Patient harm associated with serial phlebotomy and blood waste in the intensive care unit: A retrospective cohort study.
<h4>Background</h4>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 evalua...
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2021-01-01
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| author | Thomas Bodley Maverick Chan Olga Levi Lauren Clarfield Drake Yip Orla Smith Jan O Friedrich Lisa K Hicks |
| author_facet | Thomas Bodley Maverick Chan Olga Levi Lauren Clarfield Drake Yip Orla Smith Jan O Friedrich Lisa K Hicks |
| author_sort | Thomas Bodley |
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| description | <h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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. |
| format | Article |
| id | doaj-art-ca52fb60ba424b899e1237b83eb71008 |
| institution | OA Journals |
| issn | 1932-6203 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Public Library of Science (PLoS) |
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| spelling | doaj-art-ca52fb60ba424b899e1237b83eb710082025-08-20T02:00:42ZengPublic Library of Science (PLoS)PLoS ONE1932-62032021-01-01161e024378210.1371/journal.pone.0243782Patient harm associated with serial phlebotomy and blood waste in the intensive care unit: A retrospective cohort study.Thomas BodleyMaverick ChanOlga LeviLauren ClarfieldDrake YipOrla SmithJan O FriedrichLisa K Hicks<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Results</h4>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).<h4>Conclusion</h4>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.https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0243782&type=printable |
| spellingShingle | Thomas Bodley Maverick Chan Olga Levi Lauren Clarfield Drake Yip Orla Smith Jan O Friedrich Lisa K Hicks Patient harm associated with serial phlebotomy and blood waste in the intensive care unit: A retrospective cohort study. PLoS ONE |
| title | Patient harm associated with serial phlebotomy and blood waste in the intensive care unit: A retrospective cohort study. |
| title_full | Patient harm associated with serial phlebotomy and blood waste in the intensive care unit: A retrospective cohort study. |
| title_fullStr | Patient harm associated with serial phlebotomy and blood waste in the intensive care unit: A retrospective cohort study. |
| title_full_unstemmed | Patient harm associated with serial phlebotomy and blood waste in the intensive care unit: A retrospective cohort study. |
| title_short | Patient harm associated with serial phlebotomy and blood waste in the intensive care unit: A retrospective cohort study. |
| title_sort | patient harm associated with serial phlebotomy and blood waste in the intensive care unit a retrospective cohort study |
| url | https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0243782&type=printable |
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