A Standard Push-Pull Protocol for Waste-Free Sampling in the Pediatric Intensive Care Unit

McBride, Clare; Miller-Hoover, Suzan; Proudfoot, James

doi:10.1097/nan.0000000000000279

Cited by 9 publications

(11 citation statements)

References 20 publications

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“…Combining the results of ICC and Bland Altman analysis, we can conclude that the push-pull method provides reliable laboratory results without increasing the loss of blood and pain, and there was no hemolysis observed in the paired samples. These results are consistent with previous research, 10,11 and these findings are beneficial to patients who need multiple consecutive samples taken for blood testing. 18 In our study, the hematological laboratory results were similar to those of many other studies, 8,11 and there was no significant difference in the Hct levels based on the blood collecting method or infusion status.…”

Section: Discussionsupporting

confidence: 93%

“…These results are consistent with previous research, 10,11 and these findings are beneficial to patients who need multiple consecutive samples taken for blood testing. 18 In our study, the hematological laboratory results were similar to those of many other studies, 8,11 and there was no significant difference in the Hct levels based on the blood collecting method or infusion status. It seems that the push-pull method did not increase the incidence of hemodilution.…”

Section: Discussionsupporting

confidence: 93%

“…In the relevant literature, the laboratory assays focused largely on biochemical parameters, hematologic tests and drug concentrations, although the differences in a few of the lab results were statistically significant, they were not clinically significant. Two studies previously evaluated the differences in the coagulation test results obtained while comparing the push-pull method with the discard method 11 and venipuncture. 14 These studies demonstrated that the push-pull method could provide reliable coagulation test results from samples obtained from a catheter containing heparin and without the need for any discard.…”

Section: Introductionmentioning

confidence: 99%

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A comparative study on coagulation and hematologic laboratory techniques for blood sampling using the push-pull method from a CVC versus venipuncture

et al. 2022

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Objectives: To demonstrate the equivalence and substitutability of two blood collection methods: the push-pull method from a CVC and direct venous puncture (DVP). Methods: A comparative, within-subject study was conducted between September 2021 and December 2021 at a hospital in NanTong city. The sample comprised critically ill patients aged 18 and older in critical care units such as general, emergent, cardiac, respiratory, and neurological units. A total of 154 paired blood samples were collected via a CVC and direct venous puncture. This study focused on the laboratory results of the coagulation and hematologic tests. The reproducibility and reliability of the results were calculated by the mean of the coefficient of variation (CV) and the intraclass correlation coefficient (ICC). Bland–Altman statistics were used to analyze the substitutability of the two blood collection methods. Results: The difference in the means between the two methods ranged from −1.61 to 0.09, and the coefficients of variation for both methods were similar. The ICCs of the two methods were all above 0.90, which indicated excellent reliability. In the Bland–Altman plots, all of the blood samples that obtained by the push-pull method were within clinically acceptable ranges compared to the samples obtained by direct venous puncture. Conclusion: The push-pull method of collecting blood specimens from a CVC should be acceptable for coagulation and hematologic laboratory tests.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionsupporting

confidence: 93%

Section: Introductionmentioning

confidence: 99%

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A comparative study on coagulation and hematologic laboratory techniques for blood sampling using the push-pull method from a CVC versus venipuncture

et al. 2022

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“…Siegal et al showed that blood sampling conservation devices or a venous arterial blood management protection device (VAMP) can significantly reduce diagnostic blood loss by up to 80% [66]. The establishment of push-pull protocols is effective to significantly reduce the amount of discarded volume [73]. Dale et al showed, almost 30 years ago, that the amount of blood for L-Thyroxin measurements in laboratory testing is about 0.06 mL but 5.9 mL was phlebotomized [58].…”

Section: Discussionmentioning

confidence: 99%

Avoidable Blood Loss in Critical Care and Patient Blood Management: Scoping Review of Diagnostic Blood Loss

