Rodriguez, Wanda; McCarty, Doreen; O'Donnell, AnnMarie; Kane, Joyce; Nolan, Stephanie; Carlese, Cristina
March 2007
Oncology Nursing Forum;Mar2007, Vol. 34 Issue 2, p527
Academic Journal
Frequent blood sampling for laboratory testing can be an unnecessary source of blood loss in the critically ill oncology patient. The increased number of analytes measured combined with increased frequency in testing and easier collection with arterial and venous catheters can directly lead to iatrogenic anemia. As critical care oncology nurses we recognized our role in performing the majority of these tests. We wanted to seek preventive strategies to minimize excessive blood loss and decrease the patient's risk for anemia. An evidence based review of the literature was conducted to determine the minimum blood volume required to run selected lab tests. A total of 26 articles from CINAHL, PubMed, MEDLINE, Google, The Cochrane Library, and Evidence Matters were reviewed. There were a limited number of meta-analysis, randomized experimental design, quasi-experimental and non-experimental studies related to blood conserving mechanisms. Expert opinions and guidelines were evaluated. Committee members from the PACU and ICU ranked the evidence based on the Stetler Model. The current evidence supports using smaller volume vacuum collection tubes for specified laboratory tests such as troponin and basic metabolic panel. The committee concluded that blood volume needed to perform chemistry tests in our departments could be reduced by half. In PACU and ICU this lead to the use of the smaller plastic 4ml tubes versus the larger 8ml glass tubes. In addition, the smaller tubes are less likely to cause hemolysis, due to less vacuum inside the tube. Current limitations to applying the evidence from this review consist of restricting the change to critical care areas. This is primarily due to the excessive number of "add on" tests required on the inpatient units. However, this is undergoing further discussion and exploration. Moving forward we will track blood product usage, specifically RBC transfusions, in an attempt to determine the success of this new practice.


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