An Educational Intervention Optimizes the Use of Arterial Blood Gas Determinations Across ICUs From Different Specialties

Oliveira, Paulo J.; O’Rourke, Michelle; Hills, Luanne

doi:10.1016/j.chest.2016.10.035

Cited by 24 publications

(29 citation statements)

References 17 publications

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“…Two studies, Foulke [40], rated as fair, and Matinez-Balzano [41], rated as good quality, reported on the impact of policy changes or educational interventions. The policy evaluated by Foulke et al [40] required that less blood be drawn for laboratory tests, that small volume phlebotomy tubes be used, and that the total daily blood volume drawn be recorded on the patient’s chart.…”

Section: Resultsmentioning

confidence: 99%

Interventions to prevent iatrogenic anemia: a Laboratory Medicine Best Practices systematic review

Whitehead¹,

Williams²,

Meleth³

et al. 2019

Crit Care

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Background As many as 90% of patients develop anemia by their third day in an intensive care unit (ICU). We evaluated the efficacy of interventions to reduce phlebotomy-related blood loss on the volume of blood lost, hemoglobin levels, transfusions, and incidence of anemia. Methods We conducted a systematic review and meta-analysis using the Laboratory Medicine Best Practices (LMBP) systematic review methods for rating study quality and assessing the body of evidence. Searches of PubMed, Embase, Cochrane, Web of Science, PsychINFO, and CINAHL identified 2564 published references. We included studies of the impact of interventions to reduce phlebotomy-related blood loss on blood loss, hemoglobin levels, transfusions, or anemia among hospital inpatients. We excluded studies not published in English and studies that did not have a comparison group, did not report an outcome of interest, or were rated as poor quality. Twenty-one studies met these criteria. We conducted a meta-analysis if > 2 homogenous studies reported sufficient information for analysis. Results We found moderate, consistent evidence that devices that return blood from flushing venous or arterial lines to the patient reduced blood loss by approximately 25% in both neonatal ICU (NICU) and adult ICU patients [pooled estimate in adults, 24.7 (95% CI = 12.1–37.3)]. Bundled interventions that included blood conservation devices appeared to reduce blood loss by at least 25% (suggestive evidence). The evidence was insufficient to determine if these devices reduced hemoglobin decline or risk of anemia. The evidence suggested that small volume tubes reduced the risk of anemia, but was insufficient to determine if they affected the volume of blood loss or the rate of hemoglobin decline. Conclusions Moderate, consistent evidence indicated that devices that return blood from testing or flushing lines to the patient reduce the volume of blood loss by approximately 25% among ICU patients. The results of this systematic review support the use of blood conservation systems with arterial or venous catheters to eliminate blood waste when drawing blood for testing. The evidence was insufficient to conclude the devices impacted hemoglobin levels or transfusion rates. The use of small volume tubes may reduce the risk of anemia. Electronic supplementary material The online version of this article (10.1186/s13054-019-2511-9) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Interventions to prevent iatrogenic anemia: a Laboratory Medicine Best Practices systematic review

Whitehead¹,

Williams²,

Meleth³

et al. 2019

Crit Care

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“…Gold standard measurement of oxygen saturation percentage is measured using arterial blood gas (ABG) analyses [1].The method has been proven to be very accurate and useful for diagnostic purposes [2]. In current practice, the test is not a routine investigation because the method is invasive, requires skillful personnel, time consuming and provide only intermittent measurement [3].…”

Section: Introductionmentioning

confidence: 99%

Reliable monitoring of oxygen saturation via pulse oximetry: Which site to choose?

Juliana¹,

Azmani²,

Idrose³

et al. 2018

J. Fundam and Appl Sci.

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This study focuses on identifying the best site for placement of pulse oximeter probe accurate measuring of oxygen saturation. Twenty years old were recruited in this study. Cold pressor test was done to stim 460 measurements of SpO 2 analyzed using ANOVA with p < 0.05 was considered to be significant. Bias between sites are determined using Bland-Altman plot whilst the internal co sites are identified via Cronbach oxygen saturation measurement is at the earlobe using the ear sensor. Portable finger pulse oximeter oxygen saturation estimation is middle and right ring fingers) regardless of stimulation on peripheral vasoactivity.

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“…Although blood gases should not be checked routinely for all critically ill patients, 17,18 blood gas analysis is indicated with changes in respiratory status and initiation of mechanical ventilation. 14,17 In-patient blood gases frequently result in changes in clinical management, 19 but the use of blood gases in mechanically ventilated emergency department patients has not been previously described. While a majority of ventilated subjects received some blood gas analysis in this cohort, blood gases were not universal, and the blood gas data do not correlate with ventilator management in the emergency department.…”

Section: Discussionmentioning

confidence: 99%

Emergency Department Blood Gas Utilization and Changes in Ventilator Settings

et al. 2017

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In this prospective observational study of subjects mechanically ventilated in the emergency department, the majority had a blood gas checked while in the emergency department. While ABGs were associated with having changes made to ventilator settings in the emergency department, clinical findings of hypoxemia, hyperoxia, hypercapnia, and acidemia were not. Inattention to blood gas results may lead to missed opportunities in guiding ventilator changes in the emergency department.

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An Educational Intervention Optimizes the Use of Arterial Blood Gas Determinations Across ICUs From Different Specialties

Cited by 24 publications

References 17 publications

Interventions to prevent iatrogenic anemia: a Laboratory Medicine Best Practices systematic review

Interventions to prevent iatrogenic anemia: a Laboratory Medicine Best Practices systematic review

Reliable monitoring of oxygen saturation via pulse oximetry: Which site to choose?

Emergency Department Blood Gas Utilization and Changes in Ventilator Settings

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