Pam Harrison

November 04, 2015

For patients in critical care units, blood can be drawn with a pediatric syringe instead of a standard 3 mL syringe, new research shows.

"When overdone, phlebotomy can lead to transfusion and anemia, and transfusions have a lot of complications associated with them," said Phill Jensen, laboratory manager at University of Utah Health Sciences in Salt Lake City.

"We changed from using a 3cc syringe to a 1cc syringe, and in the last year, we saved patients in our cardiovascular intensive care unit alone about 25,000 mL of blood — which is a lot of blood," he told Medscape Medical News.

The study results were presented at the American Society for Clinical Pathology 2015 Annual Meeting in Long Beach, California.

Significant Blood Loss

Daily phlebotomy in the ICU steals a mean of 40 to 70 mL of blood, and previous research has suggested that this could be responsible for at least one-third of all blood transfusions (Am J Respir Crit Care Med. 2012;185:1049-1057). In addition, more than 95% of patients in the ICU are anemic after their first week in care.

Jensen and his colleagues compared blood collected with the two syringes — produced by the same manufacturer for the same cost, and that used the same concentrations of heparin — at one of the adult ICUs at the University of Utah Hospital.

Over a period of 65 days, a standard adult 3 mL syringe was used to collect 741 specimens, which were then sent to the blood gas laboratory.

Then, after a 10-day washout period, and over a period of 68 days, another 839 blood specimens were collected with a pediatric 1 mL syringe.

There was no difference in specimen integrity or in the need to repeat or reacquire specimens between the two syringes; however, the pediatric syringe clearly reduced the volume of blood drawn.

"The tests that we do in our laboratory can be performed on anywhere from 35 to 200 µL of blood, so the only reason we draw that much blood is to offset the heparin concentration in the syringe," Jensen explained. With the 1 mL syringe, "we can drop the volume down to three-tenths of a cc and potentially still run tests twice off that much blood."

The investigators are now looking to use the same strategy in other ICUs.

These results demonstrate how blood volume loss can be significantly reduced simply by switching to readily available pediatric syringes commonly used in the neonatal population, said Earl Fulcher, RRT, director of respiratory services at the University of Utah Health Care.

"With the availability of current analyzer technology, most laboratories can and should make this change," Fulcher told Medscape Medical News.

Mr Jensen and Mr Fulcher have disclosed no relevant financial relationships.

American Society for Clinical Pathology (ASCP) 2015 Annual Meeting. Presented October 30, 2015.

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