Reliability of blood test results in samples obtained using a 2-mL discard volume from the proximal lumen of a triple-lumen central venous catheter in the critically ill patient.
BACKGROUND
Intensive care patients require a high frequency of blood testing, which results in a significant amount of blood loss. When blood is obtained from a central venous catheter (CVC), a large volume is usually discarded to obtain an unaltered sample for testing.


OBJECTIVE
To determine the reliability of complete blood test results in blood samples obtained from the proximal lumen of a triple-lumen CVC using a 2-mL discard volume DESIGN: Observational study with the prospective collection of data METHODS: The subjects enrolled were all patients with a subclavian triple-lumen CVC, older than 17 years and consecutively admitted to intensive care over a 2-year period. In each of the 54 participants, one blood sample was drawn from the proximal lumen of the catheter, discarding 1·61 mL of blood plus 0·39 mL of catheter deadspace (2 mL) and without interrupting infusion in the middle and distal lumens. A second sample was then obtained by direct venous puncture. The reliability of blood test results was determined by comparing sets of variables recorded for the two sampling methods through intraclass correlation coefficients in the Bland-Altman method.


RESULTS
Inter-method reliability for the variables examined was excellent, >0·75; range (0·868-0·998). Mean differences between the two sample types for the variables most often determined in critically ill patients were leukocytes: 0·200 × 103/µL, 95% confidence interval (CI) (0·025 to 0·375); erythrocytes: 0·045 × 106/uL, 95% CI (-0·003 to 0·094); sodium: 0·074 mEq/L, 95% CI (-0·369 to 0·517); potassium: -0·002mEq/L, 95% CI (-0·065 to 0·061) and glucose: 2·426 mg/dL, 95% CI (0·498-4·354).


CONCLUSIONS
The sampling method proposed minimizes blood loss while offering reliable blood test results.


CONCLUSIONS
The main benefit of the method proposed is reduced blood loss, improving the care of a critically ill patient.
Intensive Care Unit, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain.
Pedro
P
Villalta-García
Faculty of Nursing, Physiotherapy and Podology, Universidad Complutense de Madrid, Madrid, Spain.
Marta
M
López-Herránz
Intensive Care Unit, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain.
Salvador
S
Mazo-Pascual
Intensive Care Unit, Hospital Universitario de Móstoles, Móstoles, Madrid, Spain.
Teresa
T
Honrubia-Fernández
Faculty of Psychology, Universidad Complutense de Madrid, Madrid, Spain.
Luis
L
Jáñez-Escalada
Preventive Medicine and Public Health, Unit of Clinical Methodology and Epidemiology, Preventive Medicine Service, Institute of Health Research of the Hospital Clínico de San Carlos, Universidad Complutense de Madrid, Madrid, Spain.
Cristina
C
Fernández-Pérez
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects* / Q000379:methods; D062905:Central Venous Catheters / Q000009:adverse effects*; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D004867:Equipment Design; D005260:Female; D006403:Hematologic Tests / Q000009:adverse effects / Q000379:methods; D006784:Hospitals, Teaching; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D061214:Patient Safety; D018962:Phlebotomy / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D018570:Risk Assessment; D013048:Specimen Handling
Blood discard volume; Central venous catheter; Iatrogenic anaemia; Intensive care; Nursing