Reduce Patient Safety Risks with Closed Blood Sampling
Increasing the efficiency and safety of the blood sampling and conservation process
95PCCritically ill patients are more numerous and severely ill than ever before.1 To effectively care for these patients, clinicians rely on physiologic monitoring of blood flow, oxygen transport, coagulation, metabolism, and organ function.
This type of monitoring has made the collection of blood for testing an essential part of daily management of the critically ill patient, yet it is widely recognized that excessive phlebotomy has a deleterious effect on patient health and may contribute to iatrogenic anemia. The process of obtaining a blood sample from an indwelling central venous or arterial catheter also requires a volume of diluted blood (2–10 mL) to be discarded or “cleared” from the catheter before a sample can be taken, adding to blood loss during phlebotomy.2,3
Almost 95% of patients admitted to an intensive care unit have an Hgb concentration that is below normal by day three of admission, often requiring blood transfusion.4 It has also been shown that phlebotomy accounts for 49% of the variation in the amount of red blood cells (RBC) transfused.2
Despite evidence to support a restrictive transfusion practice, the transfusion of packed red blood cells (PRBC) remains a primary intervention for the treatment of ICU patients with anemia.5 Blood transfusions are associated with negative effects on patient outcomes, including increased risk for infection, which may explain the positive correlation between organ dysfunction and the number of blood draws.6,7,8,9
Catheter-related bloodstream infection (CRBSI) is the most common nosocomial bacteremia in critically ill patients.10 It affects nearly 50,000 patients each year in the US, with an attributable mortality of up to 35% and a financial cost of up to $30,000 per case.11
Closed, in-line blood conservation systems (BCS), such as ICU Medical's SafeSet®, eliminate the need to discard the clearing volume associated with sampling through indwelling arterial catheters, reducing blood loss as well as the potential for bacterial ingress into the closed system.12
A closed, in-line BCS also reduces clinician exposure to potential bloodborne pathogens during the sampling process. Accordingly, the ability to reinfuse blood discard with SafeSet may help reduce cases of anemia in the ICU, and subsequently reduce unnecessary transfusions.
By eliminating open systems and minimizing points for bacterial ingress, closed, in-line BCSs may significantly reduce arterial and central line contamination.13 One study found the use of a BCS correlated with lower rates of intraluminal fluid contamination compared to a traditional three-way open-port stopcock system.
The ability of a BCS to prevent microbial contamination is further enhanced by incorporating needlefree connectors into the sampling port stopcock. A study comparing conventional open sampling systems to self-sealing valve connectors within a post-surgical cardiothoracic ICU reported a 4.3% hub colonization rate with valve connectors and a 14.2% colonization rate with open sampling systems.14 The study also reported 10.9% catheter tip colonization with the self-sealing valve connectors and 17.2% colonization rate with open sampling systems (See Figure 1).
The pervasive anemia experienced by the majority of patients in the ICU is minimized by the utilization of closed, in-line blood sampling and conservation systems. By reducing blood loss and the potential for iatrogenic anemia, closed blood sampling and conservation systems help reduce the need for and inherent risk of transfusions in the ICU.
In addition, the application of closed blood sampling and conservation systems prevents the transfer of bacteria into the catheter and helps clinicians in their efforts to minimize catheter-related bloodstream infections.