Diagnostic Blood Loss From Phlebotomy and Hospital-Acquired Anemia During Acute Myocardial Infarction

Salisbury, Adam C.

doi:10.1001/archinternmed.2011.361

Cited by 154 publications

(138 citation statements)

References 32 publications

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“…Although laboratory testing is an essential component of perioperative care, health care providers seldom are aware of the frequency and volume of phlebotomy for routine laboratory testing, and of recent work in medical and surgical settings identifying the association of hospitalacquired anemia and in-hospital morbidity, mortality, and resource utilization [2][3][4].…”

mentioning

confidence: 99%

Contemporary Bloodletting in Cardiac Surgical Care

Koch

Reineks

Tang

et al. 2015

The Annals of Thoracic Surgery

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mentioning

confidence: 99%

Contemporary Bloodletting in Cardiac Surgical Care

Koch

Reineks

Tang

et al. 2015

The Annals of Thoracic Surgery

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“…For example, unnecessary phlebotomy can lead to hospitalinduced anemia, need for transfusion, discomfort, work overload, and added cost. [5][6][7][8][9][10] Different strategies to ensure appropriate utilization of lab tests have been studied. 11 Nevertheless, objectively evaluating the necessity for tests is challenging, and the increasing reliance on electronic databases for this purpose has resulted in suboptimal quality of utilization reviews.…”

Section: Résumémentioning

confidence: 99%

Non-essential blood tests in the intensive care unit: a prospective observational study

Mikhaeil

Day

Ilan

2016

Can J Anesth/J Can Anesth

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Purpose Non-essential blood testing in the acute care setting can be a prominent source of morbidity, patient discomfort, increased workload for the healthcare provider, and wasteful spending. The magnitude of such non-essential blood testing has not been well described. We aimed to measure the extent of unnecessary blood testing in a 33-bed intensive care unit (ICU) at a tertiary-care teaching hospital in Ontario, Canada. Methods Over a period of four weeks, all ICU attending physicians were asked to select, from a comprehensive list, blood tests that they deemed essential to the appropriate care for each of their patients on the following day. The actual tests processed on the following day were recorded. Descriptive statistics were used to determine what proportion of all processed tests were deemed essential blood tests. The association between patient characteristics and the total cost of unnecessary tests was assessed using the Wilcoxon rank-sum test and the Spearman correlation coefficient, as appropriate. Results Nine attending physicians provided input for a total of 81 patient days. In 65 (80%) of these days, at least one test was considered non-essential. Physicians deemed only 338 (48.7%) of 694 processed blood tests as essential,

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“…11 Although this avoids the discomfort associated with fingersticks, it is not exempt from complications 12 and the daily loss of 40 to 70 mL of blood. 13,14 Increased handling of arterial catheters and access to the connections several times a day increases the risk of infection (0.31-3.36 x 1000 catheter-days), 15,16 obstruction (11%-29%), 17 chloride solution was withdrawn from the stopcock farthest from the insertion site, leaving the syringe attached. The sample was withdrawn from the stopcock nearest the insertion, and then blood in the attached syringe was reinfused.…”

Section: Intervention Groupmentioning

confidence: 99%

Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

Torredà

Llano-Serrano

Almirall-Solsona

et al. 2014

American Journal of Critical Care

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Background Use of an arterial catheter to obtain hourly blood samples for intensive insulin therapy monitoring avoids causing patients the discomfort of repeated fingersticks. Returning the clearing volume may decrease procedure-related blood loss by 50% and minimize the risk of anemia. Objectives To compare the feasibility of 2 arterial catheter clearing-volume return setups for hourly blood extractions and to evaluate the related complications and the accuracy of arterial samples in determining glycemia.Methods In an open clinical trial, 90 critical patients undergoing intensive insulin therapy who had a radial arterial catheter were randomized to an intervention group-nonwaste needleless setup or nonwaste syringe setup and compared with the standard setup (control group). Mechanical and infectious complications related to the arterial catheter were evaluated. Blood glucose measurements at point-of-care glucometer (arterial catheter or fingerstick sample) were compared with laboratory results (venous blood). Results No patient had catheter-related infection in the intervention group (an estimated 12 776 manipulations); the control group had 2 infection episodes in 5230 catheter-days (an estimated 13 075 manipulations). The incidence of bacterial colonization was not significantly higher in the needleless group than in the syringe group (22.2% vs 12.2%; relative risk, 0.55; 95% CI, 0.16-1.71), with 1778 (SD, 114) and 1918 (SD, 82) catheter manipulations, respectively. Arterial catheter complications were negligible in all patients. Glycemia was detected from arterial catheter samples as effectively as with laboratory results (venous samples) except when hematocrit was less than 25%. Conclusions Use of blood obtained via an arterial catheter is safe and effective for glucose monitoring in patients undergoing intensive insulin therapy, with no increase in complications of catheterization.

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Diagnostic Blood Loss From Phlebotomy and Hospital-Acquired Anemia During Acute Myocardial Infarction

Abstract: Blood loss from greater use of phlebotomy is independently associated with the development of HAA. These findings suggest that HAA may be preventable by implementing strategies to limit blood loss from laboratory testing.

Cited by 154 publications

References 32 publications

Contemporary Bloodletting in Cardiac Surgical Care

Contemporary Bloodletting in Cardiac Surgical Care

Non-essential blood tests in the intensive care unit: a prospective observational study

Arterial Catheter Setup for Glucose Control in Critically Ill Patients: A Randomized Controlled Trial

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