in your patients’outcomes througheffective patientblood management.

Total blood drawn Blood discarded

Patient outcome improvement

Reduce blood loss

Reduce iatrogenic anemia

Reduce hospital infections

Reduce transfusion needs

Supporting evidence

Decrease in total blood drawn and discarded 21,26,27

Reduced decline in Hb levels 21,26–29

Lower contamination risk may present potential for reduction in catheter- related bloodstream infections (CRBSI) 15,16

Reduced need for transfusion compared to conventional blood sampling 26,28,34

Closed Blood Sampling is an evidence-based solution

Your hospital’s current blood sampling practices may benefi t from implementing Patient Blood Management (PBM) procedures designed to more eff ectively conserve blood, improve patient outcomes and avoid costs.

Patient Blood Management (PBM)Patient Blood Management (PBM) is the timely application of evidence-based medical and surgical concepts designed to maintain hemoglobin concentration, optimize hemostasis and minimize blood loss in an eff ort to improve patient outcome.36

Clinical and economic impact of conventional blood samplingConventional blood sampling procedures can result in notable blood loss, unnecessary blood waste and risk of contamination. Clinical implications may include anemia, transfusions, and hospital-acquired infections that may lead to poor patient outcomes. Increased hospital costs are also associated with routine blood collection utilizing conventional sampling methods.1–27

Benefi ts of Closed Blood Sampling (CBS) as part of Patient Blood Management (PBM) Closed Blood Sampling (CBS) can be adopted as part of your hospital’s PBM program. Clinical evidence demonstrates that CBS may reduce iatrogenic blood loss, reduce hospital infections, lower the risk of developing anemia and reduce the need for transfusion. Adopting CBS as standard operating procedure in your OR and ICU may help you achieve positive patient outcomes while providing cost-eff ective care.16,21,26–29,37

Discarded blood can account for 24–30%of total daily blood loss in critically ill patients 6

In the ICU, blood may be drawn 5–24 times a day 1,2

Volume drawn per day may be 26–427 mL2–7

Blood discarded with each blood draw varies from 2–10 mL3,10,11

Comparison of total blood drawn and discarded

Reduce blood loss

350

CBS CBS CBSConventional

Volume (mL)

Conventional ConventionalPeruzzi 1993 MacIsaac 2003 Mahdy 2009

30025020015010050

0

Anemia is associated with substantial burden and increased risk of organ injury and mortality 1,2,8,31

Reducing blood draw-induced anemia diminishes the need for blood transfusion.3 Moreover, iatrogenic anemia may be reduced through a culture of blood management.3

• Every 50 mL of blood drawn increases the risk of moderate to severe iatrogenic anemia by 18% 3

• Patients with >21 days LOS who experience an increase in blood draw above 3.5 mL/day risk a twofold increase in blood transfusions to correct their anemia 3

• Pediatric ICU patients are particularly vulnerable to anemia secondary to blood draws due to small body size/blood volume 24

• Blood loss from phlebotomy in critically ill infants (birth – 2 weeks) is the primary contributor to early anemia and red blood cell (RBC) transfusion needs 20

In the ICU, reducing blood loss from sampling through improved patient blood management may reduce the need for transfusions and lead to fewer transfusion-related complications,19,23,24,26,28 which include:

• Allergy, anaphylactic and hemolytic transfusion reactions, transfusion- related acute lung injury (TRALI), transfusion associated circulatory overload (TACO), acute respiratory distress syndrome (ARDS), infections and ventilator-associated pneumonia 29

• RBC transfusion has been associated with a higher rate of post-operative infection 2

• Transfused patients have increased mortality both in the ICU and hospital, increased infection rates, organ failure, longer ICU stays 28

Reduce catheter-related bloodstream infections (CRBSI)CBS forms a closed infusion line and may reduce complications caused by intraluminal contamination. CBS has demonstrated a decrease in intraluminal fl uid contamination compared to a 3-way stopcock system (7% vs. 61%, respectively).33 A randomized controlled trial found lower rates of intraluminal fl uid contamination with CBS (1.8%) vs. 3-way stopcock system (8.2%).16

