal transfusion of blood components. Most of the items that I am finding reference the adults or filter size of 170-260 microns, yet there are some products out there with different filter sizes.

Any suggestions??

Thanks!

[Malcolm Needs ☆]

Now, I'll be honest, I know nothing about this, but, as the filters are filtering the same things (red cells from adult donors, platelet preparations from adult donors, etc), why would the filter size be different even if the same things are being transfused into neonates?

Surely, it is the contents of the bag, rather than the size of the recipient that is important?

As I say, this is not my area, so I could be talking complete rubbish (it wouldn't be the first time).

[shelleyk482]

In the Children's Hospital I worked at a couple of years ago, our neonatologists insisted on a 40 micron filter. Their claim was that microclots could be detrimental to the vasculature of their small patients. I was not able to find any literature to support this and they never furnished any but it's what they wanted so it was what we used. Pall used to have a list on their website (they may still have it) of the facilities that used their syringe aliquot system and when I called some of those facilities, I found that most used the standard 170 micron filter. If the list is still available, you may want to do a poll of these facilities and see what the current standard practice is.

Edited August 5, 2010 by shelleyk482
spelling error

[Jody]

Thank you for the responses.

You would think this would be an easy item to research and prove. We have the rumor about micro clots around here. I asked my nursing department to provide me references for this and they can't find any references to filter size in their materials.

I have also being asking the same question to the manufacturers of the sets that have smaller micron filter sizes. I have left them speechless also. I guess they never had anyone ask why or what they submitted to the FDA for approval.

[Eagle Eye]

We use pediatric syringes for aliquots so we use the filter in BB. On the floor they do not require the filter and is written in our policy.

[Jody]

We use pediatric syringes for aliquots so we use the filter in BB. On the floor they do not require the filter and is written in our policy.

Do you use a sterile connection device? I am assuming you make the syringes just before issue?

[DOGLOVER]

We use the Charter Med syringe system which has a 150 micron filter. We make the syring in Blood Bank and they don't have to filter again in the NICU. We have about 50 NICU beds and this system works well for us. If a larger amount is needed we put in a pedi-bag and the floor uses a Charter Med transfer set which also has a 150 micron filter.

[Eagle Eye]

Do you use a sterile connection device? I am assuming you make the syringes just before issue?

Yes. we use sterile connecting device and make syringes just before issue.

[Jody]

We use the Charter Med syringe system which has a 150 micron filter. We make the syring in Blood Bank and they don't have to filter again in the NICU. We have about 50 NICU beds and this system works well for us. If a larger amount is needed we put in a pedi-bag and the floor uses a Charter Med transfer set which also has a 150 micron filter.

Do you use a sterile connecting device? Our practice is too small to incorporate a SCD.

[shelleyk482]

We also use a sterile connecting device to attach the syringe to the parent bag. We only do a few aliquots per month (3-5) but I think the SCD is worth investing in. The BB staff and the nursing staff all feel that we are using a safer product since we went to using the SCD. The initial cost is fairly significant but I was able to get it through based on patient safety; plus the SCD lasts forever and rarely (if ever) needs repair.

[ahalim]

Now, I'll be honest, I know nothing about this, but, as the filters are filtering the same things (red cells from adult donors, platelet preparations from adult donors, etc), why would the filter size be different even if the same things are being transfused into neonates?

Surely, it is the contents of the bag, rather than the size of the recipient that is important?

As I say, this is not my area, so I could be talking complete rubbish (it wouldn't be the first time).

I think this is logic and i will be very sad if it came out as rubbish!!

[Townsend]

We also use the sterile connection device to prepare syringes using the Charter Medical syringe/filter sets. They use a standard 150 micron filter. We have not used a smaller microaggregate filter in many years. The only ones we used to have available required the bag to be entered, thus creating an open system with a 24 hour outdate.

We also prepare bag aliquots for larger patients that would need to be filtered at the bedside prior to administration. Although the sterile connection device is an absolute must in our Children's Hosp Transfusion Service, I can see the reluctance in having one for only a few aliquots per month. (FYI - if you prepare aliquots you would need to have a relabeling policy as well as being registered with the FDA).

One thing you may also want to think about is if you are not pre-filtering in the Transfusion Service, the nursing staff will need approximately 20mL extra of blood product (or saline if you can convince them) to prime the filter. This is one advantage of the pre-filtered syringe of only needing a few extra mLs for tubing (some of our syringes that we prepare are only 10-20mL each!)

[SMW]

We also prepare bag aliquots for larger patients that would need to be filtered at the bedside prior to administration. Although the sterile connection device is an absolute must in our Children's Hosp Transfusion Service, I can see the reluctance in having one for only a few aliquots per month. (FYI - if you prepare aliquots you would need to have a relabeling policy as well as being registered with the FDA).

Simply making aliquots, i.e. dividing a parent unit into smaller units of same product as parent unit, does not require FDA registration. But if you're manfacturing a new product, e.g., combining plasma and red cells to create a "Reconstituted whole blood" or irradiating or washing the aliquots, then FDA registration is required.

[Vic]

We use a 150micron filter and syringe adapter for Neonatal/Pediatric transfusions. (Charter medical product) We issue the filter with the blood and let nursing take it from there.