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Klin Padiatr 2020; 232(04): 197-202
DOI: 10.1055/a-1123-7809
Original Article

Implementation of a Blood-Saving Program in a Pediatric Intensive Care Unit to Reduce Diagnostic Blood Loss

Maßnahmen zur Reduktion von diagnostischem Blutverlust auf einer pädiatrischen Intensivstation
Jörg Michel 
1   Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen
,
Michael Hofbeck
1   Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen
,
Judit Vinuales Balcells
1   Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen
,
Matthias Kumpf
1   Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen
,
Felix Neunhoeffer
1   Department of Pediatric Cardiology, Pulmology and Pediatric Intensive Care Medicine, University Children’s Hospital Tübingen, Tübingen
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Abstract

Background We aimed to reduce blood loss in the pediatric critical care unit (PICU) due to blood sampling in neonates and infants. Therefore, an educational program for our staff was established and evaluated.

Methods Patients in a PICU of a tertiary referral center aged 0–12 months who underwent surgery of congenital heart disease on cardiopulmonary bypass were enrolled and divided into a pre- and a post-implementation group. We assessed frequency and types of postoperative blood samples, required blood volume, and amount of blood transfusions in the PICU within 5 days after cardiac surgery.

Results Populations were similar prior and after the implementation. Blood drawn for blood gas analysis (0,52 ml±0,16 vs. 0,38 ml±0,12, p<0,001) and for complete blood sampling (2,62 ml±0,32 vs. 2,11 ml±0,35, p<0,001) could be successfully reduced after implementation of our blood-saving program. The daily diagnostic blood loss per patient was significantly reduced by approximately 35% (1,7 ml/kg/d±1,0 vs. 1,1 ml/kg/d±0,7, p=0,008).

Discussion Our quality improvement program is feasible and effective to significantly reduce the blood loss due to blood sampling. Although the incidence of red blood cell transfusions was not significantly reduced, it is certainly beneficial to try to reduce diagnostic blood loss, especially in children with complex diseases requiring long-term intensive care treatment.

Conclusion We could demonstrate that it is possible to significantly reduce the blood loss due to blood sampling with a simple educational program for PICU staff.

Zusammenfassung

Hintergrund Unser Ziel war es, den Blutverlust durch Blutabnahmen auf der pädiatrischen Intensivstation bei Neugeborenen und Säuglingen zu reduzieren. Deshalb wurde ein Schulungsprogramm für unsere Mitarbeiter etabliert und ausgewertet.

Methode Patienten unserer pädiatrischen Intensivstation im Alter von 0–12 Monaten nach einer Operation eines angeborenen Herzfehlers mit Herz-Lungen-Maschine, wurden eingeschlossen und in eine Gruppe vor und nach der Implementierung des Schulungsprogramms zugeteilt. Wir haben die Häufigkeit und Art der postoperativen Blutproben, das benötigte Blutvolumen und die Menge der Bluttransfusionen auf der Intensivstation innerhalb von 5 Tagen nach der Herzoperation ausgewertet.

Ergebnisse Die Patientencharakteristik beider Gruppen zeigte keine relevanten Unterschiede. Blut, das für Blutgasanalysen (0,52 ml±0,16 vs. 0,38 ml±0,12, p<0,001) und für vollständige Blutentnahmen (2,62 ml±0,32 vs. 2,11 ml±0,35, p<0,001) entnommen wurde, konnte nach Umsetzung unseres Blutsparprogramms erfolgreich reduziert werden. Der tägliche diagnostische Blutverlust pro Patienten wurde signifikant um ca. 35% reduziert (1,7 ml/kg/d±1,0 vs. 1,1 ml/kg/d±0,7, p=0,008).

Diskussion Unser Schulungsprogramm für Mitarbeiter ist einfach umzusetzen und effektiv, den Blutverlust durch Blutentnahmen deutlich zu reduzieren. Obwohl die Inzidenz von Bluttransfusionen nicht signifikant reduziert wurde, ist es sicherlich erstrebenswert, den diagnostischen Blutverlust insbesondere bei Kindern mit komplexen Krankheiten, die eine langfristige Intensivbehandlung erfordern, zu reduzieren.

Schlussfolgerung Wir konnten zeigen, dass es möglich ist, den Blutverlust durch Blutentnahme mit einem einfachen Schulungsprogramm für Mitarbeiter auf der Intensivstation deutlich zu reduzieren.

Key words

cardiac surgery - congenital heart disease - anemia - blood transfusion - blood loss

Schlüsselwörter

Herzchirurgie - Angeborene Herzfehler - Anämie - Bluttransfusion - Blutverlust


Publication History

Article published online:
10 March 2020

© Georg Thieme Verlag KG
Stuttgart · New York

 

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