After blood sampling from an arterial catheter, the reinjection of the clearing fluid (a mixture of saline solution and blood) is proposed to limit blood loss. However, the status of coagulation in this clearing liquid remains poorly documented.
In the intensive care unit, blood sampling is mainly performed through an arterial catheter (radial or femoral artery). In addition to continuous arterial pressure monitoring, this provides an easy access to arterial blood without the need for venipuncture. It is standard practice to first clear the arterial sampling line before drawing blood for biological tests, to prevent the blood sample from being diluted by the arterial catheter's perfusion solution. This clearing fluid (i.e., a mixture of saline solution and blood) is usually discarded. It has been reported that the clearing fluid volume alone represents 24 to 30% of the total blood volume required for blood sampling. Devices for reinjecting this clearing fluid are already on the market. The advantages of these devices include blood saving, reduced risk of blood exposure, reduced biological waste and lower infection rates associated with catheter handling. The main drawback of these devices is their cost and the need for frequent replacement. Moreover, their impact on the decrease of blood transfusion remains unclear. Furthermore, there are too few published data on the potential coagulation of clearing fluid reinjected into the patient nor the maximum time it can be safely reinjected. The aim of this study is to assess the activation of coagulation over time in the clearing fluid during arterial catheter blood sampling
Study Type
OBSERVATIONAL
Enrollment
213
Patients of intensive care unit having an arterial catheter undergoing arterial blood sampling
Nantes university hospital
Nantes, Loire-atlantique, France
Hospital center
Saint-Nazaire, France
Composite score of the coagulation activation over time in the clearing fluid during blood sampling from an arterial catheter
Activation of coagulation in the clearing fluid will be assessed by a composite criterion defined by: * the presence of a macroscopic clot (binary YES or NO criterion) or * fibrinogen consumption (binary YES or NO criterion). Fibrinogen consumption will be classified as YES when its decrease, compared with the reference value measured at T0, is greater than the known technical variability of the assay method
Time frame: 5 minutes (T5)
Concentration of prothrombin over time in the clearing fluid during blood sampling from an arterial catheter
Prothrombin time will be assayed at T0, T3 and T5
Time frame: 5 minutes (T5)
Concentration of factor II over time in the clearing fluid during blood sampling from an arterial catheter
Factor II will be assayed at T0, T3 and T5
Time frame: 5 minutes (T5)
Concentration of factor V over time in the clearing fluid during blood sampling from an arterial catheter
Factor V will be assayed at T0, T3 and T5
Time frame: 5 minutes (T5)
Concentration of fibrin monomer over time in the clearing fluid during blood sampling from an arterial catheter
Fibrin monomers will be assayed at T0, T3 and T5
Time frame: 5 minutes (T5)
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