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Pediatric blood volumes: a one-page reference guide
1Clinical Pathology Department, City of Hope National Medical Center, Duarte, CA 91010, USA.
Insights
A new blood volume policy for pediatric lab testing was developed, balancing patient hematological status with procedural costs. While smaller volumes are sometimes necessary, larger volumes may be more cost-effective and maintain lab service quality.
Area of Science:
- Pediatric Hematology
- Clinical Laboratory Science
- Healthcare Policy
Background:
- Pediatric cancer patients often require frequent blood draws due to treatment protocols and extended hospital stays.
- Managing blood draw volumes is critical to prevent compromising pediatric patients' hematological status.
- Concerns from nursing and laboratory staff regarding blood draw volumes were identified.
Purpose of the Study:
- To develop a standardized blood volume policy for pediatric laboratory testing.
- To address the challenges of frequent blood draws in pediatric cancer patients.
- To balance patient safety with operational efficiency and cost-effectiveness.
Main Methods:
- A multidisciplinary team collaborated to create the policy.
- A three-tiered blood volume system was designed based on patient weight (<10 kg, <20 kg, and adult volumes).
- Considerations included blood volume, cost, draw time, equipment, and order flexibility.
Main Results:
- The tiered system aims to reduce blood volume for smaller patients.
- Each successive tier (smaller volumes) incurs increased procedural costs.
- Reduced blood volumes can lead to increased costs and potential decreases in laboratory service quality.
Conclusions:
- Discretion is essential when applying the blood volume guidelines to ensure quality of care.
- Restricting blood volumes is important when medically indicated.
- In non-medically necessary situations, the benefits of smaller volumes may be outweighed by increased costs and reduced lab service quality.
Abstract:
At our institution, a multidisciplinary team met to work out a blood volume policy for our pediatric patients' laboratory testing. Because we are a cancer center, many of our patients are on protocols and/or are in the hospital for an extended period of time. These factors result in multiple blood draws. It is important to manage the volumes used so that we do not compromise the hematological status of our pediatric patients. The concerns of nurses and laboratory technologists were discussed and a three-tiered system was designed consisting of adult volumes, volumes for < 20-kg patients, and volumes for < 10-kg patients. Each tier consists of less blood than the one above it but the cost for such a procedure is increased. Time to conduct the draw, the cost of equipment to do the draw, and inflexibility to verify or add to the original order without resticking the patient increase at each tier. It is imperative to the overall quality of care for all patients that discretion is used when following these guidelines. When it is medically prudent to restrict the blood volumes taken from any patient, it should be done. However, when it is not medically necessary, the increased costs and potential decrease in the quality of laboratory service outweighs the desire to use smaller blood volumes.
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