Development and Assessment of Pictorial Guide for Improved Accuracy of Visual Blood Loss Estimation in Cesarean Delivery

Homcha, Brittany; Mets, Elbert J.; Goldenberg, Michael; Kong, Lan Pei; Vaida, Sonia

doi:10.1097/sih.0000000000000246

Cited by 9 publications

(5 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The study results are heterogeneous, so there are different results about the influence of different factors of professional experience, gender, age on the accuracy of the estimate. Even the use of pictograms and other measures does not lead to clear improvements (for a detailed description of the various studies, please refer to Supplement 2) [29][30][31][32][33][34][35][36][37][38][39].…”

Section: Visual Estimationmentioning

confidence: 99%

Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis

Gerdessen

Meybohm

Choorapoikayil

et al. 2020

J Clin Monit Comput

View full text Add to dashboard Cite

Estimating intraoperative blood loss is one of the daily challenges for clinicians. Despite the knowledge of the inaccuracy of visual estimation by anaesthetists and surgeons, this is still the mainstay to estimate surgical blood loss. This review aims at highlighting the strengths and weaknesses of currently used measurement methods. A systematic review of studies on estimation of blood loss was carried out. Studies were included investigating the accuracy of techniques for quantifying blood loss in vivo and in vitro. We excluded nonhuman trials and studies using only monitoring parameters to estimate blood loss. A meta-analysis was performed to evaluate systematic measurement errors of the different methods. Only studies that were compared with a validated reference e.g. Haemoglobin extraction assay were included. 90 studies met the inclusion criteria for systematic review and were analyzed. Six studies were included in the meta-analysis, as only these were conducted with a validated reference. The mixed effect meta-analysis showed the highest correlation to the reference for colorimetric methods (0.93 95% CI 0.91–0.96), followed by gravimetric (0.77 95% CI 0.61–0.93) and finally visual methods (0.61 95% CI 0.40–0.82). The bias for estimated blood loss (ml) was lowest for colorimetric methods (57.59 95% CI 23.88–91.3) compared to the reference, followed by gravimetric (326.36 95% CI 201.65–450.86) and visual methods (456.51 95% CI 395.19–517.83). Of the many studies included, only a few were compared with a validated reference. The majority of the studies chose known imprecise procedures as the method of comparison. Colorimetric methods offer the highest degree of accuracy in blood loss estimation. Systems that use colorimetric techniques have a significant advantage in the real-time assessment of blood loss.

show abstract

Section: Visual Estimationmentioning

confidence: 99%

Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis

Gerdessen

Meybohm

Choorapoikayil

et al. 2020

J Clin Monit Comput

View full text Add to dashboard Cite

show abstract

“…Simulation has been used effectively to assess the accuracy of different methods of blood loss quantification. The use of a pictorial guide as a means to assess blood loss during a simulated cesarean delivery was evaluated by Homcha and colleagues 37 comparing assessments of blood loss prior to and after use of the guide. Prior to use of the pictorial guide, they observed a more than 25% overestimation of blood loss, whereas use of the guide revealed an increase from 7% to 24% of accurate estimation defined as an estimate within 5% of the actual volume lost.…”

Section: Simulation-based Assessment Of the Work Environment And Practice Methodsmentioning

confidence: 99%

Updates on Simulation in Obstetrical Anesthesiology Through the COVID-19 Pandemic

Mahoney¹,

Luebbert²

2021

Anesthesiology Clinics

View full text Add to dashboard Cite

“…A lack of regular feedback on the actual amount of blood loss may be an explanation for the missing learning effect. It has been demonstrated that the visual estimation method can be improved through practical training and tools like pictograms [3,[6][7][8][9][10][11]. In addition to blood collection canisters, surgical sponges play a major role in blood loss estimation, as they absorb blood directly from the surgical field.…”

Section: Plos Onementioning

confidence: 99%

“…Accounting for this issue, several studies were carried out to quantify its inaccuracy and to improve the visually based method of estimation. Focus laid on practical or web-based training in simulated scenarios [3,[6][7][8][9][10][11]. Several studies investigated visual estimation of blood loss and one study examined the influence of fluid colour on estimation accuracy [12].…”

Section: Introductionmentioning

confidence: 99%

Do we visually estimate intra-operative blood loss better with white or green sponges and is the deviation from the real blood loss clinically acceptable? Results from a simulated scenario study

et al. 2020

View full text Add to dashboard Cite

Background The intraoperative blood loss is estimated daily in the operating room and is mainly done by visual techniques. Due to local standards, the surgical sponge colours can vary (e.g. white in US, green in Germany). The influence of sponge colour on accuracy of estimation has not been in the focus of research yet. Material and methods A blood loss simulation study containing four “bleeding” scenarios each per sponge colour were created by using expired whole blood donation samples. The blood donations were applied to white and green surgical sponges after dilution with full electrolyte solution. Study participants had to estimate the absorbed blood loss in sponges in all scenarios. The difference to the reference blood loss was analysed. Multivariate linear regression analysis was performed to investigate other influence factors such as staff experience and sponge colour. Results A total of 53 anaesthesists participated in the study. Visual estimation correlated moderately with reference blood loss in white (Spearman's rho: 0.521; p = 3.748*10 −16 ) and green sponges (Spearman's rho: 0.452; p = 4.683*10 −12 ). The median visually estimated blood loss was higher in white sponges (250ml IRQ 150–412.5ml) than in green sponges (150ml IQR 100-300ml), compared to reference blood loss (103ml IQR 86–162.8). For both colour types of sponges, major under- and overestimation was observed. The multivariate statistics demonstrates that fabric colours have a significant influence on estimation (p = 3.04*10 −10 ), as well as clinician’s qualification level (p = 2.20*10 −10 , p = 1.54*10 −08 ) and amount of RBL to be estimated (p < 2*10 −16 ). Conclusion The deviation of correct blood loss estimation was smaller with white surgical sponges compared to green sponges. In general, deviations were so severe for both types of sponges, that it appears to be advisable to refrain from visually estimating blood loss whenever possible and instead to use other techniques such as e.g. colorimetric estimation.

show abstract

Development and Assessment of Pictorial Guide for Improved Accuracy of Visual Blood Loss Estimation in Cesarean Delivery

Abstract: An institution-specific pictorial guide is effective at improving the accuracy of visual blood loss estimation in a simulation and may help improve clinical care in CD.

Cited by 9 publications

References 11 publications

Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis

Comparison of common perioperative blood loss estimation techniques: a systematic review and meta-analysis

Updates on Simulation in Obstetrical Anesthesiology Through the COVID-19 Pandemic

Do we visually estimate intra-operative blood loss better with white or green sponges and is the deviation from the real blood loss clinically acceptable? Results from a simulated scenario study

Contact Info

Product

Resources

About