Reduce transfusion needs and related complications

50%

CBS Conventional

MacIsaac2003

Rezende2010

Garcia-Moron2003

p = NR40%

30%

20%

10%

0%

Percentage of patients transfused after sampling with Closed Blood Sampling vs. conventional sampling 26,28,34

In the US, approximately

50,000 patientsdevelop CRBSI each year 32

Decrease in Hb levels from admission to discharge (g/dL)Blood loss due to sampling with discarding can lead to a decline in hemoglobin (Hb), which can contribute to anemia.17,21,22

Reduce iatrogenic anemia

2.5

Peruzzi1993

MacIsaac2003

Mahdy2009

Rezende 2010

Mukhopadhyay2010

2.0

1.5

1.0

0.5

0

40%

CBS Conventional

Thorpe 2000Catheter line

Oto 2012Catheter tip

Oto 2012Intraluminal fl uid

p < 0.05

30%

20%

10%

0%

Comparison of contamination rates (%) using Closed Blood Sampling (CBS) vs. conventional sampling15,16

• In critically ill patients, CRBSI account for 19% of infections 32

• In pediatric ICUs, CRBSI are observed in 31% of nosocomial infections32

CBS Conventional

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Closed Blood Sampling: evidence-based decision making for cost-effective care.

References inserted above

Data analysis supports the economic value of Closed Blood Sampling (CBS) to hospitals37

Reduce hospital costsCBS may help avoid hospital costs by reducing transfusion incidence, with one transfusion averted in every 6 to 8 patients.26,28,37

Transfusion-related adverse events, both short- and long-term, are among the costliest contributors to healthcare expenditures.35

Additionally, CBS may help you avoid proposed penalties for hospital-acquired complications (HAC) through reduced contamination risk.16

You can make a diff erence in your patients’ outcomes through eff ective patient blood management, starting today.

Edwards Lifesciences off ers a host of resources to help your hospital implement Closed Blood Sampling including education, clinical evidence, and a value estimator. Visit Edwards.com/CBS

RBC-unit costsrange from

$522 to$1,183 35

1. Tinmouth, A.T., L.A. McIntyre, and R.A. Fowler, Blood conservation strategies to reduce the need for red blood cell transfusion in critically ill patients. CMAJ : Canadian Medical Association journal = journal de l’Association medicale canadienne, 2008. 178(1): p. 49-57.

2. Vincent, J.L., et al., Anemia and blood transfusion in critically ill patients. JAMA, 2002. 288(12): p.1499-507.

3. Barth, M.D., et al., Blood Conservation: What Is Current Blood Draw Practice? Journal of infusion nursing : the offi cial publication of the Infusion Nurses Society, 2013. 36(5): p. 323-328.

4. Smoller, B.R., M.S. Kruskall, and G.L. Horowitz, Reducing adult phlebotomy blood loss with the use of pediatric-sized blood collection tubes. Am J Clin Pathol, 1989. 91(6): p. 701-3.

5. Eyster, E. and J. Bernene, Nosocomial anemia. JAMA, 1973. 223(1): p. 73-4.

6. Henry, M.L., W.L. Garner, and P.J. Fabri, Iatrogenic anemia. Am J Surg, 1986. 151(3): p. 362-3.

7. Andrews, T., H. Waterman, and V. Hillier, Blood gas analysis: a study of blood loss in intensive care. Journal of advanced nursing, 1999. 30(4): p. 851-7.

8. O’Hare, D. and R.J. Chilvers, Arterial blood sampling practices in intensive care units in England and Wales. Anaesthesia, 2001. 56(6): p. 568-71.

9. Low, L.L., G.R. Harrington, and D.P. Stoltzfus, The eff ect of arterial lines on blood-drawing practices and costs in intensive care units. Chest, 1995. 108(1): p. 216-9.

