You can make a difference in your patients’ outcomes by incorporating evidence-based Closed Blood Sampling (CBS) procedures into your hospital’s Patient Blood Management (PBM) program. CBS is demonstrated to more effectively conserve blood, improve patient outcomes and reduce costs when compared with conventional blood sampling procedures. 12,16,20-23
Patient Blood Management (PBM) is the timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis and minimize blood loss in an effort to improve patient outcome. 30
Closed Blood Sampling (CBS) is an evidence-based solution.
Evidence supports Closed Blood Sampling (CBS) vs. conventional sampling 16, 20, 21
Reduce blood loss
Discarded blood can account for
18% to 30%
of total daily blood drawn from
critically ill patients 20
- In the ICU, blood may be drawn 5 to 24 times a day 1,2
- Volume drawn per day may be 26 to 427 mL 2-7
- Weekly blood loss due to phlebotomy may range from 340 to 660 mL in ICU patients 17
- Blood discarded with each blood draw varies from 2 to 10 mL 3, 9, 10
Evidence supports Closed Blood Sampling (CBS) vs. conventional sampling 16, 20-23
Reduce iatrogenic anemia
Anemia is associated with substantial burden and increased risk of organ injury and mortality. 1,2,8,25
- Every 50 mL of blood drawn increases the risk of moderate to severe iatrogenic anemia by 18% 3
- Patients with >21 days LOS who experience an increase in blood draw above 3.5 mL/day risk a twofold increase in blood transfusions to correct their anemia 3
- Anemia can have a negative effect on the patient's quality of life and is associated with an increased risk of cardiac related morbidity and mortality 2,25
Evidence supports Closed Blood Sampling (CBS) vs. conventional sampling
Reduce catheter-related bloodstream infections (CRBSI) 11,12
develop CRBSI each year in US 26
- In critically ill patients, CRBSI account for 19% of infections 26
- In pediatric ICUs, CRBSI are observed in 31% of nosocomial infections 26
Evidence supports Closed Blood Sampling (CBS) vs. conventional sampling
Reduce transfusion needs and related complications 20, 22, 28
- Transfusion-related acute lung injury (TRALI), transfusion associated circulatory overload (TACO), acute respiratory distress syndrome (ARDS), infections and ventilator-associated pneumonia 23
- RBC transfusion has been associated with a higher rate of post-operative infection in various populations 2
- Transfused patients have increased mortality both in the ICU and hospital, increased infection rates, organ failure, longer ICU stays 22
Closed Blood Sampling: evidence-based decision making for cost-effective care.
Reduce hospital costs
RBC-unit costs range up to
- Closed Blood Sampling (CBS) may help reduce hospital costs by reducing transfusion incidence. 23
- Transfusion-related adverse events, both short- and long-term, are among the costliest contributors to healthcare expenditures. 32
- Additionally, CBS may help you reduce proposed penalties for hospital-acquired complications (HAC) through reduced contamination risk. 12
You can make a difference in your patients’ outcomes by incorporating Closed Blood Sampling within your patient blood management program. 31
Edwards offers a host of educational resources to help your hospital implement Closed Blood Sampling including education, a value estimator and clinical evidence.
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- Tinmouth, A.T., L.A. McIntyre, and R.A. Fowler, Blood conservation strategies to reduce the need for red blood cell transfusion in critically ill patients. CMAJ : Canadian Medical Association journal = journal de l'Association medicale canadienne, 2008. 178(1): p. 49-57.
- Vincent, J.L., et al., Anemia and blood transfusion in critically ill patients. JAMA, 2002. 288(12): p.1499-507.
- Barth, M.D., et al., Blood Conservation: What Is Current Blood Draw Practice? Journal of infusion nursing : the official publication of the Infusion Nurses Society, 2013. 36(5): p. 323-328.
- Smoller, B.R., M.S. Kruskall, and G.L. Horowitz, Reducing adult phlebotomy blood loss with the use of pediatric-sized blood collection tubes. Am J Clin Pathol, 1989. 91(6): p. 701-3.
- Eyster, E. and J. Bernene, Nosocomial anemia. JAMA, 1973. 223(1): p. 73-4.
- Henry, M.L., W.L. Garner, and P.J. Fabri, Iatrogenic anemia. Am J Surg, 1986. 151(3): p. 362-3.
- Andrews, T., H. Waterman, and V. Hillier, Blood gas analysis: a study of blood loss in intensive care. Journal of advanced nursing, 1999. 30(4): p. 851-7.
- O'Hare, D. and R.J. Chilvers, Arterial blood sampling practices in intensive care units in England and Wales. Anaesthesia, 2001. 56(6): p. 568-71.
