The aim of this prospective randomized study is to evaluate blood loss caused by laboratory blood draws in patients in the paediatric ICU (Intensive Care Unit) of a tertiary hospital among two groups of patients with established long-term or mid-term intravenous access. In the first group, patients will undergo blood draws using the standard method. In the second group of patients, blood draws will be performed using a closed system.
Anaemia is one of the most common comorbidities among patients hospitalized in intensive care units. Hospital-acquired anaemia (HAA) is a newly developed anaemia that occurs during hospitalization in patients who were not anaemic prior to admission. Patients with HAA have a higher risk of developing complications such as infections, muscle weakness, and neurocognitive developmental disorders; an increased incidence of blood and blood product transfusions (and related complications); longer hospital stays, and higher morbidity and mortality. According to available data, the incidence of anaemia in adults hospitalized in the ICU ranges from 40 to 74%. There a feq data describing anemia in critically ill pediatric patients, with the estimated incidence being up to 50%. The etiology of HAA is multifactorial and is related to the severity of the underlying disease (sepsis, coagulation disorders, bleeding, renal failure, malnutrition, bone marrow suppression, decreased erythropoietin production, etc.). Another factor contributing to the development of anaemia in critically ill patients is iatrogenic blood loss caused by blood draws for laboratory testing. In addition to the standard blood collection method, closed-loop sampling (in-line sampling) can also be used, with studies in adult patients showing a reduction in the amount of blood drawn, ranging from 20 to 80% after its implementation.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SCREENING
Masking
SINGLE
Enrollment
closed technique of sample collection
Blood draws using standard steps: blood withdrawal for catheter, decontamination (disposed),blood draw for laboratory analysis,catheter flush
KDAR - department of pediatrics anesthesia and resuscitation
Brno, Czechia
Average amount of blood collected for laboratory diagnostic purposes
Average amount of blood collected for laboratory diagnostic purposes on days 1, 3, 5, 7, 10, 14, and 28 of hospitalization in two groups of patients subjected to different blood sampling techniques for laboratory testing
Time frame: On day 1,3,5,7,10,14 and 28 of patient stay at paediatric ICU
Cumulative amount of blood drawn per day of ICU hospitalization
Cumulative amount of blood drawn, relative to the patient's body weight and age, per day of ICU hospitalization
Time frame: On the day of patient' s discharge from paediatric ICU
Absolute amount of blood drawn and blood used for laboratory testing
Absolute amount of blood drawn and blood used for laboratory testing, relative to the patient's body weight, age, and day of ICU hospitalization
Time frame: On the day of patient' s discharge from paediatric ICU
Trend of haemoglobin decline over time
Trend of haemoglobin decline over time, defined as the absolute value of haemoglobin
Time frame: Ondays 1,3,5,7,10,14 and 28 of patient stay at paediatric ICU
Incidence of anaemia
decrease in haemoglobin levels below 90 g/l at any time during hospitalization
Time frame: on the day of patient' s discharge from paediatric ICU
Incidence of anaemia up to transfusion trigger
haemoglobin levels below 70 g/l at any time during hospitalization
Time frame: on the day of patient' s discharge from paediatric ICU
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Frequency of blood product transfusions and their quantity
Frequency of blood product transfusions (erythrocytes, platelets, plasma, fibrinogen, and other coagulation factors) and their quantity relative to the patient's body weight and age
Time frame: on the day of patient' s discharge from paediatric ICU
Type and frequency of laboratory tests
Type and frequency of laboratory tests noted on daily basis by ICU nursing stuff
Time frame: on the day of patient' s discharge from paediatric ICU
Incidence of coagulopathy
Incidence of coagulopathy defined as INR above 1.4 and/or aPTT above 1.5 and/or fibrinogen below 1.5 g/l
Time frame: on the day of patient' s discharge from paediatric ICU
Incidence of catheter-related complications
Incidence of catheter-related complications catheter infections, catheter occlusion defined, accidental catheter withdrawal)
Time frame: on the day of patient' s discharge from paediatric ICU
Time to catheter replacement in case of catheter exchange
Time to catheter replacement in case of catheter exchange (in days)
Time frame: on the day of patient' s discharge from paediatric ICU