Small-volume tubes to reduce anemia and transfusion (STRATUS): a pilot study

Area of Science:

• Clinical Medicine
• Laboratory Diagnostics
• Patient Blood Management

Background:

• Blood sampling for diagnostic tests contributes to patient blood loss.
• Standard-volume tubes are common, but small-volume alternatives offer potential benefits.
• The impact of small-volume tubes on transfusion needs in intensive care units (ICUs) requires investigation.

Purpose of the Study:

• To assess the feasibility of implementing small-volume blood collection tubes in an ICU setting.
• To evaluate the potential for small-volume tubes to reduce blood transfusions compared to standard-volume tubes.
• To inform the design of a larger stepped-wedge cluster trial.

Main Methods:

• A prospective, mixed-methods pilot study with a before-and-after design was conducted in one ICU.
• The study included a six-week control period (standard-volume tubes) and a six-week intervention period (small-volume tubes).
• Feasibility was assessed through successful implementation, adherence, sample adequacy, user acceptance via focus groups, and transfusion data collection.

Main Results:

• Transition to small-volume tubes was successful, with 100% compliance and no increase in inadequate samples (0.2% in both groups).
• End-user acceptability was high, with no identified barriers during ten focus groups.
• Estimated blood loss per patient per day due to laboratory testing was significantly reduced from 11 mL (standard) to 6 mL (small-volume).

Conclusions:

• Small-volume blood collection tubes are implementable in ICUs with high user acceptance and no significant barriers.
• The use of small-volume tubes did not compromise sample adequacy for diagnostic testing.
• These findings provide a strong basis for a definitive trial to determine if small-volume tubes reduce transfusion requirements.