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Crit Care Nurse 2002 Jun; 22(3): 96-95
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In Our Unit

Smaller tubes reduce the volume of blood drawn

Terry Rudisill, RN

Terry Rudisill is the resource nurse in the ICU at Wellstar Douglas Hospital, Douglasville, Ga.

"In Our Unit" highlights unique practices, innovations, research, or resourceful solutions to commonly encountered problems in critical care areas and settings where critically ill patients are cared for. If you have an idea for an upcoming "In Our Unit," send it to CRITICAL CARE NURSE, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2049; e-mail, ccn{at}aacn.org.

I magine a patient who is admitted to your intensive care unit (ICU) with the diagnosis of gastrointestinal bleeding. Even before the patient is admitted, he is hypovolemic from blood loss. As in most cases, he is intravascularly depleted because of inadequate oral intake due to vomiting and diarrhea. Because of vomiting and diarrhea, he is not getting the fluids needed to help replace the lost volume.

Upon admission, laboratory work is drawn—a complete metabolic profile, complete blood cell count with differential prothrombin time, partial thromboplastin time, and blood type and cross-match. This amounts to approximately 40 mL of blood drawn from a patient who is already volume depleted.

We start administering the intravenous fluids, transfused with packed red blood cells. Because the patient is actively bleeding, we will recheck his hemoglobin and hematocrit levels every 4 hours. In a 24-hour period, that means anywhere from 80 to 100 mL of blood being drawn for laboratory studies. However, this volume takes into account only chemistry and hematology studies. If more specialty tests, such as hepatitis profiles, human immunodeficiency virus, or thyroid profile, are needed, more blood volume must be drawn.

In May 2001, the nurses in the ICU at Wellstar Douglas Hospital, Ga, decided to record how much blood we were taking from our patients and whether we could decrease that volume. Implementing a performance improvement project, we studied 24 randomly selected patients, all with various diagnoses and conditions. We determined that we had drawn a total of 1974 mL of blood from these patients. Of this amount, 1572 mL were sent to the laboratory for testing, and 420 mL was waste drawn from central catheters and intravenous sites. All of this blood was drawn in adult-size tubes. The average volume of blood drawn per patient was 83 mL.

Using these numbers, I found that the volume of blood that would have been needed for the same tests if it had been drawn in minimal-volume tubes would have been 1072 mL, compared with the 1974 mL actually drawn. Only 670 mL would have been sent to the laboratory for testing, compared with 1572 mL. The same amount of waste would have been drawn from each patient. This dropped the average amount of blood drawn from each patient to 44 mL, almost 50% less. (I calculated these figures by reducing the volume drawn for only chemistries, coagulation, and hematology studies. Blood bank studies and reference laboratory studies were calculated in full-volume tubes.)

As a result of these calculations, we met with our laboratory technologists and contacted the manufacturers to find tubes that would be compatible with our machines. We were able to find minimal-volume tubes that reduce the amount from 5 mL to 3 mL for hematology studies and from 7 mL to 2.5 mL for chemistry studies. Although we use the 5-mL tube for coagulation studies, we can use pediatric tubes for our critically ill patients, which reduces the volume drawn to 3 mL. We have implemented these new minimal-volume tubes at all 5 of our Wellstar hospitals.



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  		Specimen calculations used were for chemistry, hematolology, and coagulation studies. Full adult tube quantities were used for blood bank specimens.

 




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