PURPOSE: Analyses of arterial blood gases (ABG) are essential in the postoperative phase of cardiothoracic (CT) surgery. With the current trend toward blood management (a program to reduce the need for transfusion of blood and/or blood products in selected surgery populations), we are attempting to decrease the amount of blood drawn from our CT surgical patients. The amount of blood required for analysis with current instrumentation (Radiometer ABL800) is nominally 165 microliters.
METHODS: The study patients were postoperative CT surgical patients. The Respiratory Therapists were blinded to the purpose of the study. A standard 3 ml syringe was used at our facility for ABG sampling. The ABG lab recorded the amount of blood in each syringe. After 310 samples were logged, 1 ml syringes were provided for blood sampling, and continued until 237 additional samples were received.
RESULTS: The mean sample size using 3 ml syringes was 1.58 ml (S.D. 0.40 ml, range 0.50 –2.8 ml). The mean sample size using the 1 ml syringe was 0.55 ml (S.D. 0.14 ml, range 0.25 –1.0 ml). This translated into a mean reduction of 1.03 ml per blood sample, a net blood savings of 65%. The typical number of samples per patient was 4 for an average reduction of 4.12 ml. The ABG Laboratory noted that in no cases the smaller blood samples precluded their ability to perform analysis.
CONCLUSION: By utilizing a smaller syringe we were able to decrease by nearly two-thirds the amount of blood taken from our patients. It is our goal to standardize the use of 1 ml syringes for blood sampling throughout the institution.
CLINICAL IMPLICATIONS: Administration of blood transfusions is associated with increased morbidity and mortality. The simple practice change of decreasing sample size may play an important role in blood management.
DISCLOSURE: Sally Whitten, No Financial Disclosure Information; No Product/Research Disclosure Information