Identifying factors to minimize phlebotomy-induced blood loss in the pediatric intensive care unit

Department of Anesthesia and Perioperative Medicine, Division of Critical Care Medicine, Children's Hospital Boston, Boston, MA, USA.
Pediatric Critical Care Medicine (Impact Factor: 2.34). 04/2011; 13(1):22-7. DOI: 10.1097/PCC.0b013e318219681d
Source: PubMed


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.

33 Reads
  • [Show abstract] [Hide abstract]
    ABSTRACT: This article describes the incidence and etiology of anemia in critically ill children. In addition, the article details the pathophysiology and clinical ramifications of anemia in this population. The use of transfused packed red blood cells as a therapy for anemia in critically ill patients is also discussed, including the indications for and complications associated with this practice as well as potential reasons for these complications. Finally, the article lists some therapeutic practices that may lessen the risks associated with transfusion, and briefly discusses the use of blood substitutes.
    Critical care clinics 04/2013; 29(2):301-17. DOI:10.1016/j.ccc.2012.11.005 · 2.16 Impact Factor

  • Pediatric Critical Care Medicine 05/2013; 14(4):439-40. DOI:10.1097/PCC.0b013e31827d0e32 · 2.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: To minimise the volume of blood used for diagnostic procedures, especially in children, we investigated whether the size of sample tubes affected whole blood coagulation analyses. Methods: We included 20 healthy individuals for rotational thromboelastometry (RoTEM®) analyses and compared three blood sampling tubes of different size: 1.8, 2.7, and 3.6 mL. All tubes were made of plastic and contained 3.2% sodium-citrate as anticoagulant. Platelet aggregation was investigated in 12 healthy individuals employing the Multiplate® Analyser comparing tubes of 3.6 mL and 1.8 mL. Platelet count was determined for each of the sampling tubes after 10, 60, and 120 min. Results: No significant differences were found in any of the RoTEM® measurements between the three sizes of tubes (p=0.07-0.53). Platelet aggregation was significantly lower when using smaller tubes (p=0.0004). The platelet count remained stable using a 3.6 mL tube during the entire observation period of 120 min (p=0.74), but decreased significantly after 60 min when using tubes smaller than 3.6 mL (p<0.0001). Conclusions: RoTEM® analyses were not affected by the size of blood sampling tubes. Therefore, 1.8 mL tubes should be preferred for RoTEM® analyses in order to minimise the volume of blood drawn. With regard to platelet aggregation analysed by impedance aggregometry tubes of different size cannot be used interchangeably. If platelet count is determined later than 10 min after blood sampling using tubes containing citrate as anticoagulant, a 3.6 mL tube should be preferred to avoid false low values.
    Clinical Chemistry and Laboratory Medicine 12/2013; 52(5):1-6. DOI:10.1515/cclm-2013-0836 · 2.71 Impact Factor
Show more