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Trials Jan 2023Blood loss and red blood cell (RBC) transfusion in liver surgery are areas of concern for surgeons, anesthesiologists, and patients alike. While various methods are...
INTRODUCTION
Blood loss and red blood cell (RBC) transfusion in liver surgery are areas of concern for surgeons, anesthesiologists, and patients alike. While various methods are employed to reduce surgical blood loss, the evidence base surrounding each intervention is limited. Hypovolemic phlebotomy, the removal of whole blood from the patient without volume replacement during liver transection, has been strongly associated with decreased bleeding and RBC transfusion in observational studies. This trial aims to investigate whether hypovolemic phlebotomy is superior to usual care in reducing RBC transfusions in liver resection.
METHODS
This study is a double-blind multicenter randomized controlled trial. Adult patients undergoing major hepatic resections for any indication will be randomly allocated in a 1:1 ratio to either hypovolemic phlebotomy and usual care or usual care alone. Exclusion criteria will be minor resections, preoperative hemoglobin <100g/L, renal insufficiency, and other contraindication to hypovolemic phlebotomy. The primary outcome will be the proportion of patients receiving at least one allogeneic RBC transfusion unit within 30 days of the onset of surgery. Secondary outcomes will include transfusion of other allogeneic blood products, blood loss, morbidity, mortality, and intraoperative physiologic parameters. The surgical team will be blinded to the intervention. Randomization will occur on the morning of surgery. The sample size will comprise 440 patients. Enrolment will occur at four Canadian academic liver surgery centers over a 4-year period. Ethics approval will be obtained at participating sites before enrolment.
DISCUSSION
The results of this randomized control trial will provide high-quality evidence regarding the use of hypovolemic phlebotomy in major liver resection and its effects on RBC transfusion. If proven to be effective, this intervention could become standard of care in liver operations internationally and become incorporated within perioperative patient blood management programs.
TRIAL REGISTRATION
ClinicalTrials.gov NCT03651154 . Registered on August 29 2018.
Topics: Adult; Humans; Hypovolemia; Phlebotomy; Canada; Blood Transfusion; Liver; Randomized Controlled Trials as Topic; Multicenter Studies as Topic; Clinical Trials, Phase III as Topic
PubMed: 36653812
DOI: 10.1186/s13063-022-07008-y -
The Southern African Journal of... 2022Prevention of iatrogenic blood loss is an essential component of patient blood management (PBM) in intensive care units (ICUs). The amount of iatrogenic blood loss from...
BACKGROUND
Prevention of iatrogenic blood loss is an essential component of patient blood management (PBM) in intensive care units (ICUs). The amount of iatrogenic blood loss from diagnostic phlebotomy in the ICUs at Universitas Academic Hospital, Free State Province, South Africa, is unknown.
OBJECTIVES
To quantify diagnostic phlebotomy volumes, and volumes submitted in excess for diagnostic testing in the ICU.
METHODS
We conducted a prospective descriptive observational study on adults who were admitted to ICUs at a single centre over a period of 14 days. The weight of each filled phlebotomy tube was calculated using the specific gravity of blood and averages of empty phlebotomy tubes, establishing the total volume.
RESULTS
Data from 59 participants with a median length of stay at the ICU of 3 days were analysed. The median phlebotomy volume was 7.0 mL day and 13.6 mL/ICU admission. The volume of blood required for analysis daily and ICU admission was 0.7 mL and 2.2 mL, respectively. The median phlebotomy volume in excess of the amount required for analysis daily and ICU admission was 5.05 mL and 12.11 mL, respectively.
CONCLUSION
While the median excess daily phlebotomy volume in this present study may seem insignificant and underestimating the true excess of phlebotomy volume, interventions to reduce phlebotomy volumes and development of a PBM guideline for appropriate phlebotomy volumes and preventing wastage of patients' blood in the ICU is required.
CONTRIBUTIONS OF THE STUDY
We determined blood volume requirements for laboratory instrumentation, which allows phlebotomists to be cognisant of the true requirements for diagnostic tests to be undertaken accurately. We established diagnostic blood loss volumes in critical care units at a tertiary hospital in South Africa and we advocate for the introduction of patient blood management practice guidelines at local institutions.
