Blood management

Adopting Closed Blood Sampling (CBS) as part of your Patient Blood Management (PBM) program as standard operating procedure in your OR and ICU may help you achieve positive patient outcome while providing cost-effective care. CBS is demonstrated to more effectively conserve blood, improve patient outcomes and reduce costs when compared with conventional blood sampling procedures.12, 17, 22-25

Patient blood management (PBM)
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.31

Clinical and economic impact of conventional blood sampling
Conventional blood sampling procedures can result in notable blood loss, unnecessary blood waste and risk of contamination. Clinical implications may include anemia, transfusions, and hospital-acquired infections that may lead to poor patient outcomes. Increased hospital costs are also associated with routine blood collection utilizing conventional sampling methods.1-4, 6-9, 11-16, 18, 20-21, 25, 30, 34

Closed blood sampling (CBS)

Closed blood sampling (CBS) is an evidence-based solution.16,26,27

Adopting CBS as part of your PBM program as standard operating procedure in your OR and ICU may help you achieve positive patient outcomes while providing cost-effective care.32

Closed Blood Sampling (CBS) is an evidence-based solution.16,26,27

Reduce blood loss

Comparison of total blood drawn and discarded

Discarded blood can account for

18% to 30%

of total daily blood drawn from
critically ill patients22

  • In the ICU, blood may be drawn 5 to 24 times a day1,2
  • Volume drawn per day may be 26 to 427 mL2-6
  • Weekly blood loss due to phlebotomy may range from 340 to 660 mL in ICU patients18
  • Blood discarded with each blood draw varies from 2 to 10 mL3,9,10

Closed Blood Sampling (CBS) is an evidence-based solution.6,26,27

Reduce iatrogenic anemia

Blood loss due to sampling with discarding can lead to a decline in hemoglobin (Hb), which can contribute to anemia.13,16-18

Reduce iatrogenic anemia

Anemia is associated with substantial burden and increased risk of organ injury and mortality.1,2,7,26

Reducing blood draw-induced anemia diminishes the need for blood transfusion.3 Moreover, iatrogenic anemia may be reduced through a culture of blood management.3

  • 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 anemia3
  • 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 mortality2,26

Closed Blood Sampling (CBS) is an evidence-based solution.6,26,27

Reduce catheter-related bloodstream infections (CRBSI)

CBS forms a closed infusion line and may reduce complications caused by intraluminal contamination.12

Compare contamination rates

CBS has demonstrated a decrease in intraluminal fluid contamination compared to a 3-way stopcock system (7% vs. 61%, respectively).28 A randomized controlled trial found lower rates of intraluminal fluid contamination with CBS (1.8%) vs. 3-way stopcock system (8.2%).12

50,000 patients

develop CRBSI each year in US27

  • In critically ill patients, CRBSI account for 19% of infections27
  • In pediatric ICUs, CRBSI are observed in 31% of nosocomial infections27

Closed Blood Sampling (CBS) is an evidence-based solution.

Reduce transfusion needs and related complications

RBC transfusions are associated with a number of adverse effects.25

transfusion needs

In the ICU, reducing blood loss from sampling through improved patient blood management may reduce the need for transfusions and lead to fewer transfusion-related complications,15,19,20,22,24 which include:
  • Transfusion-related acute lung injury (TRALI), transfusion associated circulatory overload (TACO), acute respiratory distress syndrome (ARDS), infections and ventilator-associated pneumonia25
  • RBC transfusion has been associated with a higher rate of post-operative infection in various populations2
  • Transfused patients have increased mortality both in the ICU and hospital, increased infection rates, organ failure, longer ICU stays24

Closed blood sampling may help reduce hospital costs by reducing transfusion incidence.25

Reduce hospital costs

RBC-unit costs range from

$522 to $118330

  • Transfusion-related adverse events, both short- and long-term, are among the costliest contributors to healthcare expenditures.33
  • Additionally, CBS may help you avoid reduce proposed penalties for hospital-acquired complications (HAC) through reduced contamination risk.16,35

You may make a difference in your patients’ outcomes by incorporating closed blood sampling within your patient blood management program.32

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For more educational information

  1. 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.
  2. Vincent, J.L., et al., Anemia and blood transfusion in critically ill patients. JAMA, 2002. 288(12): p.1499-507.
  3. 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.
  4. 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.
  5. Henry, M.L., W.L. Garner, and P.J. Fabri, Iatrogenic anemia. Am J Surg, 1986. 151(3): p. 362-3.
  6. 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.
  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.
  8. Low, L.L., G.R. Harrington, and D.P. Stoltzfus, The effect of arterial lines on blood-drawing practices and costs in intensive care units. Chest, 1995. 108(1): p. 216-9.
  9. Yucha, C.B. and E. DeAngelo, The minimum discard volume: accurate analysis of peripheral hematocrit. J Intraven Nurs, 1996. 19(3): p. 141-6.
  10. 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.
  11. Holmes, K.R., Comparison of push-pull versus discard method from central venous catheters for blood testing. J Intraven Nurs, 1998. 21(5): p. 282-5.
  12. 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.
  13. 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.
  14. Salisbury, A.C., et al., Diagnostic blood loss from phlebotomy and hospital-acquired anemia during acute myocardial infarction. Archives of internal medicine, 2011. 171(18): p. 1646-53.
  15. 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.
  16. Lin, J.C., et al., Phlebotomy overdraw in the neonatal intensive care nursery. Pediatrics, 2000. 106(2): p. E19.
  17. 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.
  18. 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.
  19. 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.
  20. 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.
  21. Corwin, H.L., et al., The CRIT Study: Anemia and blood transfusion in the critically ill—current clinical practice in the United States. Critical care medicine, 2004. 32(1): p. 39-52.
  22. 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.
  23. 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.
  24. 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.
  25. 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.
  26. Rudis, M.I., et al., Managing anemia in the critically ill patient. Pharmacotherapy, 2004. 24(2): p. 229-47.
  27. 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.
  28. 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.
  29. Moron N., J.E., Moreno I., Lazaro A., Dispositivo VAMP Beneficis para el paciente critico. Rev ROL Enf, 2003. 26(9): p. 591-594.
  30. Shander, A., et al., Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion, 2010. 50(4): p. 753-65.
  31. Society for the Advancement of Blood Management, Professional Definition of Patient Blood Management (PBM) on homepage,, retrieved April 17, 2015.
  32. Society for the Advancement of Blood Management®. SABM Administrative and Clinical Standards for Patient Blood Management Programs, 3rd Edition. Unpublished work © 2014.
  33. 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
  34. 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.
  35. Centers for Medicare & Medicaid Services. Hospital-Acquired Condition (HAC) Reduction Program.
All information provided by Edwards Lifesciences is gathered from third party sources and is presented for informational purposes only. This information is not intended to describe, recommend, or suggest any use, feature, or benefit of any Edwards product and does not constitute reimbursement, medical or legal advice. Edwards makes no representation or warranty regarding his information or its completeness, accuracy or timeliness. It is not intended to make a recommendation regarding clinical practice. Laws, regulations, and payer policies concerning reimbursement are complex and change frequently; service providers are responsible for all decisions relating to clinical serves, coding and reimbursement submissions. Accordingly, Edwards strongly recommends consultation with payers, reimbursement specialists and/or legal counsel regarding coding, coverage and reimbursement matters.

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