Effect of blood conservation practices on reducing blood sampling volumes and other clinical sequelae in intensive care. A systematic review

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Keogh, Samantha
Mathew, Saira
Ullman, Amanda J
Rickard, Claire M
Coyer, Fiona
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2020
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Abstract

Introduction: Blood sampling to inform decision making is an important aspect of intensive care. This is often facilitated by vascular access devices (VADs) connected to fluid administration and monitoring systems. Repeated blood sampling either via phlebotomy or VADs can result in blood wastage and contamination, which can lead to iatrogenic anaemia and systemic infection.

Objectives/Aims: The aim of this systematic review was to critically appraise and synthesise results from trials evaluating the impact of blood conservation strategies and systems in intensive care.

Methods: A systematic search was conducted in Medline, CINAHL, PUBMED and EMBASE databases. Two reviewers independently screened potential studies for eligibility. The search was limited to randomised controlled and clustered trials, published in English language between 2000-2019. Primary outcomes were blood sample volumes and haemoglobin change. Secondary outcomes included blood transfusion use and infection outcomes. Quality appraisal was conducted using the Cochrane Risk of Bias tool. A narrative synthesis and meta-analysis with the Mantel-Haenszel model using random effects approach in RevMan was conducted.

Results: Seven studies from 513 were eligible (n=934). There were no published trials after 2014. Six studies were conducted in adults and one in paediatrics. Six studies evaluated the impact of a closed loop blood sampling system and one studied a conservative phlebotomy protocol. Studies were of low to moderate quality. Meta-analysis was not possible for blood sample volumes or haemoglobin. Decreased blood sample volumes reported in five studies were attributable to the intervention. Meta-analysis demonstrated that use of a closed system was associated with a reduced risk of intraluminal fluid colonisation [Risk Ratio (RR) 0.25, 95% CI 0.10-0.66] and number of transfused units delivered [RR 0.66, 95% CI 0.47-0.94].

Conclusion: Closed loop blood sampling systems were associated with reduced blood sample loss, blood transfusion use and intraluminal fluid colonisation. This requires confirmation in larger, contemporary, rigorous trial analysis using clinically relevant outcomes.

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Australian Critical Care
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Clinical sciences
Nursing
Science & Technology
Life Sciences & Biomedicine
Critical Care Medicine
General & Internal Medicine
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Keogh, S; Mathew, S; Ullman, AJ; Rickard, CM; Coyer, F, Effect of blood conservation practices on reducing blood sampling volumes and other clinical sequelae in intensive care. A systematic review, Australian Critical Care, 2020, 33, pp. S43-S43