Blood Conservation: Identifying Factors

to Reduce Phlebotomy Induced Blood

Loss in the PICU

Stacey Valentine, MD MPH

Instructor, Division of Critical Care Medicine
Childrens Hospital Boston
CRIT Collaborative
May 29, 2012

Phlebotomy Induced Blood Loss In Adult

Critically Ill Patients
Vincent et al. 2002

Phlebotomy frequency in adult critically ill patients varies between 5 24

samples per day, with a mean volume of 41 ml/day
Daily phlebotomy volumes have been independently associated with the
likelihood of transfusion in adult critically ill patients

Fowler et al. 2003

Patients treated with a restrictive diagnostic phlebotomy and blood

conservation strategy were less likely to receive a packed red cell blood
transfusion during their ICU stay
The use of a closed system for blood draws demonstrated a 50% reduction
in phlebotomy volumes compared to standard phlebotomy practices

Vincent et al. 2002. JAMA

Fowler et al. 2003. Crit Care

Anemia and Blood Loss in the PICU:

Epidemiology:
Bateman et al. 2008
977 patients from 2004 to 2005
Blood draws occurred in 96% of critically ill pediatric
patients
Phlebotomy accounted for 73% of blood loss
Blood loss from phlebotomy was associated with
increased odds of transfusion

Bateman et al. 2008. Am J Respir Crit Care Med

Study Aim:
Aim: To identify avoidable factors associated with
phlebotomy induced blood loss.
Hypothesis: Phlebotomy overdraw significantly contributes
to phlebotomy induced blood loss and can be avoided.
Blood draws taken from an indwelling catheter without a
closed system result in significantly greater blood
overdraw volumes.

Methods
Prospective observational study from September 2004 to
January 2005
All blood draws, including draw volume, site and tests
ordered were recorded
The minimum amount of blood needed for each blood
draw was calculated
Blood overdraw was defined as the percentage of blood
drawn in excess of phlebotomy requirements

Patient Demographics

Blood Draw Demographics

Percent Volume Blood Overdraw by Blood Draw Site

Percent Volume Blood Overdraw by Number of Tests

Per Draw
**

Percent Volume Blood Overdraw by Patient Weight

Conclusions
Blood overdraw volumes ranged from 55% to 375% the
needed volume to perform the laboratory test
Blood overdraw accounted for >50% of the total
phlebotomy blood loss
Patients < 10 kg had a greater amount of blood loss per
kilogram per PICU stay compared to patients >10kg
Blood draws sent from central venous catheters were
associated with increased phlebotomy overdraw
Blood draws sent for single laboratory evaluations were
associated with increased phlebotomy overdraw

References
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