Small-volume blood sample collection tubes in adult intensive care units: A rapid practice guideline

Jeannie Callum; Zbignew Putowski; Waleed Alhazzani; Emilie Belley-Cote; Morten Hylander Møller; Nicola Curry; Zainab Al Duhailib; Mark Fung; Louise Giocobbo; Anders Granholm; Vernon Louw; Patrick Maybohm; Marcella Muller; Nathan Nielsen; Curtis Oleschuk; Sheharyar Raza; Elizabeth Scruth; Deborah Siegal; Simon J Stanworth; Alexander P J Vlaar; Micheline White; Simon Oczkowski

doi:10.1111/aas.14497

Small-volume blood sample collection tubes in adult intensive care units: A rapid practice guideline

Acta Anaesthesiol Scand. 2024 Nov;68(10):1319-1326. doi: 10.1111/aas.14497. Epub 2024 Jul 21.

Authors

Jeannie Callum¹, Zbignew Putowski², Waleed Alhazzani^{3

4

5

6

7}, Emilie Belley-Cote^{3

4

7

8}, Morten Hylander Møller^{7

9

10}, Nicola Curry^{11

12}, Zainab Al Duhailib^{13

14}, Mark Fung¹⁵, Louise Giocobbo¹⁶, Anders Granholm^{7

9}, Vernon Louw¹⁷, Patrick Maybohm¹⁸, Marcella Muller¹⁹, Nathan Nielsen²⁰, Curtis Oleschuk¹, Sheharyar Raza²¹, Elizabeth Scruth²², Deborah Siegal^{23

24}, Simon J Stanworth^{12

25

26}, Alexander P J Vlaar^{19

27}, Micheline White²⁸, Simon Oczkowski^{3

4

6

7}

Affiliations

¹ Pathology and Molecular Medicine, Queen's University and Kingston Health Sciences Centre, Kingston, Ontario, Canada.
² Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland.
³ Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
⁴ Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
⁵ Department of Critical Care, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
⁶ Research Institute of St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.
⁷ GUIDE Group, Hamilton, Ontario, Canada.
⁸ Population Health Research Institute, Hamilton, Ontario, Canada.
⁹ Department of Intensive Care, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
¹⁰ Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹¹ Department of Clinical Haematology, Haemophilia & Thrombosis Centre, Oxford University Hospitals National Health Service Foundation Trust, Oxford, UK.
¹² John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
¹³ Critical Care Medicine Department, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.
¹⁴ Department of Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia.
¹⁵ University of Vermont Medical Center, Burlington, Vermont, USA.
¹⁶ Halton Healthcare, Oakville Trafalgar Memorial Hospital, Oakville, Ontario, Canada.
¹⁷ Division Clinical Haematology, Department of Medicine, University of Cape Town and Groote Schuur Hospital, Cape Town, South Africa.
¹⁸ Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Würzburg, Würzburg, Germany.
¹⁹ Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, the Netherlands.
²⁰ Division of Pulmonary, Critical Care and Sleep Medicine, and Section of Transfusion Medicine and Therapeutic Pathology, University of New Mexico School of Medicine, Albuquerque, New Mexico, USA.
²¹ Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
²² NCAL Quality, Safety, Risk Department, Kaiser Permanente, Oakland, California, USA.
²³ Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
²⁴ Ottawa Hospital Resarch Institute, Ottawa, Ontario, Canada.
²⁵ Radcliffe Department of Medicine, University of Oxford, Oxford, UK.
²⁶ Systematic Review Initiative, NHS Blood and Transplant, Oxford, UK.
²⁷ Laboratory of Experimental Intensive Care and Anesthesiology, Amsterdam University Medical Centers - Location Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
²⁸ College of the Humanities and the Department of English, Carleton University, Ottawa, Ontario, Canada.

PMID: 39034625
DOI: 10.1111/aas.14497

Abstract

Background: This Intensive Care Medicine Rapid Practice Guideline (ICM-RPG) provides an evidence-based recommendation to address the question: in adult patients in intensive care units (ICUs), should we use small-volume or conventional blood collection tubes?

Methods: We included 23 panelists in 8 countries and assessed and managed financial and intellectual conflicts of interest. Methodological support was provided by the Guidelines in Intensive Care, Development, and Evaluation (GUIDE) group. We conducted a systematic review, including evidence from observational and randomized studies. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach, we evaluated the certainty of evidence and developed recommendations using the Evidence-to-Decision framework.

Results: We identified 8 studies (1 cluster and 2 patient-level randomized trials; 5 observational studies) comparing small-volume to conventional tubes. We had high certainty evidence that small-volume tubes reduce daily and cumulative blood sampling volume; and moderate certainty evidence that they reduce the risk of transfusion and mean number of red blood cell units transfused, but these estimates were limited by imprecision. We had high certainty that small-volume tubes have a similar rate of specimens with insufficient quantity. The panel considered that the desirable effects of small-volume tubes outweigh the undesirable effects, are less wasteful of resources, and are feasible, as demonstrated by successful implementation across multiple countries, although there are upfront implementation costs to validate small-volume tubes on laboratory instrumentation.

Conclusion: This ICM-RPG panel made a strong recommendation for the use of small-volume sample collection tubes in adult ICUs based on overall moderate certainty evidence.

Keywords: ICM‐RPG; blood transfusion; guidelines; intensive care; phlebotomy; rapid practice guideline; small‐volume tubes.

Publication types

Practice Guideline
Systematic Review

MeSH terms

Adult
Blood Specimen Collection* / instrumentation
Blood Specimen Collection* / methods
Blood Specimen Collection* / standards
Critical Care / methods
Critical Care / standards
Humans
Intensive Care Units* / standards