http://www.medscape.com/viewarticle/497905

Blood Conservation Strategy Can Eliminate Phlebotomy Waste

Peggy Peck
Medscape Medical News 2005. © 2005 Medscape

Jan. 19, 2005 (Phoenix) - Results of a pilot study examining the feasibility
of a blood conservation strategy for critically ill adults suggest that "we
can reduce the volume of blood [tested] by 50%," according to Robert Fowler,
MD, the lead investigator of the study.
Dr. Fowler, assistant professor at the University of Toronto and associate
scientist at the departments of critical care medicine and general internal
medicine at Sunnybrook and Women's College Health Science Centre in Toronto,
Ontario, presented results of the blood conservation pilot study here at the
34th Critical Care Congress of the Society of Critical Care Medicine (SCCM).
Blood conservation is a response to the observation that patients in the
intensive care unit (ICU) are often oversampled in terms of phlebotomy and
arterial sampling, Dr. Fowler told Medscape. The blood volume lost to
frequent "sticks" is likely to contribute to ICU anemia, he said.
In the pilot study, which was conducted in conjunction with Stamford
University and was funded by an SCCM research grant, four conservation
strategies were initiated: no waste sampling, point-of-care microanalysis,
small volume phlebotomy (using pediatric tubes), and blood conservation
education.
Consecutive ICU patients admitted and treated at a single center before
initiation of the conservation strategy served as control subjects for 144
patients prospectively enrolled in the conservation plan. The primary
outcome was feasibility. Secondary outcomes, which are nadir hematocrit,
phlebotomy comparison, and transfusions, will not be reported until
completion of the ongoing multicenter trial.
"Conservation is feasible, and the best illustration of this is that waste
sampling was completely eliminated by the conservation strategy," Dr. Fowler
said.
In the control group, an average of 2.9 samples per patient per day, or 32%
of all samples, were phlebotomy waste. These accounted for the largest
volume of all blood draws and were 35% of the total blood volume in the
control group.
Although the study found that conservation is feasible, Dr. Fowler said that
conservation is not easy to implement. "One of the most difficult aspects
was the phlebotomy tubes," he said. "The regular-size tubes kept turning up
and we had to regularly sweep through the unit to remove them."
During the discussion after the presentation Dr. Fowler said that
point-of-care microanalysis was considered the most "painful" aspect of the
trial because it is labor-intensive and expensive, which makes it a hard
sell to hospitals.
Derek Angus, MD, a professor of critical care medicine at the University of
Pittsburgh in Pennsylvania and moderator of the SCCM session at which the
paper was presented, said the initial findings were very promising.
"It seems intuitive that by reducing the phlebotomy and phlebotomy waste we
would reduce ICU anemia," Dr. Angus told Medscape. But he cautioned that
this attractive theory needs to be proven in the larger study. Nonetheless,
he applauded the early results, noting he was especially pleased that "Dr.
Fowler has used an SCCM grant so well." Dr. Angus was not involved in the
trial.

SCCM 34th Critical Care Congress: Abstract 36. Presented Jan. 17, 2005.
Reviewed by Gary D. Vogin, MD