Phlebotomy overdraw in the neonatal intensive care nursery

Area of Science:

• Neonatal Medicine
• Laboratory Medicine
• Patient Safety

Background:

• Blood loss from laboratory testing is a primary cause of anemia in preterm infants.
• Phlebotomy overdraw, or excess blood drawn, is a potentially correctable source of this blood loss.

Purpose of the Study:

• To quantify blood loss from phlebotomy overdraw in neonates.
• To identify clinical factors associated with excessive blood draws.
• To explore potentially correctable causes of phlebotomy overdraw.

Main Methods:

• Blood samples from neonates in special care units were weighed to determine volume drawn.
• Clinical data including collection container, infant weight, location (NICU), and phlebotomist experience were recorded.
• Univariate and multivariate analyses were used to identify factors associated with overdraw.

Main Results:

• Mean blood draw volume exceeded requested amounts by 19%.
• Factors associated with greater overdraw included unmarked collection tubes, lower infant weight, and critically ill infants in the NICU.
• Individual phlebotomist variation significantly contributed to overdraw, increasing the model's explanatory power.

Conclusions:

• Significant blood loss occurs due to phlebotomy overdraw, exacerbating anemia of prematurity and potentially increasing transfusion needs.
• Using collection tubes with fill-lines and addressing phlebotomist-specific variations may reduce overdraw.
• The finding that lightest and most critically ill infants experienced the greatest overdraw highlights a critical area for intervention.