Observational studyPloS one2021
Patient harm associated with serial phlebotomy and blood waste in the intensive care unit: A retrospective cohort study.
Observational study in PloS one, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 21 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
21 citing papers in PubMed, 36 citations in OpenAlex.
- Article
- Patient blood management in general intensive care patients.Intensive care medicine · 2026Review
- Determination of the Minimum Discard Volume in the Extraction of Blood Samples Through Arterial Catheters in Critical Patients.Nursing in critical care · 2026Article
- Redefining Acute Respiratory Distress Syndrome: A New Clinical Perspective.Tuberculosis and respiratory diseases · 2026Article
- Optimizing Intervention Sequences to Reduce Physician Blood Urea Nitrogen Test Overuse: A Multi-Hospital Analysis.Journal of general internal medicine · 2025Article
- Contact activation of coagulation in newly inserted indwelling catheters.Scientific reports · 2025Observational
- Clot formation risk in the clearing fluid after arterial catheter blood sampling: coagulation factors consumption over time - a prospective pilot study.Journal of clinical monitoring and computing · 2025Observational
- Micro blood analysis technology (μBAT): multiplexed analysis of neutrophil phenotype and function from microliter whole blood samples.Lab on a chip · 2024Article
- A Canadian survey of perceptions and practices related to ordering of blood tests in the intensive care unit.Canadian journal of anaesthesia = Journal canadien d'anesthesie · 2024Article
- Evaluation of hemostasis understanding in medical and pharmacy students from a Parisian university.Research and practice in thrombosis and haemostasis · 2024Article
- The environmental impact of laboratory measurements in high-resource ICUs.Intensive care medicine · 2024Article
- A New Global Definition of Acute Respiratory Distress Syndrome.American journal of respiratory and critical care medicine · 2024Article
- Blood microsampling technologies: Innovations and applications in 2022.Analytical science advances · 2023Review
- Pulse oximetry for the diagnosis and management of acute respiratory distress syndrome.The Lancet. Respiratory medicine · 2022Review
- Coagulation test understanding and ordering by medical trainees: Novel teaching approach.Research and practice in thrombosis and haemostasis · 2022Article
- Patient blood management in the ICU: A narrative review of the literature.European journal of anaesthesiology and intensive care · 2022Review
- Avoidable Blood Loss in Critical Care and Patient Blood Management: Scoping Review of Diagnostic Blood Loss.Journal of clinical medicine · 2022Article
- Iatrogenic blood loss in critical care: A prospective observational study conducted at Universitas Academic Hospital in the Free State Province, South Africa.The Southern African journal of critical care : the official journal of the Critical Care Society · 2022Article
- Using Residual Blood from the Arterial Blood Gas Test to Perform Therapeutic Drug Monitoring of Vancomycin: An Example of Good Clinical Practice Moving towards a Sustainable Intensive Care Unit.Critical care research and practice · 2022Article
- Perioperative Trajectory of Haemoglobin, Predictors of Blood Transfusion and Tailoring Targets for Patient Blood Management Interventions: A Single-centre, Retrospective Study of Non-emergent Cardiac Surgery Patients.Romanian journal of anaesthesia and intensive care · 2021Article
Corrections and comments
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Authors and funding
8 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIntensive care unit (ICU) patients are at high risk of anemia, and phlebotomy is a potentially modifiable source of blood loss. Our objective was to quantify daily phlebotomy volume for ICU patients, including blood discarded as waste during vascular access, and evaluate the impact of phlebotomy volume on patient outcomes.
methodsThis was a retrospective observational cohort study between September 2014 and August 2015 at a tertiary care academic medical-surgical ICU. A prospective audit of phlebotomy practices in March 2018 was used to estimate blood waste during vascular access. Multivariable logistic regression was used to evaluate phlebotomy volume as a predictor of ICU nadir hemoglobin < 80 g/L, and red blood cell transfusion.
resultsThere were 428 index ICU admissions, median age 64.4 yr, 41% female. Forty-four patients (10%) with major bleeding events were excluded. Mean bedside waste per blood draw (144 draws) was: 3.9 mL from arterial lines, 5.5 mL central venous lines, and 6.3 mL from peripherally inserted central catheters. Mean phlebotomy volume per patient day was 48.1 ± 22.2 mL; 33.1 ± 15.0 mL received by the lab and 15.0 ± 8.1 mL discarded as bedside waste. Multivariable regression, including age, sex, admission hemoglobin, sequential organ failure assessment score, and ICU length of stay, showed total daily phlebotomy volume was predictive of hemoglobin <80 g/L (p = 0.002), red blood cell transfusion (p<0.001), and inpatient mortality (p = 0.002). For every 5 mL increase in average daily phlebotomy the odds ratio for nadir hemoglobin <80 g/L was 1.18 (95% CI 1.07-1.31) and for red blood cell transfusion was 1.17 (95% CI 1.07-1.28).
conclusionA substantial portion of daily ICU phlebotomy is waste discarded during vascular access. Average ICU phlebotomy volume is independently associated with ICU acquired anemia and red blood cell transfusion which supports the need for phlebotomy stewardship programs.
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