Phlebotomy Overdraw in the Neonatal Intensive Care Nursery

• Published in: Pediatrics (Evanston) 2000-08, Vol.106 (2), p.332-332
• Main Authors: Lin, James C, Strauss, Ronald G, Kulhavy, Jeff C, Johnson, Karen J, Zimmerman, M. Bridget, Cress, Gretchen A, Connolly, Natalie W, Widness, John A
• Format: Article
• Language: English
• Subjects: Anemia in children; Causes of; Complications and side effects; Health aspects; Infants (Premature); Pediatric anemia; Phlebotomy; Premature infants; Puncture; Veins
• ISSN: 0031-4005

Objective. Because blood loss attributable to laboratory testing is the primary cause of anemia among preterm infants during the first weeks of life, we quantified blood lost attributable to phlebotomy overdraw, ie, excess that might be avoided. We hypothesized that phlebotomy overdraw in excess of that requested by the hospital laboratory was a common occurrence, that clinical factors associated with excessive phlebotomy loss would be identified, and that some of these factors are potentially correctable. Design, Outcome Measures, and Analysis. Blood samples drawn for clinical purposes from neonates cared for in our 2 neonatal special care units were weighed, and selected clinical data were recorded. The latter included the test performed; the blood collection container used; the infant's location (ie, neonatal intensive care unit [NICU] and intermediate intensive care unit); the infant's weight at sampling; and the phlebotomist's level of experience, work shift, and clinical role. Data were analyzed by univariate and multivariate procedures. Phlebotomists included laboratory technicians stationed in the neonatal satellite laboratory, phlebotomists assigned to the hospital's central laboratory, and neonatal staff nurses. Phlebotomists were considered experienced if they had worked in the nursery setting for [is greater than] 1 year. Blood was sampled from a venous or arterial catheter or by capillary stick from a finger or heel. Blood collection containers were classified as tubes with marked fill-lines imprinted on the outside wall, tubes without fill-lines, and syringes. Infants were classified by weight into 3 groups: [is less than] 1 kg, 1 to 2 kg, and [is greater than] 2 kg. The volume of blood removed was calculated by subtracting the weight of the empty collection device from that of the device filled with blood and dividing by the specific gravity of blood, ie, 1.050 g/mL. The volume of blood withdrawn for individual laboratory tests was expressed as a percentage of the volume requested by the hospital laboratory. Results. The mean (± standard error of the mean) volume of blood drawn for the 578 tests drawn exceeded that requested by the hospital laboratory by 19.0% ± 1.8% per test. The clinical factors identified as being significantly associated with greater phlebotomy overdraw in the multiple regression model included: 1) collection in blood containers without fill-lines; 2) lighter weight infants; and 3) critically ill infants being cared for