Background: To study the impact of 3 blood-saving strategies to reduce the amount of blood collected on the analyses performed on critically ill patients. Methods: Pre-post quasi-experimental study. Population: patients > 18 years of age, stay of more than 24 hours. Variables: sex, age, diagnosis, admission unit, number of tests performed in 24 hours, volume of waste, usable blood volume, total volume collected in 24 hours, haemoglobin (Hb) at admission and at 24 hours, weight balance, Acute Physiology and Chronic Health Evaluation (APACHE) severity indices, Simplified Acute Physiologic Score (SAPS), catheter, extraction technique, and work experience. A descriptive analysis of variance and association of variables was carried out using the SPSS Statistics 20.0. Results: The average number of laboratory tests per patient 24 hours after admission in the post-intervention phase was 5.8 (±1.9), compared to 7.2 (±2.6) in the pre-intervention phase (p < 0.001). The average volume of waste was 14 mL (±10.2) vs. 31.6 mL (±15.8) with p < 0.001. The average volume of usable blood for the analyses was 22.9 mL (±10) vs. 48.1 mL (±16.7) p < 0.001. The total volume of usable blood was 38.6 mL (±17.6) vs. 80.7 mL (±26.8) p < 0.001. Professionals with < 5 years’ experience were found to discard the most blood (p < 0.001). Conclusions: The implementation of 3 blood-saving strategies has reduced the volume collected for clinical analysis in critically ill patients by more than 50% in the first 24 hours of admission.
Cite this paper
Palau, M. M. and Juan, E. P. (2021). Analysis of a Blood-Saving Intervention during Blood Collection in Critical Patients. Open Access Library Journal, 8, e7425. doi: http://dx.doi.org/10.4236/oalib.1107425.
Corwin, H.L. (2004) Anemia and Blood Transfusion in the Critically Ill Patient: Role of Erythropoietin. Critical Care, 8, Article No. S42.
https://doi.org/10.1186/cc2411
Chant, C., Wilson, G. and Friedrich, J.O. (2006) Anemia, Transfusion, and Phlebotomy Practices in Critically Ill Patients with Prolonged ICU Length of Stay: A Cohort Study. Critical Care, 10, Article No. R140. https://doi.org/10.1186/cc5054
James, T., Barty, R., Liu, Y., Rochwerg, B., Heddle, N. and Siegal, D.M. (2018) Blood Loss Due to Laboratory Testing in Critical Care Patients: A Retrospective Cohort Study. Blood, 132, Article No. 4885. https://doi.org/10.1182/blood-2018-99-114289
Barie, P.S. (2004) Phlebotomy in the Intensive Care Unit: Strategies for Blood Conservation. Critical Care, 8, Article No. S34. https://doi.org/10.1186/cc2454
Maqueda-Palau, M. and Pérez-Juan, E. (2018) Blood Volume Extracted from the Critical Patient in the First 24 Hours after Admission. Volumen de sangre extraído al paciente crítico las primeras 24h de ingreso. Enfermería Intensiva, 29, 14-20.
https://doi.org/10.1016/j.enfi.2017.09.002
Pérez Juan, E. and Maqueda Palau, M. (2018) Flebotomía en la unidad de cuidados intensivos: volumen útil vs. volumen desechado. Evidentia, 15, 1-6.
http://ciberindex.com/c/ev/e11719
World Health Assembly, 63. (2010) Availability, Safety and Quality of Blood Products. World Health Organization.
http://apps.who.int/gb/ebwha/pdf_files/WHA63/A63_R12-en.pdf
Althoff, F.C., Neb, H., Herrmann, E., Trentino, K.M., Vernich, L., Füllenbach, C., Freedman, J., Waters, J.H., et al. (2019) Multimodal Patient Blood Management Program Based on a Three-Pillar Strategy: A Systematic Review and Meta-Analysis. Annals of Surgery, 269, 794-804. https://doi.org/10.1097/SLA.0000000000003095
Badamosi, R., DiGiovine, B., Iribarren, J. and McClellan, B. (2011) Impact of Blood Conservation Strategy in the Medical Intensive Care Unit (The Anemia Bundle). Chest, 140, Article No. 347A. https://doi.org/10.1378/chest.1116780
Jensen, P.R. and Markewitz, B.A. (2016) Safe Reduction of Blood Volume in the Blood Gas Laboratory. Laboratory Medicine, 47, 326-329.
https://doi.org/10.1093/labmed/lmw039
Bulger, J., Nickel, W., Messler, J., Goldstein, J., O’Callaghan, J., Auron, M., et al. (2013) Choosing Wisely in Adult Hospital Medicine: Five Opportunities for Improved Healthcare Value. Journal of Hospital Medicine, 8, 486-492.
