Using Adult Level One Blood Infusers in Pediatric Trauma Patients
Adult level one blood infusers can be used for pediatric trauma patients, but require appropriate modifications based on the child's size and careful monitoring for electrolyte imbalance and hypothermia during rapid blood administration. 1
Considerations for Pediatric Blood Administration
Size-Appropriate Modifications
When using adult blood infusion devices in pediatric trauma patients, several important considerations must be addressed:
Volume-based prescription: Blood should be prescribed in volume (ml/kg) rather than units for pediatric patients 1
- Red blood cells: 10 ml/kg (expected to increase Hb by approximately 20 g/l)
- Platelets: 10-20 ml/kg
- Fresh frozen plasma: 10-15 ml/kg
- Cryoprecipitate: 5-10 ml/kg
Blood volume awareness: Children have different blood volumes based on age 1
- Standard estimate: 70 ml/kg for most children
- Newborns: Up to 100 ml/kg
- This awareness is critical when calculating replacement volumes
Special Risks in Pediatric Patients
Children face unique risks during rapid blood administration that must be monitored closely:
- Electrolyte imbalance: Pediatric patients are particularly susceptible to electrolyte disturbances during rapid blood administration 1
- Hypothermia: Children have a larger surface area to volume ratio and are at higher risk of hypothermia during massive transfusion 1
- Rate control: Adult infusion devices must be carefully adjusted to deliver appropriate rates for smaller patients
Trauma Resuscitation Principles
The AAGBI guidelines indicate that adult trauma resuscitation principles can generally be applied to children with appropriate modifications 1:
Follow damage control resuscitation principles:
- Early hemorrhage control using temporary hemostatic devices
- Permissive hypotension (with modification for head/spinal injuries)
- Avoid crystalloid/colloid during uncontrolled hemorrhage
- Target trauma-induced coagulopathy
Tranexamic acid dosing for pediatric trauma: 15 mg/kg loading dose followed by 2 mg/kg/h infusion 1
Blood product ratios: Similar to adults, use 1:1 ratio of RBC:FFP during active hemorrhage control 1
Practical Implementation
When using an adult level one infuser for pediatric trauma patients:
- Device selection: Ensure the infuser can be adjusted to appropriate flow rates for children
- Warming function: Utilize the warming capability to prevent hypothermia
- Pressure settings: Adjust pressure settings based on child's size and vascular access
- Monitoring: Implement close monitoring of temperature, electrolytes, and calcium levels
Pitfalls to Avoid
- Overinfusion: Adult devices may deliver volumes too rapidly for smaller children
- Inadequate warming: Failure to properly warm blood products can rapidly induce hypothermia
- Ignoring weight-based calculations: Always calculate volumes based on the child's weight
- Failure to monitor electrolytes: Particularly calcium levels during massive transfusion
Recent research indicates that pediatric massive transfusion protocols have become more standardized 2, though specific guidelines for pediatric massive transfusion remain less defined than adult protocols 3. When using adult equipment, the principles must be adapted with careful attention to the child's size and physiologic differences.