title: Highly conservative phlebotomy in adult intensive care--a prospective randomized controlled trial.
abstract: Anaemia in critically ill patients is common and phlebotomy associated blood loss may contribute towards this anaemia. The aims of this study were twofold. Firstly, a survey was conducted to provide a summary of current phlebotomy practices within Australian intensive care units. A standardized telephone survey was aimed at Australian intensive care units registered with Australia and New Zealand Intensive Care Society (ANZICS) and questions regarding phlebotomy procedures directed at nursing staff. Secondly, a prospective randomized controlled trial aimed to assess the impact of a highly conservative phlebotomy procedure on haemoglobin concentration in intensive care patients. Patients admitted to our own intensive care unit were randomized using a sealed envelope technique to either a highly conservative phlebotomy group, or standardized controls. Blood was taken according to strict protocols and recorded along with haemoglobin concentration daily. The survey demonstrated that 16% of Australian units return deadspace volumes from in-line arterial sets and no unit routinely used paediatric-sized blood collection tubes. Using our highly conservative protocol, median phlebotomy-associated blood loss was reduced by over 80% (40 ml vs 8 ml P<0.001). Mean haemoglobin fell from 13.7 g/dl to 11.7 g/dl in controls (P=0.002) and from 12.7 g/dl to 11.5 g/dl (P=0.074) in our study group. We conclude that highly conservative phlebotomy is feasible in a critical care unit and is associated with a reduction in blood loss.
authors.affiliation: Logan Hospital Intensive Care Unit, Brisbane, Queensland, Australia.
authors.forename: C R
authors.initials: CR
authors.lastname: Harber
authors.forename: K J
authors.initials: KJ
authors.lastname: Sosnowski
authors.forename: R M
authors.initials: RM
authors.lastname: Hegde
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D001315:Australia; D003422:Critical Care; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D018962:Phlebotomy / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*; D011446:Prospective Studies