Effectiveness of Closed Blood-Sampling Devices in Critically Ill Adults: A Feasibility Trial.
Marta Raurell-Torredà, Susana Arias-Rivera, Rafael-Jesús Fernández-Castillo and 5 others
PMID 41546433WHAT IT FOUND
Only 9.3% of screened patients were eligible, 27.1% of randomised patients were lost to follow-up, and 91.7% received care as planned.
The device group reported lower transfusion and discard volume, but the trial did not test whether it worked.
Key findings
01Only 63 of 678 screened patients were eligible, 48 were randomised, 13 were lost to follow-up, 4 intervention patients were excluded for off-protocol care, and 31 were analysed.
02The feasibility targets were met only for allocation (76.2%) and missing data; eligibility (9.3%), fidelity (91.7%) and retention (27.1% loss to follow-up) were not met.
03For every 100 arterial catheter days, reported transfusion was 5.2 units in the device group versus 15.6 in the control group, and discard volume was 53.1 mL versus 970.7 mL, but no statistical inference was performed.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
Only 31 of the 48 randomised patients were analysed, because 13 were lost to follow-up and 4 intervention patients received care outside the study protocol. The trial did not test whether closed sampling devices reduce transfusion, because no statistical inference was performed. Eligibility was very low (9.3% of screened patients), mainly because many patients were expected to have arterial catheters for less than 3 days. Intervention fidelity was 91.7%, and one ICU routinely used venous blood-gas sampling despite the arterial device, increasing discard volume. The study was open-label, and transfusion decisions were made by ICU physicians not involved in the study. Only two ICUs and two device models were studied, and no cost-effectiveness analysis was done.
Declared interests
The authors declared no conflicts of interest. The work was funded by ASISA cathedra-Madrid European University, the General Council of Official Nursing Boards of Spain and the Spanish Institute of Nursing Research.
The easy way to misread this
Do not conclude that closed blood-sampling devices reduce transfusion needs. This feasibility trial analysed only 31 patients, did not test whether differences could be due to chance, and its primary outcome was feasibility, not transfusion reduction.