Effective measures for reducing blood loss from diagnostic laboratory tests in intensive care unit patients

We studied ICU patient blood loss as a result of diagnostic testing (DBL) and the effect of two measures to reduce it. A policy of using small volumes (pediatric phlebotomy tubes, reduced syringe volumes) for the most frequent laboratory tests was implemented in our medical ICU. We prospectively studied 151 patients admitted during two consecutive 10-wk periods. During period 2, DBL was displayed on each ICU flow sheet. The DBL/day (43.6 +/- 3 [SEM] ml) was significantly lower (62.6 +/- 4 ml) than it would have been if standard volume tubes had been used. This represented an average savings of 33%. During period 1 (n = 81), eight (10%) patients with no diagnosis involving blood loss had a decrease in Hct and received transfusion. DBL was significantly higher (316 +/- 81 vs. 168 +/- 18 ml, p less than .001) for these patients and represented an average of 17% of transfusion requirements. During period 2 (n = 70), such transfusion requirements were significantly reduced (only one of 70, p less than .001), as were tests ordered/day (7.8 +/- 0.5 vs. 9.5 +/- 0.6, p less than .05). We conclude that DBL is a major health problem for the ICU patient. Routine use of small specimen volumes in this setting is warranted. Recording DBL for use in physician decision-making also significantly impacts this problem and should be considered an important part of the ICU database.