Best practices for iatrogenic anaemia prevention in the intensive care unit: Blood-sparing techniques.
Marta Raurell-Torredà, Rafael-Jesús Fernández-Castillo, María-Esther Rodríguez-Delgado and 2 others
PMID 38654607WHAT IT FOUND
ICU blood-sparing devices reduce blood lost during testing, but did not clearly prevent anaemia or reduce transfusions.
Closed sampling systems may be easier than small tubes, so use them with protocols limiting unnecessary tests.
Key findings
01Blood-sparing techniques reduced the volume of blood drawn, but they did not reliably prevent haemoglobin decline or reduce transfusion need.
02Closed sampling systems return discarded blood to the venous or arterial circuit, which may make them easier to implement than small-volume tubes.
03The most recent review reported fewer catheter infections with closed sampling systems, but older studies reported a risk of systolic arterial pressure overestimation.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
This is a review of previously published studies, not a new trial in ICU patients. Many included studies were old, and the reviews noted a high risk of bias. Different studies measured blood loss, haemoglobin change and transfusion in different ways, making direct comparison difficult. Most studies excluded patients with active bleeding, who may benefit most from blood-sparing techniques. No cost-effectiveness studies were found, so this review cannot guide budget or sustainability decisions. Evidence on arterial pressure accuracy with closed systems came from papers from 2014 or earlier.
Declared interests
No conflict of interest was declared by the authors.
The easy way to misread this
Do not conclude that closed sampling systems prevent ICU anaemia or reduce transfusions. The reviewed studies showed lower blood loss, but haemoglobin decline and transfusion need were not consistently improved, and the guideline evidence was low or very low certainty.