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Identifying factors to minimize phlebotomy-induced blood loss in the pediatric intensive care unit
Stacey L Valentine1, Scot T Bateman
1Department of Anesthesia and Perioperative Medicine, Division of Critical Care Medicine, Children's Hospital Boston, Boston, MA, USA. stacey.valentine@childrens.havard.edu
Insights
Excessive blood draws in critically ill children are common. Using indwelling catheters and drawing for single tests significantly increases blood loss, highlighting the need for improved phlebotomy practices.
Area of Science:
- Pediatric Critical Care Medicine
- Laboratory Medicine
- Patient Safety
Background:
- Phlebotomy-induced blood loss is a significant contributor to anemia in critically ill children.
- Minimizing iatrogenic blood loss is crucial for improving patient outcomes in the pediatric intensive care unit.
Purpose of the Study:
- To identify factors contributing to phlebotomy-induced blood loss in critically ill children.
- To quantify the extent of blood overdraw during phlebotomy procedures.
Main Methods:
- Prospective observational study conducted in a single-center pediatric intensive care unit.
- Involved 63 patients admitted for over 48 hours.
- Data collected on blood volume loss per draw, per day, and per intensive care unit stay.
Main Results:
- Mean blood loss per draw was 2.5 mL, with 1.4 mL discarded as excess.
- Blood drawn via central venous catheters showed significantly higher overdraw (254%) compared to arterial (168%) or peripheral lines (143%).
- Single blood tests resulted in higher overdraw (278%) than multiple tests.
Conclusions:
- Blood drawn in excess of requirements is substantial, often double the volume needed.
- Indwelling catheters necessitate discard volumes, increasing overall blood loss.
- Consolidating tests and utilizing closed systems can reduce overdraw and phlebotomy-induced blood loss.
Objective:
Phlebotomy-induced blood loss in critically ill children is common, contributes to anemia, and may be avoidable. We aimed to identify factors associated with phlebotomy-induced blood loss.
Design:
Prospective observational study, single-center tertiary children's hospital.
Setting:
Pediatric intensive care unit.
Patients:
A total of 63 patients admitted to the pediatric intensive care unit for >48 hrs from 2004 to 2005.
Interventions:
None.
Measurements And Main Results:
Phlebotomy resulted in a mean blood volume loss of 2.5 ± 1.4 mL per draw, 7.1 ± 5.3 mL per day, and 34 ± 37 mL per pediatric intensive care unit stay, of which 1.4 ± 1.1 mL per draw, 3.8 ± 3.6 mL per day, and 23 ± 31 mL per pediatric intensive care unit stay were discarded as excess. This excess represents 210% ± 174% of the volume requested by the laboratory and a 110% overdraw. Blood drawn from central venous catheters had significantly greater overdraw volumes, 254% ± 112%, compared to those of arterial, 168% ± 44%, and peripheral intravenous catheters, 143% ± 39%, p < .001. Blood draws sent for one test had an associated overdraw of 278% ± 81%, compared to draws sent for two, 168% ± 48%, three 173% ± 4%, and four or greater tests 55% ± 5%, p < .001. Patients <10 kg had significantly greater mean volumes of blood loss/kg/day compared to patients ≥ 10 kg, p < .001.
Conclusion:
Blood drawn in excess of phlebotomy requirements exceeds the blood volume loss drawn for phlebotomy by two fold. Using indwelling catheters for phlebotomy often requires a discard volume to be drawn before obtaining the laboratory sample. Consolidating phlebotomy tests and using a closed system may decrease the amount of blood overdrawn and minimize overall phlebotomy-induced blood loss.
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