Reduction of Blood Loss From Diagnostic Sampling in Critically III Patients Using a Blood-Conserving Arterial Line System

Silver, Mitchell; Li, Yue-Han; Gragg, Lisa A.; Jubran, Fuad; Stoller, James K.

doi:10.1378/chest.104.6.1711

Cited by 57 publications

(36 citation statements)

References 11 publications

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“…Patients with indwelling catheters are usually critically ill and require repetitive testing. Moreover, a volume of blood (flush) is discarded (9,10 ).…”

mentioning

confidence: 99%

Blood Loss from Laboratory Tests

Wisser

Ackern²,

Knoll

et al. 2003

Clinical Chemistry

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Background: Laboratory tests can be an important source of blood loss in hospitals, especially for newborns and patients in intensive care. The aim of this study was to quantify blood loss for laboratory diagnostic tests in a large number of patients in a teaching hospital. Methods: We estimated blood loss by multiplying the number and volumes of sampling tubes collected from 2654 adult inpatients. We compared the number of tests per patient for all inpatients and intensive care unit patients during the first period and again in the same time period 1 year later when cumulative blood-loss volumes were being reported to physicians and educational information had been given to decrease blood loss from laboratory tests. Results: For 95% of the patients, blood loss during hospitalization was <196 mL. The largest proportion of the blood samples was used for clinical chemical tests (median, 45%), followed by hematologic (median, 26%) and coagulation (median, 17%) tests. In the surgical and cardiovascular surgical intensive care units, however, blood gas analyses accounted for 19 -34% (medians) of the use. For 5% of the patients, all undergoing intensive care, blood loss was >200 mL and for 0.7% was >600 mL during their hospital stay. Such high blood losses were observed in patients with long-term ventilation, coagulation disorders, and repeated surgery. The largest median blood loss was in patients undergoing cardiovascular surgery (median, 201 mL). The mean number of tests was 44 per inpatient before cumulative blood loss was being reported and 46 when it was being reported.

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“…Patients with indwelling catheters are usually critically ill and require repetitive testing. Moreover, a volume of blood (flush) is discarded (9,10 ).…”

mentioning

confidence: 99%

Blood Loss from Laboratory Tests

Wisser

Ackern²,

Knoll

et al. 2003

Clinical Chemistry

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“…The tissue oxygenation index of the NIRO 300 provides continuous and noninvasive monitoring and therefore has the potential to become a tool for intra-operative estimation of haemoglobin concentration, minimising the risk of delayed detection of critically low values because of the intermittent character of conventional laboratory testing. In addition, repeated blood drawing for diagnostic laboratory testing could be prevented, which can lead to considerable blood loss and iatrogenic anaemia in paediatric patients [2,15,16]. Our measurements demonstrate poor agreement between tissue haemoglobin index-derived haemoglobin concentrations and invasively measured haemoglobin concentrations.…”

Section: Discussionmentioning

confidence: 83%

Non‐invasive monitoring of haemoglobin concentration in paediatric surgical patients using near‐infrared spectroscopy*

et al. 2004

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SummaryWe evaluated the near-infrared spectroscopy based tissue haemoglobin index for continuous non-invasive monitoring of haemoglobin concentration during paediatric surgery. Blood samples from 40 children (from birth to 16 years old) were analysed oximetrically. From the first blood sample the tissue haemoglobin index ⁄ haemoglobin concentration coefficient was calculated for further tissue haemoglobin index-derived haemoglobin concentrations in each patient. Comparison of corresponding values revealed a bias and precision of -0.02 and 5.41 g.l )1 , respectively.Sensitivity and specificity of tissue haemoglobin index were 73.1% and 70.0%, respectively, for predicting falling haemoglobin concentration values. Currently, the tissue haemoglobin index is not suitable for monitoring haemoglobin concentration in children undergoing surgery.

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“…[13][14][15][16] Additional recommended strategies include decreasing the number of tests and reducing or avoiding large discard volumes to clear tubings. 17 At our small community hospital, a number of blood conservation methods were in place, including the use of small-volume specimen tubes, pointof-care testing, and reservoir systems to eliminate the need to discard blood/fluid mixtures when withdrawing a sample from an indwelling catheter.…”

Section: Blood Loss In Mechanically Ventilated Patients Shaffermentioning

confidence: 99%

“…Table II summarizes clinical strategies that have been associated with reducing diagnostic blood loss. [13][14][15][16] Potentially useful strategies include evaluating standard protocols for laboratory tests and adapting them for individual patient needs. In addition, all patient prescriptions should be routinely and systematically reviewed to question the medical need for tests that seem redundant or clinically unjustified.…”

Section: Blood Loss In Mechanically Ventilated Patients Shaffermentioning

confidence: 99%

Diagnostic blood loss in mechanically ventilated patients

Shaffer

2007

Heart & Lung

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Reduction of Blood Loss From Diagnostic Sampling in Critically III Patients Using a Blood-Conserving Arterial Line System

Cited by 57 publications

References 11 publications

Blood Loss from Laboratory Tests

Blood Loss from Laboratory Tests

Non‐invasive monitoring of haemoglobin concentration in paediatric surgical patients using near‐infrared spectroscopy*

Diagnostic blood loss in mechanically ventilated patients

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