Helmer

Hottenrott

Steinisch

et al. 2022

JCM

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Background: Anemia remains one of the most common comorbidities in intensive care patients worldwide. The cause of anemia is often multifactorial and triggered by underlying disease, comorbidities, and iatrogenic factors, such as diagnostic phlebotomies. As anemia is associated with a worse outcome, especially in intensive care patients, unnecessary iatrogenic blood loss must be avoided. Therefore, this scoping review addresses the amount of blood loss during routine phlebotomies in adult (>17 years) intensive care patients and whether there are factors that need to be improved in terms of patient blood management (PBM). Methods: A systematic search of the Medline Database via PubMed was conducted according to PRISMA guidelines. The reported daily blood volume for diagnostics and other relevant information from eligible studies were charted. Results: A total of 2167 studies were identified in our search, of which 38 studies met the inclusion criteria (9 interventional studies and 29 observational studies). The majority of the studies were conducted in the US (37%) and Canada (13%). An increasing interest to reduce iatrogenic blood loss has been observed since 2015. Phlebotomized blood volume per patient per day was up to 377 mL. All interventional trials showed that the use of pediatric-sized blood collection tubes can significantly reduce the daily amount of blood drawn. Conclusion: Iatrogenic blood loss for diagnostic purposes contributes significantly to the development and exacerbation of hospital-acquired anemia. Therefore, a comprehensive PBM in intensive care is urgently needed to reduce avoidable blood loss, including blood-sparing techniques, regular advanced training, and small-volume blood collection tubes.

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“…The push-pull sampling method is another promising blood conservation method to avoid blood wasting during sampling. Its effect on diagnostic blood loss, anemia, and transfusion remains unclear as current studies are focused on the validity of laboratory results on blood sampled by using this method compared with standard blood sampling (69)(70)(71)(72)(73).…”

Section: Discussionmentioning

confidence: 99%

Strategies to Reduce Diagnostic Blood Loss and Anemia in Hospitalized Patients: A Scoping Review

François

Charlier

Balandier

et al. 2022

Pediatric Critical Care Medicine

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Blood sampling is a recognized contributor to hospital-acquired anemia. We aimed to bundle all published neonatal, pediatric, and adult data regarding clinical interventions to reduce diagnostic blood loss.DATA SOURCES: Four electronic databases were searched for eligible studies from inception until May 2021.STUDY SELECTION: Two reviewers independently selected studies, using predefined criteria. DATA EXTRACTION:One author extracted data, including study design, population, period, intervention type and comparator, and outcome variables (diagnostic blood volume and frequency, anemia, and transfusion).DATA SYNTHESIS: Of 16,132 articles identified, we included 39 trials; 12 (31%) were randomized controlled trials. Among six types of interventions, 27 (69%) studies were conducted in adult patients, six (15%) in children, and six (15%) in neonates. Overall results were heterogeneous. Most studies targeted a transfusion reduction (n = 28; 72%), followed by reduced blood loss (n = 24; 62%) and test frequency (n = 15; 38%). Small volume blood tubes (n = 7) and blood conservation devices (n = 9) lead to a significant reduction of blood loss in adults (8/9) and less transfusion of adults (5/8) and neonates (1/1). Point-of-care testing (n = 6) effectively reduced blood loss (4/4) and transfusion (4/6) in neonates and adults. Bundles including staff education and protocols reduced blood test frequency and volume in adults (7/7) and children (5/5). CONCLUSIONS:Evidence on interventions to reduce diagnostic blood loss and associated complications is highly heterogeneous. Blood conservation devices and smaller tubes appear effective in adults, whereas point-of-care testing and bundled interventions including protocols and teaching seem promising in adults and children.

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A Standard Push-Pull Protocol for Waste-Free Sampling in the Pediatric Intensive Care Unit

Cited by 9 publications

References 20 publications

A comparative study on coagulation and hematologic laboratory techniques for blood sampling using the push-pull method from a CVC versus venipuncture

A comparative study on coagulation and hematologic laboratory techniques for blood sampling using the push-pull method from a CVC versus venipuncture

Avoidable Blood Loss in Critical Care and Patient Blood Management: Scoping Review of Diagnostic Blood Loss

Strategies to Reduce Diagnostic Blood Loss and Anemia in Hospitalized Patients: A Scoping Review

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