PubMed: 36176738
DOI: 10.7196/SAJCC.2022.v38i2.539 -
Family Practice Nov 2020
Topics: COVID-19; Chronic Disease; Continuity of Patient Care; Delivery of Health Care; Humans; Inventions; Medication Adherence; Phlebotomy; Primary Health Care; Remote Consultation; Smartphone; Telemedicine; Wearable Electronic Devices
PubMed: 32668006
DOI: 10.1093/fampra/cmaa067 -
Pediatrics and Neonatology Jan 2022Iron deficiency anemia (IDA) is a public health problem in children and adolescents that is characterized by reduced hemoglobin (Hb) levels. Non-invasive monitoring...
BACKGROUND
Iron deficiency anemia (IDA) is a public health problem in children and adolescents that is characterized by reduced hemoglobin (Hb) levels. Non-invasive monitoring devices can measure Hb levels continuously without pain or discomfort; however, little is known about their accuracy in children and adolescents. This study estimated the accuracy of a non-invasive Hb monitor in this age group.
METHODS
Participants were outpatients visiting the Tokyo Metropolitan Children's Medical Center for blood tests between January and March 2019. Hb levels were measured using both non-invasive Astrim Fit monitoring devices and invasive blood collection followed by automated analysis. Bland-Altman analysis assessed the agreement between the two measurements.
RESULTS
Overall, 120 schoolchildren (9-15 years old, 51 % female) were enrolled. The non-invasive measuring device recorded Hb levels of 13.5 ± 1.6 g/dL (mean ± standard deviation [SD]), while the mean Hb level obtained from the collected blood was 13.7 ± 1.7 g/dL. Therefore, the mean difference of bias and SD of precision was 0.17 ± 1.95 g/dL. Values of lower and upper limits of agreement were -3.65 and 3.99, respectively. There was no systematic fixed or proportion bias. Fifty-nine participants (49 %) had a relative error of ± 0.10.
CONCLUSION
The Astrim Fit non-invasive Hb monitor can be used to evaluate Hb levels among schoolchildren for health promotion or research purposes because of its extremely low bias (or precision), no systematic biases (including fixed or proportion biases), and positive correlation between non-invasive monitoring and blood drawing. However, it is difficult to assess Hb levels in children and adolescents using the Astrim Fit device for diagnostic purposes.
Topics: Adolescent; Anemia, Iron-Deficiency; Child; Female; Hemoglobins; Humans; Male; Monitoring, Physiologic; Phlebotomy
PubMed: 34389262
DOI: 10.1016/j.pedneo.2021.05.028 -
Medicine Feb 2019Chronic urticaria is a common disease affecting patients' quality of life, and leading to substantial burden to both patients and society. Many trials have shown that... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Chronic urticaria is a common disease affecting patients' quality of life, and leading to substantial burden to both patients and society. Many trials have shown that bloodletting therapy is effective in treating chronic urticaria. There are currently no systematic reviews of bloodletting therapy for chronic urticaria. This protocol aims to present the methods used to assess the effectiveness and safety of bloodletting therapy for patients with chronic urticaria.
METHODS
The following databases will be searched from their inception: the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, EMBASE, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM), Chinese Scientific Journal Database (VIP database), and Wan-Fang Database. Clinical randomised controlled trials related to bloodletting therapy for treating chronic urticaria will be included, regardless of publication status and languages. Study selection, data collection, and quality assessment will be independently conducted by 2 researchers. For data synthesis, we will select either the fixed-effects or random-effects model according to heterogeneity assessment. Disease activity control will be assessed as the primary outcomes. Response rate, recurrence rate and adverse events will be evaluated as secondary outcomes. If it is appropriate for meta-analysis, RevMan V.5.3 statistical software will be used. Otherwise, a systematic narrative synthesis will be conducted. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference (WMD) or standard mean difference (SMD) 95% CIs for continuous data.
DISSEMINATION AND ETHICS
The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualised.
TRIAL REGISTRATION NUMBER
PROSPERO CRD42018111143.
Topics: Bloodletting; Chronic Disease; Humans; Medicine, Chinese Traditional; Quality of Life; Randomized Controlled Trials as Topic; Recurrence; Research Design; Urticaria
PubMed: 30762796
DOI: 10.1097/MD.0000000000014541 -
PloS One 2014Retro-bulbar sinus puncture and facial vein phlebotomy are two widely used methods for blood sampling in laboratory mice. However, the animal welfare implications...