- Yucha, C.B. and E. DeAngelo, The minimum discard volume: accurate analysis of peripheral hematocrit. J Intraven Nurs, 1996. 19(3): p. 141-6.
- Keller, C.A., Methods of drawing blood samples through central venous catheters in pediatric patients undergoing bone marrow transplant: results of a national survey. Oncol Nurs Forum, 1994. 21(5): p. 879-84.
- Thorpe, S. and A.N. Thomas, The use of a blood conservation pressure transducer system in critically ill patients. Anaesthesia, 2000. 55(1): p. 27-31.
- Oto, J., et al., Comparison of bacterial contamination of blood conservation system and stopcock system arterial sampling. American Journal of Infection, 2012. 40(6): p. 530-4.
- Thavendiranathan, P., et al., Do blood tests cause anemia in hospitalized patients? The effect of diagnostic phlebotomy on hemoglobin and hematocrit levels. Journal of general internal medicine, 2005. 20(6): p. 520-4.
- Chant, C., G. Wilson, and J.O. Friedrich, Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged ICU length of stay: a cohort study. Critical care, 2006. 10(5): p. R140.
- Lin, J.C., et al., Phlebotomy overdraw in the neonatal intensive care nursery. Pediatrics, 2000. 106(2): p. E19.
- Peruzzi, W.T., et al., A clinical evaluation of a blood conservation device in medical intensive care unit patients. Critical care medicine, 1993. 21(4): p. 501-6.
- Page, C., A. Retter, and D. Wyncoll, Blood conservation devices in critical care: a narrative review. Annals of intensive care, 2013. 3(1): p. 14.
- Corwin, H.L., K.C. Parsonnet, and A. Gettinger, RBC transfusion in the ICU. Is there a reason? Chest, 1995. 108(3): p. 767-71.
- Bateman, S.T., et al., Anemia, blood loss, and blood transfusions in North American children in the intensive care unit. Am J Respir Crit Care Med, 2008. 178(1): p. 26-33.
- MacIsaac, C.M., et al., The influence of a blood conserving device on anemia in intensive care patients. Anaesth Intensive Care, 2003. 31(6): p. 653-7.
- Mahdy, S., et al., Evaluation of a blood conservation strategy in the intensive care unit: a prospective, randomised study. Middle East J Anesthesiol, 2009. 20(2): p. 219-23.
- Rezende E, F.M., Manoel Da Silva Junior J, et al, Closed system for blood sampling and transfusion in critically ill patients. Rev Bras Ter Intensiva, 2010. 22: p. 5-10.
- Mukhopadhyay, A., et al., The use of a blood conservation device to reduce red blood cell transfusion requirements: a before and after study. Critical care, 2010. 14(1): p. R7.
- Hare, G.M., J. Freedman, and C. David Mazer, Review article: risks of anemia and related management strategies: can perioperative blood management improve patient safety? Can J Anaesth, 2013. 60(2): p. 168-75.
- Rudis, M.I., et al., Managing anemia in the critically ill patient. Pharmacotherapy, 2004. 24(2): p. 229-47.
- De Gaudio, A.R. and A. Di Filippo, Device-related infections in critically ill patients. Part I: Prevention of catheter-related bloodstream infections. J Chemother, 2003. 15(5): p. 419-27.
- Crow, S., et al., Microbial contamination of arterial infusions used for hemodynamic monitoring: a randomized trial of contamination with sampling through conventional stopcocks versus a novel closed system. Infection control and hospital epidemiology: the official journal of the Society of Hospital Epidemiologists of America, 1989. 10(12): p. 557-61.
- Moron N., J.E., Moreno I., Lazaro A., Dispositivo VAMP Beneficis para el paciente critico. Rev ROL Enf, 2003. 26(9): p. 591-594.
- Abraham, I. and D. Sun, The cost of blood transfusion in Western Europe as estimated from six studies. Transfusion, 2012. 52(9): p. 1983-8.
- Society for the Advancement of Blood Management, Professional Definition of Patient Blood Management (PBM) on homepage, http://sabm.org, retrieved April 17, 2015.
- Society for the Advancement of Blood Management®. SABM Administrative and Clinical Standards for Patient Blood Management Programs, 3rd Edition. Unpublished work © 2014.
- Shander, A., et al., Estimating the cost of blood: past, present, and future directions. Best Practice & Research Clinical Anaesthesiology, 2007. Vol 21, No. 2, p. 271-289. doi:10.1016/j.bpa.2007.01.002
- Tang, M., et al. Closed Blood Conservation Device for Reducing Catheter-Related Infections in Children After Cardiac Surgery. Crit Care Nurse, 2014. Oct;34(5):53-60. doi:10.4037/ccn2014416.
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