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What blood conservation practices are effective at reducing blood sampling volumes and other clinical sequelae in intensive care? A systematic review

  • Samantha Keogh
    Correspondence
    Corresponding author at: c/- QUT School of Nursing, Victoria Park Road, Kelvin Grove, Brisbane, Qld 4059, Australia. Tel.: +61 7 3138 3881.
    Affiliations
    School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Qld, Australia

    Centre for Nursing and Midwifery Research and Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia

    Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia
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  • Saira Mathew
    Affiliations
    Poche Centre for Indigenous Health, The University of the Queensland, Brisbane, Qld, Australia
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  • Amanda J. Ullman
    Affiliations
    Centre for Nursing and Midwifery Research and Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia

    Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia

    School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Qld, Australia

    Queensland Children's Hospital, Children's Health Queensland Hospital and Health Service, Brisbane, Qld, Australia
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  • Claire M. Rickard
    Affiliations
    Centre for Nursing and Midwifery Research and Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia

    Alliance for Vascular Access Teaching and Research (AVATAR), School of Nursing and Midwifery, Griffith University, Brisbane, Qld, Australia

    School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Qld, Australia
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  • Fiona Coyer
    Affiliations
    School of Nursing and Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, Qld, Australia

    Centre for Nursing and Midwifery Research and Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Qld, Australia
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Published:January 10, 2023DOI:https://doi.org/10.1016/j.aucc.2022.12.002

      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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