Identifying factors to minimize phlebotomy-induced blood loss in the pediatric intensive care unit
ABSTRACT Phlebotomy-induced blood loss in critically ill children is common, contributes to anemia, and may be avoidable. We aimed to identify factors associated with phlebotomy-induced blood loss.
Prospective observational study, single-center tertiary children's hospital.
Pediatric intensive care unit.
A total of 63 patients admitted to the pediatric intensive care unit for >48 hrs from 2004 to 2005.
Phlebotomy resulted in a mean blood volume loss of 2.5 ± 1.4 mL per draw, 7.1 ± 5.3 mL per day, and 34 ± 37 mL per pediatric intensive care unit stay, of which 1.4 ± 1.1 mL per draw, 3.8 ± 3.6 mL per day, and 23 ± 31 mL per pediatric intensive care unit stay were discarded as excess. This excess represents 210% ± 174% of the volume requested by the laboratory and a 110% overdraw. Blood drawn from central venous catheters had significantly greater overdraw volumes, 254% ± 112%, compared to those of arterial, 168% ± 44%, and peripheral intravenous catheters, 143% ± 39%, p < .001. Blood draws sent for one test had an associated overdraw of 278% ± 81%, compared to draws sent for two, 168% ± 48%, three 173% ± 4%, and four or greater tests 55% ± 5%, p < .001. Patients <10 kg had significantly greater mean volumes of blood loss/kg/day compared to patients ≥ 10 kg, p < .001.
Blood drawn in excess of phlebotomy requirements exceeds the blood volume loss drawn for phlebotomy by two fold. Using indwelling catheters for phlebotomy often requires a discard volume to be drawn before obtaining the laboratory sample. Consolidating phlebotomy tests and using a closed system may decrease the amount of blood overdrawn and minimize overall phlebotomy-induced blood loss.
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ABSTRACT: One of the most difficult challenges in pediatric drug research is in exposing children to risk, often without a balanced chance of benefits. While the concept of risk is similar in adult research, the adult patient can decide for himself/herself on an acceptable level of risk, whereas children have to accept the decisions of their guardians. This paper attempts to put the complexities of estimating risk in pediatric drug research into their practical perspective, and to familiarize the reader with the way such processes are conducted in different parts of the world. Although there are regional differences, all authorities typically quantify risks of pediatric research in general, and drug research in particular, in three levels: those experienced in day-to-day life; risks slightly above this 'baseline' risk; and risks substantially above 'baseline risk'. Proportionally, the diligence of the ethics process depends on these levels, as well as on the potential benefits (or lack of) to the child involved in the research. Importantly, risk is context dependent, and a particular intervention may be effective or safe in one setting but not in another, based on local experience, staffing levels, and similar variabilities.Paediatric Drugs 11/2014; 17(1). DOI:10.1007/s40272-014-0100-6 · 1.72 Impact Factor
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ABSTRACT: Background: Intestinal fatty acid-binding protein (I-FABP) is a promising marker for necrotizing enterocolitis (NEC). It can be measured in plasma (I-FABPp) and urine (I-FABPu). Data on the best way to measure I-FABP (in plasma or urine) and the necessity of simultaneous measurement of the urinary creatinine concentration to correct for physiological variations in urine concentration are not available. This holds also true for the reciprocal relation between I-FABPp, I-FABPu and other more conventional laboratory parameters. Objectives: To evaluate the above-mentioned correlations of I-FABP measurements in neonates with suspected NEC. Methods: All neonates with suspected NEC were prospectively included. I-FABPp and I-FABPu were analyzed at regular intervals during the first 24 h after onset of symptoms. Correlation and agreement were assessed between these and other parameters (i.e. IL-6, WBC, platelet count, CRP, pH and lactate). Results: Included were 24 boys, 13 girls [median (range) GA 28 weeks (24-36), median birth weight 1,190 g (570-2,400)]. I-FABPu correlated strongly with I-FABPp (r 0.80, p < 0.001) with an adequate agreement. A very strong correlation between I-FABPu and I-FABPu/urine creatinine ratio (r 0.98, p < 0.001) existed. Correlations between I-FABPp/u and conventional parameters were moderate to strong until 8 h after onset of symptoms. Conclusion: In neonates with suspected NEC, I-FABPu correlates strongly with I-FABPp, offering an opportunity to choose the most appropriate way of measuring I-FABP. Calculating urinary IFABP/creatinine ratio seems redundant. Moderately strong correlations between I-FABPu and IL-6, WBC and lactate were found. © 2014 S. Karger AG, Basel.Neonatology 05/2014; 106(1):49-54. DOI:10.1159/000358582 · 2.57 Impact Factor
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ABSTRACT: Introduction: Blood loss due to laboratory testing is greatest for the most premature neonates with very low birth weight who require many weeks of intensive support and monitoring. Objective: The purpose of this study was to find out the volume of blood withdrawn for analytical purposes in neonates. Design: Retrospective chart analysis Setting: Neonatal intensive care unit (NICU) of a tertiary care teaching hospital of central India Participants: Neonates admitted to NICU over a period of three months. All medical records of recruited patients were reviewed and amount of blood withdrawn for analytical purposes was recorded. Intervention: None. Main Outcome Measures: The amount of blood overdrawn per test and blood overdrawn per newborn. Results: A total of 153 neonates were admitted to the NICU during the study period. A total of 684 samples were performed, corresponding to 4.47±3.36 (range 1-17) per neonate. The mean volume of blood removed was 9.38 ml ± 8.8 ml per newborn (range 1 -51 ml). The amount of blood withdrawn was inversely proportional to the gestational age and birth weight i.e., neonates less than 32 weeks gestation and those with birth weight <1500 gm had statistically significant more phlebotomy loss (p<0.0001). The amount of blood withdrawn per test was significantly more than required by laboratory. Conclusion: The volume of blood sampled in our NICU was higher in neonates with low birth weight and lesser gestational age. The amount of blood overdrawn per test was much higher than required by laboratory.