Retro-bulbar sinus puncture and facial vein phlebotomy are two widely used methods for blood sampling in laboratory mice. However, the animal welfare implications associated with these techniques are currently debated, and the possible physiological and pathological implications of blood sampling using these methods have been sparsely investigated. Therefore, this study was conducted to assess and compare the impacts of blood sampling by retro-bulbar sinus puncture and facial vein phlebotomy. Blood was obtained from either the retro-bulbar sinus or the facial vein from male C57BL/6J mice at two time points, and the samples were analyzed for plasma corticosterone. Body weights were measured at the day of blood sampling and the day after blood sampling, and the food consumption was recorded automatically during the 24 hours post-procedure. At the end of study, cheeks and orbital regions were collected for histopathological analysis to assess the degree of tissue trauma. Mice subjected to facial vein phlebotomy had significantly elevated plasma corticosterone levels at both time points in contrast to mice subjected to retro-bulbar sinus puncture, which did not. Both groups of sampled mice lost weight following blood sampling, but the body weight loss was higher in mice subjected to facial vein phlebotomy. The food consumption was not significantly different between the two groups. At gross necropsy, subcutaneous hematomas were found in both groups and the histopathological analyses revealed extensive tissue trauma after both facial vein phlebotomy and retro-bulbar sinus puncture. This study demonstrates that both blood sampling methods have a considerable impact on the animals' physiological condition, which should be considered whenever blood samples are obtained.
Topics: Animal Welfare; Animals; Body Weight; Corticosterone; Eating; Jugular Veins; Male; Mice; Mice, Inbred C57BL; Orbit; Phlebotomy; Punctures; Stress, Psychological
PubMed: 25426941
DOI: 10.1371/journal.pone.0113225 -
AIDS and Behavior Aug 2014Retention in care for HIV is essential for effective disease management; however, factors that may confer risk or protection for adherence to regular HIV care are less...
Retention in care for HIV is essential for effective disease management; however, factors that may confer risk or protection for adherence to regular HIV care are less well understood. This study tested whether HIV-associated cognitive impairment (CI) and low health literacy reduced adherence to routine HIV medical and phlebotomy visits and if social support and patient-provider relationship conferred a protective effect. Participants were 210 HIV-infected patients enrolled in outpatient care and followed for 28-weeks. Results showed that those attending >75 % of phlebotomy visits were more likely to be virally suppressed. Health literacy was unassociated with adherence to medical or phlebotomy visits. CI was not directly related to medical or phlebotomy visit adherence; however those with CI and greater use of social support were less likely to miss medical visits. Utilizing social support may be an effective means of managing visit adherence, especially among patients with CI.
Topics: Adult; Ambulatory Care; Cognition Disorders; Communication; Cross-Sectional Studies; Female; HIV Infections; Health Literacy; Humans; Male; Neuropsychological Tests; Office Visits; Patient Compliance; Phlebotomy; Protective Factors; Risk Factors; Social Support; United States
PubMed: 24085375
DOI: 10.1007/s10461-013-0633-7 -
Medecine Et Sante Tropicales Feb 2019To determine the influence of therapeutic phlebotomy on the reduction of vaso-occlusive crises (VOCs) and of hospital admissions of patients with sickle cell disease and...
To determine the influence of therapeutic phlebotomy on the reduction of vaso-occlusive crises (VOCs) and of hospital admissions of patients with sickle cell disease and to describe how they experience this practice. Descriptive cross-sectional study of 27 patients with sickle cell disease who underwent phlebotomies. We estimated the number of VOCs, hemoglobin levels, and patient response. Among 27 sickle cell patients (24 SC and 3 SS) who underwent phlebotomies, there were 22 men (81.5 %) men and 5 (18.5 %) women, with an average age of 34.6 ±10.9 years (range: 21-56 years). Before the phlebotomies, 23 (85.2 %) had showed signs of hyperviscosity, they had a mean of 5.3 ± 1.02 (range: 3-8) VOCs annually, and their mean hemoglobin level was 14.3 ±1.5g/dl (range: 10.4 g/dl-16.8 g/dl). The mean number of phlebotomies was 4.9±4.11 (range: 1-13). After this treatment, 21 (91.3 %) reported that their signs of hyperviscosity disappeared, and the mean number of VOCs annually decreased to 0.9 ±0.07 (range: 0-2). The mean change in hemoglobin was 1.9 ±0.8 g/dl (range: 0.9-3.2 g/dl). Nine patients (6SC and 3SS), 7 under anti-anemic treatment, initially refused phlebotomy, mainly because they did not understand how it could be useful to reduce the amount of blood in patients with a potentially anemic disease. Phlebotomy has resulted in a decrease in the frequency of VOCs and hospitalizations. It is essential to further popularize it and increase patients' aware of its value in combatting sickle cell disease and thus improve their willingness for and adherence to this treatment.
