Adriana Chou, MD,
Resident
University of Massachusetts Medical School
Worcester, Massachusetts
Disclosure information not submitted.
Marissa Parrillo, DO
Resident Physician
University of Massachusetts Medical School, Massachusetts, United States
Disclosure information not submitted.
Stacey Valentine, MD
Associate Professor, Attending Physician
University of Massachusetts Boston, United States
Disclosure information not submitted.
Scot Bateman, MD
Professor
University of Massachusetts Memorial Medical Center, Inc, United States
Disclosure information not submitted.
Amanda Johnson, MD
Assistant Professor
University of Massachusetts Medical School, United States
Disclosure information not submitted.
Title: Reducing Phlebotomy Waste in the PICU: a Longitudinal Quality-Improvement Study
Introduction: Phlebotomy-induced blood loss contributes to iatrogenic anemia in critically ill children and is associated with increased blood transfusions. Up to 50% of all blood collected is wasted due to discarded volumes drawn from indwelling catheters, use of large-volume containers, and frequent collections, especially in smaller children. Our objectives are to reduce phlebotomy waste by minimizing these factors and to maintain these improvements over time.
Methods: Quality improvement study comparing pre- and post- intervention data after clinical staff were educated about standardized phlebotomy waste volumes and introduction of 500 uL microtainers. Data were collected for two 2-month intervals, separated by a 6 month washout period, including volume of blood discarded and sent to the lab with each blood draw. After another extended washout period of 6 years without additional interventions, 2 weeks of data were collected to determine the longevity of the initial improvements in phlebotomy waste.
Results: Initially, post-intervention mean volume sent to the lab (1.52 ±1.50mL) and wasted (0.89 ±0.61mL) were both reduced compared to pre-intervention (2.25 ±1.87mL and 1.64 ±1.67mL, respectively; both p< 0.05). Currently, 60% of tubes analyzed are microtainers (N=30 tubes). A mean of 0.97 + 0.39mL is sent via microtainers, similar to the post-intervention volumes in 2015 (1.52 + 1.50mL, p=0.551). Volumes discarded per draw are significantly higher compared to the 2015 post-intervention group (2.11 + 1.34mL vs 0.89 + 0.61, p< 0.001). Volumes sent and discarded do not differ by draw site. Among microtainer draws, volumes sent do not differ by age group, however mean volumes discarded are significantly lower in younger patients (p=0.001).
Conclusions: Introduction of 500 uL phlebotomy microtainers and education about standardized waste volumes led to significant reduction in phlebotomy-induced blood loss in our patients. Without further intervention, the reduction in volume of blood sent via microtainers is maintained, however the improvements in discarded volumes has been lost. We will continue to collect data to examine the changes to phlebotomy waste over time, then introduce a new PDSA cycle aimed at increasing availability and frequency of microtainer use and re-evaluation of standardized waste volumes.