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Pediatric size phlebotomy tubes and transfusions in adult critically ill patients: a pilot randomized controlled
Javier Barreda Garcia1, Jonathan Z Xian1, Claudia Pedroza2
1Division of Critical Care Medicine, Department of Internal Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin Street, MSB 1.434, Houston, TX 77030 USA.
Insights
Pediatric phlebotomy tubes are acceptable for adult intensive care unit (ICU) patients, potentially reducing red blood cell (RBC) transfusions. Further trials are recommended, especially for patients with lower hemoglobin levels.
Area of Science:
- Critical Care Medicine
- Hematology
- Medical Devices
Background:
- Red blood cell (RBC) transfusions are common but carry risks and are resource-limited.
- Reducing iatrogenic blood loss is key to minimizing transfusions.
- Pediatric phlebotomy tubes were investigated as an intervention to reduce blood loss in critically ill adults.
Purpose of the Study:
- To assess the feasibility and acceptability of using pediatric phlebotomy tubes in adult ICU patients.
- To evaluate the potential effectiveness of pediatric tubes in reducing RBC transfusions.
- To determine the suitability of patient eligibility criteria for future trials.
Main Methods:
- A pilot randomized controlled trial was conducted in a university-affiliated ICU.
- 200 adult patients were randomized to use either pediatric or adult size phlebotomy tubes.
- Feasibility was assessed by blood test recollections and discontinued use; effectiveness was measured by time to RBC transfusion or hemoglobin below 7 g/dL.
Main Results:
- Pediatric tubes were found to be acceptable, with infrequent test recollections and no discontinuations.
- The baseline hemoglobin category was the only factor associated with RBC transfusions.
- Fewer patients in the pediatric tube group (6%) received RBC transfusions compared to the adult tube group (11%).
Conclusions:
- Pediatric phlebotomy tubes are acceptable for use in adult ICU patients.
- The intervention shows potential effectiveness, particularly in patients with baseline hemoglobin levels below 9.5 g/dL.
- A definitive trial is warranted to confirm these findings.
Background:
Transfusion of red blood cells (RBC) is common, can have adverse effects, and is a costly and limited resource. Interventions that reduce iatrogenic blood losses could reduce transfusions. The objectives of this pilot trial were to assess the feasibility (acceptability of the intervention and suitability of eligibility criteria) and potential effectiveness of pediatric size phlebotomy tubes in adult critically ill patients.
Methods:
We conducted a pilot, randomized controlled trial in the medical intensive care unit (ICU) of a university-affiliated, tertiary care referral hospital from November 2017 to September 2018. A total of 200 patients with hemoglobin of at least 7 g/dL and without bleeding were randomized to pediatric or adult size phlebotomy tubes. Stratification was according to baseline hemoglobin (7-9.49 g/dL, 9.5-11.99 g/dL, and 12 g/dL or greater). Acceptability was measured via the number of blood test recollections and the number of patients that discontinued the use of pediatric tubes. The suitability of patient eligibility criteria was determined by identifying baseline characteristics associated with RBC transfusions. Potential effectiveness was estimated from the time to RBC transfusion or to hemoglobin level below 7 g/dL.
Results:
The use of pediatric tubes was acceptable as patients experienced a low number of tests recollections (on average 1 every 57 days), and none of the participants discontinued their use. The baseline hemoglobin category was the only factor that appeared to be independently associated with RBC transfusions. A total of 6 patients (6%) in the pediatric tube group and 11 patients (11%) in the adult tube group (hazard ratio, 0.69; 95% CI, 0.25 to 1.9) received an RBC transfusion or reached hemoglobin below 7 g/dL. Almost all of these patients (16 of 17 participants) had baseline hemoglobin of 7-9.49 g/dL.
Conclusions:
This pilot study suggests that pediatric phlebotomy tubes are acceptable to patients and can therefore be used in adult ICU patients. A future study should focus on patients with hemoglobin levels below 9.5 g/dL, as these patients have a high risk of transfusions. This intervention has the potential of being successful in selected patients. A definitive trial is warranted.
Trial Registration:
ClinicalTrials.gov, NCT03286465. Retrospectively registered on September 18, 2017.
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