Topics: Adult; Anemia, Sickle Cell; Cross-Sectional Studies; Female; Hemoglobins; Humans; Male; Middle Aged; Phlebotomy; Togo; Young Adult
PubMed: 31031233
DOI: 10.1684/mst.2019.0886 -
MedEdPORTAL : the Journal of Teaching... Mar 2020Recognizing the need for interprofessional education for trainees, the University of Kansas Schools of Nursing (SON) and Medicine (SOM) created interprofessional...
INTRODUCTION
Recognizing the need for interprofessional education for trainees, the University of Kansas Schools of Nursing (SON) and Medicine (SOM) created interprofessional procedure workshops to foster collaboration, communication, and learning with and from other disciplines. The first workshop focused on venipuncture and peripheral intravenous catheter (PIV) insertion.
METHODS
An interprofessional work group including SON and SOM faculty developed a PIV procedure training workshop based on the "learn, see, practice, prove, do, maintain" framework. SON faculty and graduate nursing students provided support and mentoring during the training sessions. Nursing students acted as peer coaches for their medical student colleagues with the help of an evidence-based, standardized, deliberate practice guide. The document broke the procedure into phases-planning, preparation, insertion, and postinsertion care-and provided scaffolding for the beginner through assessment.
RESULTS
On survey, most students felt the program was beneficial and met the learning objectives. After the sessions, medical students completed a PIV assessment, and nursing students completed a reflection on the experience. These postsession assignments for each group confirmed that the learning objectives had been met.
DISCUSSION
The interprofessional PIV workshop was one module in a longitudinal interprofessional curriculum providing training for SON and SOM learners. One goal of this curriculum was to achieve higher graduate competencies in procedural skills and interprofessional practice. Additionally, in developing the workshop, a deliberate practice guide was created that provided an educationally sound and best-practice procedure to be standardized to all university learners on campus.
Topics: Catheterization, Peripheral; Clinical Competence; Cooperative Behavior; Education, Medical; Female; Humans; Interprofessional Relations; Kansas; Learning; Male; Peer Group; Phlebotomy; Students, Medical; Students, Nursing
PubMed: 32175475
DOI: 10.15766/mep_2374-8265.10884 -
Journal of the American Association For... May 2017Tail tip amputation with minimal restraint is not widely used for mouse phlebotomy. In part, this infrequency may reflect policies influenced by tail tip amputation... (Comparative Study)
Comparative Study
Comparing Phlebotomy by Tail Tip Amputation, Facial Vein Puncture, and Tail Vein Incision in C57BL/6 Mice by Using Physiologic and Behavioral Metrics of Pain and Distress.
Tail tip amputation with minimal restraint is not widely used for mouse phlebotomy. In part, this infrequency may reflect policies influenced by tail tip amputation procedures for genotyping, which involve greater handling and tissue removal. To assess tail tip amputation with minimal restraint as a phlebotomy technique, we compared it with 2 more common methods: scruffing with facial vein puncture and lateral tail vein incision with minimal restraint. Blood glucose levels, audible and ultrasonic vocalizations, postphlebotomy activity and grooming behavior, open field and elevated plus maze behaviors, nest-building scores, and histologic changes at the phlebotomy site were evaluated. Mice in the facial vein phlebotomy group produced more audible vocalizations, exhibited lower postphlebotomy activity in the open field, and had more severe histologic changes than did mice in the tail incision and tail tip amputation groups. Facial vein phlebotomy did not affect grooming behavior relative to sham groups, whereas tail vein incision-but not tail tip amputation-increased tail grooming compared with that in control mice. Blood glucose levels, nest-building scores, and elevated plus maze behavior did not differ between groups, and no mice in any group produced ultrasonic vocalizations. Tail tip amputation mice did not perform differently than sham mice in any metric analyzed, indicating that this technique is a potentially superior method of blood collection in mice in terms of animal wellbeing.
Topics: Animals; Behavior, Animal; Grooming; Jugular Veins; Mice; Mice, Inbred C57BL; Pain; Phlebotomy; Punctures; Random Allocation; Tail
PubMed: 28535866
DOI: No ID Found