Blood sampling in adult critical care: a mixed methods study

Area of Science:

• Critical Care Medicine
• Nursing Practice
• Laboratory Medicine

Background:

• Limited research exists on blood sampling practices in critical care settings.
• The perspectives of nursing staff regarding blood sampling are underrepresented in the literature.

Purpose of the Study:

• To investigate blood sampling practices within a specialist orthopaedic National Health Service (NHS) trust.
• To explore the views and experiences of nursing staff concerning blood sampling procedures.

Main Methods:

• A mixed-methods approach was employed, combining an audit of sampling practices over four weeks with two focus group discussions with nurses.
• Data collection involved quantitative audit data and qualitative insights from nursing staff.

Main Results:

• Routine daily blood sampling was common, with volumes comparable to other studies.
• Qualitative findings identified four key themes: training and responsibility, influences and impacts, nursing time, and errors.
• Daily blood loss from sampling may contribute to post-operative hemoglobin decline and subsequent blood transfusions.

Conclusions:

• Current routine blood sampling may not be patient-centered and could lead to unnecessary blood loss.
• Recommendations include considering small-volume phlebotomy tubes (SVPT), closed sampling systems, and increased Point of Care Testing (POCT).
• Enhanced education and clear protocols are crucial to minimize unnecessary blood draws in elective adult critical care.