Reducing Blood Loss From Phlebotomy in Adult Neurocritical Care Patients: An Evidence-Based Practice Project

Area of Science:

• Critical Care Medicine
• Hematology
• Quality Improvement

Background:

• Phlebotomy-induced blood loss is a major contributor to hospital-acquired anemia.
• Small-volume (Pedi) tubes reduce blood loss by 40% without increasing repeat lab draws.
• Pedi tube utilization is a key strategy in blood management programs to reduce anemia and transfusions in ICUs.

Purpose of the Study:

• To implement and assess the feasibility of using Pedi tubes for laboratory draws in adult neurocritical care patients.
• To evaluate the impact of Pedi tube implementation on key patient outcomes.

Main Methods:

• A pre-/post-intervention quality improvement project design.
• Inclusion of consecutive adult patients (18-99 years) admitted to the neurocritical care unit.
• Intervention involved using Pedi tubes for routine lab draws, excluding admission and crisis labs, with retrospective chart review for comparison.

Main Results:

• Successful implementation of Pedi tube use with a significant reduction in repeat laboratory collections (P = .001).
• A 1-day decrease in both ICU and hospital length of stay in the intervention group.
• A reduction in the number of blood transfusions required in the Pedi tube intervention cohort.

Conclusions:

• Small-volume tube phlebotomy is feasible in adult neurocritical care settings.
• Pedi tube implementation can decrease the need for blood transfusions in the ICU.
• This practice supports effective patient blood management strategies.