title: Identifying factors to minimize phlebotomy-induced blood loss in the pediatric intensive care unit.
abstract: OBJECTIVE
  Phlebotomy-induced blood loss in critically ill children is common, contributes to anemia, and may be avoidable. We aimed to identify factors associated with phlebotomy-induced blood loss.
  
  
  METHODS
  Prospective observational study, single-center tertiary children's hospital.
  
  
  METHODS
  Pediatric intensive care unit.
  
  
  METHODS
  A total of 63 patients admitted to the pediatric intensive care unit for >48 hrs from 2004 to 2005.
  
  
  METHODS
  None.
  
  
  RESULTS
  Phlebotomy resulted in a mean blood volume loss of 2.5 ± 1.4 mL per draw, 7.1 ± 5.3 mL per day, and 34 ± 37 mL per pediatric intensive care unit stay, of which 1.4 ± 1.1 mL per draw, 3.8 ± 3.6 mL per day, and 23 ± 31 mL per pediatric intensive care unit stay were discarded as excess. This excess represents 210% ± 174% of the volume requested by the laboratory and a 110% overdraw. Blood drawn from central venous catheters had significantly greater overdraw volumes, 254% ± 112%, compared to those of arterial, 168% ± 44%, and peripheral intravenous catheters, 143% ± 39%, p < .001. Blood draws sent for one test had an associated overdraw of 278% ± 81%, compared to draws sent for two, 168% ± 48%, three 173% ± 4%, and four or greater tests 55% ± 5%, p < .001. Patients <10 kg had significantly greater mean volumes of blood loss/kg/day compared to patients ≥ 10 kg, p < .001.
  
  
  CONCLUSIONS
  Blood drawn in excess of phlebotomy requirements exceeds the blood volume loss drawn for phlebotomy by two fold. Using indwelling catheters for phlebotomy often requires a discard volume to be drawn before obtaining the laboratory sample. Consolidating phlebotomy tests and using a closed system may decrease the amount of blood overdrawn and minimize overall phlebotomy-induced blood loss.
authors.affiliation: Department of Anesthesia and Perioperative Medicine, Division of Critical Care Medicine, Children's Hospital Boston, Boston, MA, USA. stacey.valentine@childrens.havard.edu
authors.forename: Stacey L
authors.initials: SL
authors.lastname: Valentine
authors.forename: Scot T
authors.initials: ST
authors.lastname: Bateman
mesh_terms: D017677:Age Distribution; D000740:Anemia / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D001800:Blood Specimen Collection / Q000009:adverse effects / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality / Q000628:therapy; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology* / Q000209:etiology* / Q000517:prevention & control; D006776:Hospitals, Pediatric; D006801:Humans; D015994:Incidence; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D061214:Patient Safety; D018962:Phlebotomy / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution