Assuming excellent technique is used to prevent a CLBSi, does anyone have any information on the effect on the RBC count if labs are drawn from a cvl multiple times in a 24 hour period?
First, I don't think you can completely assure that there will be no increased risk of contamination when you are increasing the manipulation of catheter hubs to obtain blood samples. But I realize that using the catheter is the only method available for some patients. There is plenty of evidence about iatrogenic anemia, also called nosocomial blood loss mainly in the critical care literature. Several years ago I gave a presentation on this at AVA. This is old but here is the reference list I used from 2004.
Nosocomial blood loss, iatrogenic anemia and blood sampling procedures
Reference list
1.Spiess B. Blood transfusion: The silent epidemic. Annals of Thoracic Surgery. 2001;72:S1832-1837.
2.Vincent J, Baron J, Reinhart K, et al. Anemia and blood transfusion in critically ill patients. Journal of American Medical Association. 2002;288(12):1499-1507.
3.Ahsen Nv, Muller C, Serke S, Frei U, Eckardt K. Important role of nondiagnostic blood loss and blunted erythropoietic response in the anemaia of medical intensive care patients. Critical Care Medicine. 1999;27(12):2630-2639.
4.Corwin H, Gettinger A, Pearl R, et al. The CRIT study: Anemia and blood transfusion in the critically ill- Current clinical practice in the United States. Critical Care Medicine. 2004;32(1):39-52.
5.Beland D, D'Angelo C, Vinci D. Reducing unnecessary blood work in the neurosurgical ICU. Journal of Neuroscience Nursing. 2003;35(3):149-152.
6.Malone D, Dunne J, Tracy K, Putnam A, Scalea T, Napolitano L. Blood transfusion, independent of shock severity, is associated with worse outcome in traumaa. Journal of Trauma. 2003;54(5):898-905.
7.Rudis M, Jacobi J, Hassan E, Dasta J. Managing anemia in the critically ill patient. Pharmacotherapy. 2004;24(2):229-247
8.Estrin J, Schocket L, Kregenow R, Henry D. A retrospective review of blood transfusions in cancer patients with anemia. The Oncologist. 1999;4(4):318-324.
9.Hanna H, Raad I. Blood products: A Significant risk factor for long-term catheter-related bloodstream infections in cancer patients. Infect Control Hosp Epidemiol. 2001;22(3):165-166
10.Taylor R, Manganaro L, O'Brien J, Trottier S, Parkar N, Veremakis C. Impact of allogenic packed red blood cell transfusion on nosocomial infection rates in the critically ill patient. Critical Care Medicine. 2002;30(10):2249-2254.
11.Busch M, Kleinman S, Nemo G. Current and emerging infectious risks of blood products. Journal of the American Medical Association. 2003;289(8):959-962.
12.Grant M. The effect of blood drawing techniques and equipment on the hemolysis of ED laboratory blood samples. Journal of Emergency Nursing. 2003;29(2):116-121.
13.Norberg A, Christopher N, Ramundo M, Bower J, Berman S. Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter. Journal of the American Medical Association. 2003;289(6):726-729.
14.Seemann S, Reinhardt A. Blood sample collection from a peripheral catheter system compared with phlebotomy. Journal of Intravenous Nursing. 2000;23(5):290-297.
15.Seemann S, Reinhardt A. Blood sample collection from a peripheral catheter system compared with phlebotomy. Journal of Intravenous Nursing. 2000;23(5):290-297.
16.Mohler M, Sato Y, Bobick K, Wise L. The reliability of blood sampling from peripheral intravenous infusion lines. Journal of Intravenous Nursing. 1998;21(4):209-214.
17.Himberger J, Himberger L. Accuracy of drawing blood through infusing intravenous lines. Heart & Lung. 2001;30:66-73.
18.Fincher R, Strong J, Jackson J. Accuracy of measurements of hemoglobulin and potassium in blood samples from peripheral catheters. American Journal of Critical Care. 1998;7(6):439-443.
19.Ramsook C, Childers K, Cron S, Nirken M. Comparison of blood-culture contamination rates in a pediatric emergency room: Newly inserted intravenous catheters versus venipuncture. Infect Control Hosp Epidemiol. 2000;21(10):649-651.
20.Jonge Md, Mathot R, Dam Sv, Rodenjuis S, Beijnen J. Sorption of thiotepa to polyurethane catheter causes falsely elevated plasma levels. Therapeutic Drug Monitoring. 2003;25(3):261-263.
21.Claviez A, Glass B, Dreger P, Suttorp M. Elevated blood drug levels obtained from indwelling silicon catheters during oral cyclosporine A administration. Bone Marrow Transplantation. 2002;29(6):535-536.
22.Jackson E, Wiese J, Sigal B, Miller J. Effects of crystalloid solutions on circulating lactate concentrations: Part 1. Implications for the proper handling of blood specimens obtained from critically ill patients. Critical Care Medicine. 1997;25(11):1840-1846.
23.Johnston J, Messina M. Erroneous laboratory values obtained from central catheters. Journal of Intravenous Nursing. 1991;14(1):13-15.
24.Fagerman KE. Erroneous tobramycin sampling in home intravenous therapy avoidable with modified blood draw. Journal of Intravenous Nursing. 1994;17(3):135-137.
25.MacIsaac C, Presneill J, Boyce C, byron K, Cade J. The influence of a blood conserving device on anaemia in intensive care patients. Anaesth Intensive Care. 2003;31(6):653-657.
26.Kost G, Ehrmeyer S, Chernow B, Winkelman J. The laboratory-clinical interface: Point-of-care testing. Chest. 1999;115:1140-1154.
27.Rickard C, Coiuchman B, Schmidt S, Dank A, Purdie D. A discard volume of twice the deadspace ensures clinically accurate arterial blood gases and electrolytes and prevents unnecessary blood loss. Critical Care Medicine. 2003;31(6):1654-1658.
28.Hinds P, Quargnenti A, Gattuso J, Srivastava D. Comparing the results of coagulation tests on blood drawn by venipuncture and through heparinized tunneled venous access devices in pediatric patients with cancer. Oncology Nursing Forum. 2002;29(3).
29.Shulman R, Ou C, Reed T, Gardner P. Central venous catheters vs peripheral veins for sampling blood levels of commonly used drugs. Journal of Parenteral and Enteral Nutrition. 1998;22:234-237.
30.Holmes K. Comparison of push-pull versus discard method from central venous catheters for blood testing. Journal of Intravenous Nursing. 1998;21(5):282-285.
31.Frey A. Drawing blood from vascular access devices: Evidence-based practice. Journal of Infusion Nursing. 2003;26(5):285-295.
First, I don't think you can completely assure that there will be no increased risk of contamination when you are increasing the manipulation of catheter hubs to obtain blood samples. But I realize that using the catheter is the only method available for some patients. There is plenty of evidence about iatrogenic anemia, also called nosocomial blood loss mainly in the critical care literature. Several years ago I gave a presentation on this at AVA. This is old but here is the reference list I used from 2004.
Nosocomial blood loss, iatrogenic anemia and blood sampling procedures
Reference list
1. Spiess B. Blood transfusion: The silent epidemic. Annals of Thoracic Surgery. 2001;72:S1832-1837.
2. Vincent J, Baron J, Reinhart K, et al. Anemia and blood transfusion in critically ill patients. Journal of American Medical Association. 2002;288(12):1499-1507.
3. Ahsen Nv, Muller C, Serke S, Frei U, Eckardt K. Important role of nondiagnostic blood loss and blunted erythropoietic response in the anemaia of medical intensive care patients. Critical Care Medicine. 1999;27(12):2630-2639.
4. Corwin H, Gettinger A, Pearl R, et al. The CRIT study: Anemia and blood transfusion in the critically ill- Current clinical practice in the United States. Critical Care Medicine. 2004;32(1):39-52.
5. Beland D, D'Angelo C, Vinci D. Reducing unnecessary blood work in the neurosurgical ICU. Journal of Neuroscience Nursing. 2003;35(3):149-152.
6. Malone D, Dunne J, Tracy K, Putnam A, Scalea T, Napolitano L. Blood transfusion, independent of shock severity, is associated with worse outcome in traumaa. Journal of Trauma. 2003;54(5):898-905.
7. Rudis M, Jacobi J, Hassan E, Dasta J. Managing anemia in the critically ill patient. Pharmacotherapy. 2004;24(2):229-247
8. Estrin J, Schocket L, Kregenow R, Henry D. A retrospective review of blood transfusions in cancer patients with anemia. The Oncologist. 1999;4(4):318-324.
9. Hanna H, Raad I. Blood products: A Significant risk factor for long-term catheter-related bloodstream infections in cancer patients. Infect Control Hosp Epidemiol. 2001;22(3):165-166
10. Taylor R, Manganaro L, O'Brien J, Trottier S, Parkar N, Veremakis C. Impact of allogenic packed red blood cell transfusion on nosocomial infection rates in the critically ill patient. Critical Care Medicine. 2002;30(10):2249-2254.
11. Busch M, Kleinman S, Nemo G. Current and emerging infectious risks of blood products. Journal of the American Medical Association. 2003;289(8):959-962.
12. Grant M. The effect of blood drawing techniques and equipment on the hemolysis of ED laboratory blood samples. Journal of Emergency Nursing. 2003;29(2):116-121.
13. Norberg A, Christopher N, Ramundo M, Bower J, Berman S. Contamination rates of blood cultures obtained by dedicated phlebotomy vs intravenous catheter. Journal of the American Medical Association. 2003;289(6):726-729.
14. Seemann S, Reinhardt A. Blood sample collection from a peripheral catheter system compared with phlebotomy. Journal of Intravenous Nursing. 2000;23(5):290-297.
15. Seemann S, Reinhardt A. Blood sample collection from a peripheral catheter system compared with phlebotomy. Journal of Intravenous Nursing. 2000;23(5):290-297.
16. Mohler M, Sato Y, Bobick K, Wise L. The reliability of blood sampling from peripheral intravenous infusion lines. Journal of Intravenous Nursing. 1998;21(4):209-214.
17. Himberger J, Himberger L. Accuracy of drawing blood through infusing intravenous lines. Heart & Lung. 2001;30:66-73.
18. Fincher R, Strong J, Jackson J. Accuracy of measurements of hemoglobulin and potassium in blood samples from peripheral catheters. American Journal of Critical Care. 1998;7(6):439-443.
19. Ramsook C, Childers K, Cron S, Nirken M. Comparison of blood-culture contamination rates in a pediatric emergency room: Newly inserted intravenous catheters versus venipuncture. Infect Control Hosp Epidemiol. 2000;21(10):649-651.
20. Jonge Md, Mathot R, Dam Sv, Rodenjuis S, Beijnen J. Sorption of thiotepa to polyurethane catheter causes falsely elevated plasma levels. Therapeutic Drug Monitoring. 2003;25(3):261-263.
21. Claviez A, Glass B, Dreger P, Suttorp M. Elevated blood drug levels obtained from indwelling silicon catheters during oral cyclosporine A administration. Bone Marrow Transplantation. 2002;29(6):535-536.
22. Jackson E, Wiese J, Sigal B, Miller J. Effects of crystalloid solutions on circulating lactate concentrations: Part 1. Implications for the proper handling of blood specimens obtained from critically ill patients. Critical Care Medicine. 1997;25(11):1840-1846.
23. Johnston J, Messina M. Erroneous laboratory values obtained from central catheters. Journal of Intravenous Nursing. 1991;14(1):13-15.
24. Fagerman KE. Erroneous tobramycin sampling in home intravenous therapy avoidable with modified blood draw. Journal of Intravenous Nursing. 1994;17(3):135-137.
25. MacIsaac C, Presneill J, Boyce C, byron K, Cade J. The influence of a blood conserving device on anaemia in intensive care patients. Anaesth Intensive Care. 2003;31(6):653-657.
26. Kost G, Ehrmeyer S, Chernow B, Winkelman J. The laboratory-clinical interface: Point-of-care testing. Chest. 1999;115:1140-1154.
27. Rickard C, Coiuchman B, Schmidt S, Dank A, Purdie D. A discard volume of twice the deadspace ensures clinically accurate arterial blood gases and electrolytes and prevents unnecessary blood loss. Critical Care Medicine. 2003;31(6):1654-1658.
28. Hinds P, Quargnenti A, Gattuso J, Srivastava D. Comparing the results of coagulation tests on blood drawn by venipuncture and through heparinized tunneled venous access devices in pediatric patients with cancer. Oncology Nursing Forum. 2002;29(3).
29. Shulman R, Ou C, Reed T, Gardner P. Central venous catheters vs peripheral veins for sampling blood levels of commonly used drugs. Journal of Parenteral and Enteral Nutrition. 1998;22:234-237.
30. Holmes K. Comparison of push-pull versus discard method from central venous catheters for blood testing. Journal of Intravenous Nursing. 1998;21(5):282-285.
31. Frey A. Drawing blood from vascular access devices: Evidence-based practice. Journal of Infusion Nursing. 2003;26(5):285-295.
Lynn Hadaway, M.Ed., RN, NPD-BC, CRNI
Lynn Hadaway Associates, Inc.
PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861