Abstract
Objectives
The objective of this study was to critically appraise and synthesise evidence for
blood conservation strategies in intensive care. Blood sampling is a critical aspect
of intensive care to guide clinical decision-making. Repeated blood sampling can result
in blood waste and contamination, leading to iatrogenic anaemia and systemic infection.
Review method used
Cochrane systematic review methods were used including meta-analysis, and independent
reviewers.
Data sources
A systematic search was conducted in Medline, CINAHL, PUBMED and EMBASE databases.
The search was limited to randomised controlled trials (RCTs) and cluster RCTs, published
in English between 2000 and 2021.
Review methods
Paired authors independently assessed database search results and identified eligible
studies. Trials comparing any blood conservation practice or product in intensive
care were included. Primary outcomes were blood sample volumes and haemoglobin change.
Secondary outcomes included proportion of patients receiving transfusions and infection
outcomes. Quality appraisal employed the Cochrane Risk of Bias tool. Meta-analysis
using random effects approach and narrative synthesis summarised findings.
Results
Eight studies (n = 1027 patients), all RCTs were eligible. Six studies included adults,
one studied paediatrics and one studied preterm infants. Seven studies evaluated 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 interventions
targeting blood sample volumes or haemoglobin. Decreased blood sample volumes reported
in four studies were attributable to a closed loop system or conservative phlebotomy.
No study reported a significant change in haemoglobin. Meta-analysis demonstrated
that use of a closed system (compared to open system) reduced the proportion of patients
receiving transfusion [Risk Ratio (RR) 0.65, 95% CI 0.46–0.92; 287 patients] and reduced
intraluminal fluid colonisation [RR 0.25, 95% CI 0.07–0.58; 500 patients].
Conclusions
Limited evidence demonstrates closed loop blood sampling systems reduced transfusion
use and fluid colonisation. Simultaneous effectiveness-implementation evaluation of
these systems and blood conservation strategies is urgently required.
PROSPERO protocol registration reference
CRD42019137227.
Keywords
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Article info
Publication history
Published online: January 10, 2023
Accepted:
December 2,
2022
Received in revised form:
November 24,
2022
Received:
July 19,
2022
Publication stage
In Press Corrected ProofIdentification
Copyright
© 2022 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.