https://doi.org/10.1002/jhm.2063
González de Molina, F., Gordo, F., Estella, A., Morrondo, P., Fernández, J., Caballero, J., et al. (2018) “Do Not Do” Recommendations of the Working Groups of the Spanish Society of Intensive and Critical Care Medicine and Coronary Units (SEMICYUC) for the Management of Critically Ill Patients. Medicina Intensiva (English Edition), 42, 425-443. https://doi.org/10.1016/j.medine.2018.04.007
Dhanani, J.A., Barnett, A.G., Lipman, J. and Reade, M.C. (2018) Strategies to Reduce Inappropriate Laboratory Blood Test Orders in Intensive Care Are Effective and Safe: A Before-and-After Quality Improvement Study. Anaesthesia and Intensive Care, 46, 313-320. https://doi.org/10.1177%2F0310057X1804600309
Garcías, M., March, C., Janer, T., Soliva, L., Figueras, A., García, I., et al. (2019) Retrato actual de la Unidad Coronaria. Presentado en el LIV Congreso Nacional de la Sociedad Española de Medicina Intensiva, Crítica y Unidades Coronarias (SEMICYUC), Palma Mallorca, 9-12 June 219, 1-3.
Kurniali, P.C., Curry, S., Brennan, K.W., Velletri, K., Shaik, M., Schwartz, K.A., et al. (2014) A Retrospective Study Investigating the Incidence and Predisposing Factors of Hospital-Acquired Anemia. Anemia, 2014, Article ID: 634582.
https://doi.org/10.1155/2014/634582
Dolman, H.S., Evans, K., Zimmerman, L.H., Lavery, T., Baylor, A.E., Wilson, R.F., et al. (2015) Impact of Minimizing Diagnostic Blood Loss in the Critically Ill. Surgery, 158, 1083-1088. https://doi.org/10.1016/j.surg.2015.05.018
Sanchez-Giron, F. and Alvarez-Mora, F. (2008) Reduction of Blood Loss from Laboratory Testing in Hospitalized Adult Patients Using Small-Volume (Pediatric) Tubes. Archives of Pathology & Laboratory Medicine, 132, 1916-1919.
https://doi.org/10.5858/132.12.1916
Van der Bom, J.G. and Cannegieter, S.C. (2015) Hospital-Acquired Anemia: The Contribution of Diagnostic Blood Loss. Journal of Thrombosis and Haemostasis, 13, 1157-1159. https://doi.org/10.1111/jth.12886
Low, L.L., Harrington, G.R. and Stoltzfus, D.P. (1995) The Effect of Arterial Lines on Blood-Drawing Practices and Costs in Intensive Care Units. Chest, 108, 216-219.
https://doi.org/10.1378/chest.108.1.216
MacIsaac, C.M., Presneill, J.J., Boyce, C.A., Byron, K.L. and Cade, J.F. (2003) The Influence of a Blood Conserving Device on Anaemia in Intensive Care Patients. Anaesth Intensive Care, 31, 653-657.
https://doi.org/10.1177%2F0310057X0303100607
Coene, K.L., Roos, A.N. and Scharnhorst, V. (2015) Iatrogenic Anemia/Twenty-Five Million Liters of Blood into the Sewer: Comment. Journal of Thrombosis and Hae- mostasis, 13, 1160-1161. https://doi.org/10.1111/jth.12831
Walsh, T.S., Lee, R.J., Maciver, C.R., Garrioch, M., MacKirdy, F., Binning, A.R., et al. (2006) Anemia during and at Discharge from Intensive Care: The Impact of Restrictive Blood Transfusion Practice. Intensive Care Medicine, 32, 100-109.
https://doi.org/10.1007/s00134-005-2855-2
Muñoz, M., Noval, L., García, J.A. and Naveira, E. (2007) Prevalencia y tratamiento de la anemiaen el paciente crítico. Medicina Intensiva, 31, 388-398.
https://doi.org/10.1016/S0210-5691(07)74843-X
Makam, A.N., Nguyen, O.K., Clark, C. and Halm, E.A. (2017) Incidence, Predictors, and Outcomes of Hospital-Acquired Anemia. Journal of Hospital Medicine, 12, 317- 322. https://doi.org/10.12788/jhm.2723
Rivera, D. and Pérez, A. (2011) Blood-Saving Techniques in Surgery. Colombian Journal of Anestesiology, 39, 545-559. https://doi.org/10.5554/rca.v39i4.148
http://www.scielo.org.co/scielo.php?script=sci_arttext&pid=S0120-33472011000400007&lng=en