Researchers Develop Tool to Reduce Phlebotomy Blood Loss

Reducing the volume of blood drawn from neonates has often been a subject of Phlebotomy Today over the years. I've not written about it in a while because there's just not been much new on the topic in the published literature. Along comes an article published in the Annals of Clinical Biochemistry that I think really helps managers comply with CLSI's mandate to monitor blood volumes drawn from patients susceptible to iatrogenic anemia (anemia caused by diagnostic sampling).

CLSI's venipuncture standard not only requires susceptible populations (e.g., neonates, geriatric, oncology, preemies, etc.) to have the volume of blood withdrawn from them to be monitored, but limited. It does no good to merely monitor them if we don't apply triggers at which remedial action is required. Such triggers and their subsequent actions are up to the facility.

The new research led to a spreadsheet managers can implement to facilitate clinical decisions. When a physician places an order, the tool calculates the minimum volume of blood required for the tests. That way, phlebotomists and other healthcare professionals with blood collection responsibilities don't guess at how much is required, but are provided with guidance on what size of tubes are required to prevent overdraws. Calculations are based on the laboratory's instrumentation and test methodologies to ensure adequate volumes of serum or plasma can be extracted from the collection tubes to satisfy test requirements with minimal excess. The patient's hematocrit is also considered as well as dead volumes required for instrument probes, and samples shared between laboratory departments. 

Prior to implementing the tool, researchers analyzed the volumes of blood and number of tubes their hospital's LIS recommended. After the spreadsheet tool was implemented, the recommended volume of blood to be collected dropped 56% (11,222 mL versus 4,915 mL). The number of tubes recommended decreased 18% (18,509 versus 15,549).

The authors concluded the spreadsheet allows for a customized, objective determination of the minimum blood volume required for ordered test combinations. Reductions of up to half the blood volume withdrawn from susceptible populations is a realistic expectation. 

Read the abstract.

Anyone interested in more information on preventing iatrogenic anemia can simply enter "iatrogenic" into the search window in the right panel on this page.