Related Experiment Video
Updated: Dec 26, 2025
Continuous Manual Exchange Transfusion for Patients with Sickle Cell Disease: An Efficient Method to Avoid Iron Overload
Published on: March 14, 2017
Implementation of a Blood-Saving Program in a Pediatric Intensive Care Unit to Reduce Diagnostic Blood Loss
Jörg Michel1, Michael Hofbeck1, Judit Vinuales Balcells1
1Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children's Hospital Tübingen, Tübingen.
Insights
A quality improvement program successfully reduced blood loss from blood sampling in a pediatric critical care unit (PICU). This educational initiative significantly decreased daily diagnostic blood loss by approximately 35% in infants.
Area of Science:
- Pediatric Critical Care Medicine
- Quality Improvement Initiatives
- Neonatal and Infant Health
Background:
- Blood loss due to frequent blood sampling is a concern in pediatric critical care units (PICUs).
- Neonates and infants undergoing cardiac surgery are particularly vulnerable to blood loss.
- An educational program was developed to address this issue.
Purpose of the Study:
- To reduce blood loss from blood sampling in neonates and infants in the PICU.
- To evaluate the effectiveness of an educational program for staff in minimizing blood loss.
- To assess the impact on blood volume and transfusions post-cardiac surgery.
Main Methods:
- A quality improvement program involving staff education was implemented in a tertiary referral center's PICU.
- Patients aged 0-12 months undergoing congenital heart disease surgery on cardiopulmonary bypass were divided into pre- and post-implementation groups.
- Postoperative blood sample frequency, types, volume, and blood transfusions within 5 days were assessed.
Main Results:
- The educational program led to a significant reduction in blood drawn for blood gas analysis and complete blood counts.
- Daily diagnostic blood loss per patient was reduced by approximately 35% (1.7 ml/kg/d to 1.1 ml/kg/d).
- Patient populations were similar before and after the program, indicating the program's direct impact.
Conclusions:
- A simple educational program for PICU staff is feasible and effective in significantly reducing blood loss from diagnostic sampling.
- While red blood cell transfusions were not significantly reduced, minimizing diagnostic blood loss is crucial for critically ill children.
- This quality improvement initiative offers a beneficial approach to patient blood management in pediatric intensive care.
Background:
We aimed to reduce blood loss in the pediatric critical care unit (PICU) due to blood sampling in neonates and infants. Therefore, an educational program for our staff was established and evaluated.
Methods:
Patients in a PICU of a tertiary referral center aged 0-12 months who underwent surgery of congenital heart disease on cardiopulmonary bypass were enrolled and divided into a pre- and a post-implementation group. We assessed frequency and types of postoperative blood samples, required blood volume, and amount of blood transfusions in the PICU within 5 days after cardiac surgery.
Results:
Populations were similar prior and after the implementation. Blood drawn for blood gas analysis (0,52 ml±0,16 vs. 0,38 ml±0,12, p<0,001) and for complete blood sampling (2,62 ml±0,32 vs. 2,11 ml±0,35, p<0,001) could be successfully reduced after implementation of our blood-saving program. The daily diagnostic blood loss per patient was significantly reduced by approximately 35% (1,7 ml/kg/d±1,0 vs. 1,1 ml/kg/d±0,7, p=0,008).
Discussion:
Our quality improvement program is feasible and effective to significantly reduce the blood loss due to blood sampling. Although the incidence of red blood cell transfusions was not significantly reduced, it is certainly beneficial to try to reduce diagnostic blood loss, especially in children with complex diseases requiring long-term intensive care treatment.
Conclusion:
We could demonstrate that it is possible to significantly reduce the blood loss due to blood sampling with a simple educational program for PICU staff.
Hintergrund:
Unser Ziel war es, den Blutverlust durch Blutabnahmen auf der pädiatrischen Intensivstation bei Neugeborenen und Säuglingen zu reduzieren. Deshalb wurde ein Schulungsprogramm für unsere Mitarbeiter etabliert und ausgewertet.
Methode:
Patienten unserer pädiatrischen Intensivstation im Alter von 0-12 Monaten nach einer Operation eines angeborenen Herzfehlers mit Herz-Lungen-Maschine, wurden eingeschlossen und in eine Gruppe vor und nach der Implementierung des Schulungsprogramms zugeteilt. Wir haben die Häufigkeit und Art der postoperativen Blutproben, das benötigte Blutvolumen und die Menge der Bluttransfusionen auf der Intensivstation innerhalb von 5 Tagen nach der Herzoperation ausgewertet.
Ergebnisse:
Die Patientencharakteristik beider Gruppen zeigte keine relevanten Unterschiede. Blut, das für Blutgasanalysen (0,52 ml±0,16 vs. 0,38 ml±0,12, p<0,001) und für vollständige Blutentnahmen (2,62 ml±0,32 vs. 2,11 ml±0,35, p<0,001) entnommen wurde, konnte nach Umsetzung unseres Blutsparprogramms erfolgreich reduziert werden. Der tägliche diagnostische Blutverlust pro Patienten wurde signifikant um ca. 35% reduziert (1,7 ml/kg/d±1,0 vs. 1,1 ml/kg/d±0,7, p=0,008).
Diskussion:
Unser Schulungsprogramm für Mitarbeiter ist einfach umzusetzen und effektiv, den Blutverlust durch Blutentnahmen deutlich zu reduzieren. Obwohl die Inzidenz von Bluttransfusionen nicht signifikant reduziert wurde, ist es sicherlich erstrebenswert, den diagnostischen Blutverlust insbesondere bei Kindern mit komplexen Krankheiten, die eine langfristige Intensivbehandlung erfordern, zu reduzieren.
Schlussfolgerung:
Wir konnten zeigen, dass es möglich ist, den Blutverlust durch Blutentnahme mit einem einfachen Schulungsprogramm für Mitarbeiter auf der Intensivstation deutlich zu reduzieren.
