Thomas Bodley1,2, Maverick Chan3, Olga Levi2,3, Lauren Clarfield2, Drake Yip4, Orla Smith2,3, Jan O Friedrich1,2,3, Lisa K Hicks2,3,5. 1. Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada. 2. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 3. Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada. 4. Division of Laboratory Medicine, St. Michael's Hospital, Toronto, Ontario, Canada. 5. Division of Hematology/Oncology, St. Michael's Hospital, Toronto, Ontario, Canada.
Abstract
BACKGROUND: Intensive care unit (ICU) patients are at high risk of anemia, and phlebotomy is a potentially modifiable source of blood loss. Our objective was to quantify daily phlebotomy volume for ICU patients, including blood discarded as waste during vascular access, and evaluate the impact of phlebotomy volume on patient outcomes. METHODS: This was a retrospective observational cohort study between September 2014 and August 2015 at a tertiary care academic medical-surgical ICU. A prospective audit of phlebotomy practices in March 2018 was used to estimate blood waste during vascular access. Multivariable logistic regression was used to evaluate phlebotomy volume as a predictor of ICU nadir hemoglobin < 80 g/L, and red blood cell transfusion. RESULTS: There were 428 index ICU admissions, median age 64.4 yr, 41% female. Forty-four patients (10%) with major bleeding events were excluded. Mean bedside waste per blood draw (144 draws) was: 3.9 mL from arterial lines, 5.5 mL central venous lines, and 6.3 mL from peripherally inserted central catheters. Mean phlebotomy volume per patient day was 48.1 ± 22.2 mL; 33.1 ± 15.0 mL received by the lab and 15.0 ± 8.1 mL discarded as bedside waste. Multivariable regression, including age, sex, admission hemoglobin, sequential organ failure assessment score, and ICU length of stay, showed total daily phlebotomy volume was predictive of hemoglobin <80 g/L (p = 0.002), red blood cell transfusion (p<0.001), and inpatient mortality (p = 0.002). For every 5 mL increase in average daily phlebotomy the odds ratio for nadir hemoglobin <80 g/L was 1.18 (95% CI 1.07-1.31) and for red blood cell transfusion was 1.17 (95% CI 1.07-1.28). CONCLUSION: A substantial portion of daily ICU phlebotomy is waste discarded during vascular access. Average ICU phlebotomy volume is independently associated with ICU acquired anemia and red blood cell transfusion which supports the need for phlebotomy stewardship programs.
BACKGROUND: Intensive care unit (ICU) patients are at high risk of anemia, and phlebotomy is a potentially modifiable source of blood loss. Our objective was to quantify daily phlebotomy volume for ICU patients, including blood discarded as waste during vascular access, and evaluate the impact of phlebotomy volume on patient outcomes. METHODS: This was a retrospective observational cohort study between September 2014 and August 2015 at a tertiary care academic medical-surgical ICU. A prospective audit of phlebotomy practices in March 2018 was used to estimate blood waste during vascular access. Multivariable logistic regression was used to evaluate phlebotomy volume as a predictor of ICU nadir hemoglobin < 80 g/L, and red blood cell transfusion. RESULTS: There were 428 index ICU admissions, median age 64.4 yr, 41% female. Forty-four patients (10%) with major bleeding events were excluded. Mean bedside waste per blood draw (144 draws) was: 3.9 mL from arterial lines, 5.5 mL central venous lines, and 6.3 mL from peripherally inserted central catheters. Mean phlebotomy volume per patient day was 48.1 ± 22.2 mL; 33.1 ± 15.0 mL received by the lab and 15.0 ± 8.1 mL discarded as bedside waste. Multivariable regression, including age, sex, admission hemoglobin, sequential organ failure assessment score, and ICU length of stay, showed total daily phlebotomy volume was predictive of hemoglobin <80 g/L (p = 0.002), red blood cell transfusion (p<0.001), and inpatient mortality (p = 0.002). For every 5 mL increase in average daily phlebotomy the odds ratio for nadir hemoglobin <80 g/L was 1.18 (95% CI 1.07-1.31) and for red blood cell transfusion was 1.17 (95% CI 1.07-1.28). CONCLUSION: A substantial portion of daily ICU phlebotomy is waste discarded during vascular access. Average ICU phlebotomy volume is independently associated with ICU acquired anemia and red blood cell transfusion which supports the need for phlebotomy stewardship programs.
Authors: Thomas J Wang; Elizabeth A Mort; Paul Nordberg; Yuchiao Chang; Mary E Cadigan; Laura Mylott; Lillian V Ananian; B Taylor Thompson; Michael Fessler; William Warren; Amy Wheeler; Mark Jordan; Michael A Fifer Journal: Arch Intern Med Date: 2002-09-09
Authors: Jason G Quinn; Adrian R Levy; Calvino K Cheng; Steve Doucette; Chris Theriault; Don Doiron; Bryce A Kiberd; Karthik K Tennankore Journal: Transfusion Date: 2019-07-08 Impact factor: 3.157
Authors: Adam H Corson; Vincent S Fan; Travis White; Sean D Sullivan; Kenji Asakura; Michael Myint; Christopher R Dale Journal: J Hosp Med Date: 2015-03-21 Impact factor: 2.960
Authors: Alan Rosenberg; Abiy Agiro; Marc Gottlieb; John Barron; Peter Brady; Ying Liu; Cindy Li; Andrea DeVries Journal: JAMA Intern Med Date: 2015-12 Impact factor: 21.873
Authors: Philipp Helmer; Sebastian Hottenrott; Andreas Steinisch; Daniel Röder; Jörg Schubert; Udo Steigerwald; Suma Choorapoikayil; Patrick Meybohm Journal: J Clin Med Date: 2022-01-10 Impact factor: 4.241