Impact of Phlebotomy Tourniquet Use on Blood Lactate Levels in Acutely Ill Patients.
OBJECTIVE
Lactate levels are increasingly used to guide resuscitation efforts. Some surgical literature suggests that tourniquet use during phlebotomy falsely elevates results, although studies in healthy volunteers have not demonstrated this. The purpose of this study was to determine in clinical practice whether tourniquet use during the drawing of a lactate results in significantly altered levels compared to the result of a level drawn without a tourniquet.


METHODS
A prospective cohort study was carried out on emergency department patients whose clinical presentation led a physician to order a lactate level. Written informed consent was obtained from patients or their proxies. Study lactates were obtained using a tourniquet during the draw sequence of other laboratory studies. Lactate levels for clinical use were drawn per hospital protocol with no tourniquet. The time of lactate measurements and patient demographic information were recorded. Lactate levels for each patient were compared with the Wilcoxon Rank-Sum Test.


RESULTS
40 patients were consented and enrolled. The median clinical lactate level was 1.9 (interquartile range 1.5-2.6), and the median study lactate level was 1.9 (interquartile range 1.4-2.7). There was no difference between paired lactate values (p=0.95).


CONCLUSIONS
Tourniquet use appears to have no impact on measured lactate levels. Our findings suggest that current practices at many institutions regarding lactate collection are likely too stringent and should be changed.
*Department of Emergency Medicine,St. Luke's University Hospital,Bethlehem,PA,USA.
Vamsi
V
Balakrishnan
*Department of Emergency Medicine,St. Luke's University Hospital,Bethlehem,PA,USA.
John
J
Wilson
*Department of Emergency Medicine,St. Luke's University Hospital,Bethlehem,PA,USA.
Brent
B
Taggart
†Department of Trauma/Critical Care,St. Luke's University Hospital,Bethlehem,PA,USA.
James
J
Cipolla
*Department of Emergency Medicine,St. Luke's University Hospital,Bethlehem,PA,USA.
Rebecca
R
Jeanmonod
D000328:Adult; D001774:Blood Chemical Analysis; D015331:Cohort Studies; D016638:Critical Illness; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D019344:Lactic Acid / Q000097:blood*; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D018962:Phlebotomy / Q000379:methods*; D011446:Prospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D018709:Statistics, Nonparametric; D014111:Tourniquets / Q000009:adverse effects / Q000706:statistics & numerical data*; D014193:Trauma Centers
D019344:Lactic Acid
blood lactate; phlebotomy; tourniquet use