10. Yucha, C.B. and E. DeAngelo, The minimum discard volume: accurate analysis of peripheral hematocrit. J Intraven Nurs, 1996. 19(3): p. 141-6.

11. Keller, C.A., Methods of drawing blood samples through central venous catheters in pediatric patients undergoing bone marrow transplant: results of a national survey. Oncol Nurs Forum, 1994. 21(5): p. 879-84.

12. Holmes, K.R., Comparison of push-pull versus discard method from central venous catheters for blood testing. J Intraven Nurs, 1998. 21(5): p. 282-5.

13. Walrath, J.M., et al., Stopcock: bacterial contamination in invasive monitoring systems. Heart Lung, 1979. 8(1): p. 100-4.

14. Shinozaki, T., et al., Bacterial contamination of arterial lines. A prospective study. JAMA, 1983. 249(2): p. 223-5.

15. Thorpe, S. and A.N. Thomas, The use of a blood conservation pressure transducer system in critically ill patients. Anaesthesia, 2000. 55(1): p. 27-31.

16. Oto, J., et al., Comparison of bacterial contamination of blood conservation system and stopcock system arterial sampling. American Journal of Infection Control, 2012. 40(6): p. 530-4.

17. Thavendiranathan, P., et al., Do blood tests cause anemia in hospitalized patients? The eff ect of diagnostic phlebotomy on hemoglobin and hematocrit levels. Journal of general internal medicine, 2005. 20(6): p. 520-4.

18. Salisbury, A.C., et al., Diagnostic blood loss from phlebotomy and hospital-acquired anemia during acute myocardial infarction. Archives of internal medicine, 2011. 171(18): p. 1646-53.

19. Chant, C., G. Wilson, and J.O. Friedrich, Anemia, transfusion, and phlebotomy practices in critically ill patients with prolonged ICU length of stay: a cohort study. Critical care, 2006. 10(5): p. R140.

20. Lin, J.C., et al., Phlebotomy overdraw in the neonatal intensive care nursery. Pediatrics, 2000. 106(2): p. E19.

21. Peruzzi, W.T., et al., A clinical evaluation of a blood conservation device in medical intensive care unit patients. Critical care medicine, 1993. 21(4): p. 501-6.

22. Page, C., A. Retter, and D. Wyncoll, Blood conservation devices in critical care: a narrative review. Annals of intensive care, 2013. 3(1): p. 14.

23. Corwin, H.L., K.C. Parsonnet, and A. Gettinger, RBC transfusion in the ICU. Is there a reason? Chest, 1995. 108(3): p. 767-71.

24. Bateman, S.T., et al., Anemia, blood loss, and blood transfusions in North American children in the intensive care unit. Am J Respir Crit Care Med, 2008. 178(1): p. 26-33.

25. Corwin, H.L., et al., The CRIT Study: Anemia and blood transfusion in the critically ill—current clinical practice in the United States. Critical care medicine, 2004. 32(1): p. 39-52.

26. MacIsaac, C.M., et al., The infl uence of a blood conserving device on anemia in intensive care patients. Anaesth Intensive Care, 2003. 31(6): p. 653-7.

27. Mahdy, S., et al., Evaluation of a blood conservation strategy in the intensive care unit: a prospective, randomised study. Middle East J Anesthesiol, 2009. 20(2): p. 219-23.

28. Rezende E, F.M., Manoel Da Silva Junior J, et al, Closed system for blood sampling and transfusion in critically ill patients. Rev Bras Ter Intensiva, 2010. 22: p. 5-10.

29. Mukhopadhyay, A., et al., The use of a blood conservation device to reduce red blood cell transfusion requirements: a before and after study. Critical care, 2010. 14(1): p. R7.

30. Hare, G.M., J. Freedman, and C. David Mazer, Review article: risks of anemia and related management strategies: can perioperative blood management improve patient safety? Can J Anaesth, 2013. 60(2): p. 168-75.

31. Rudis, M.I., et al., Managing anemia in the critically ill patient. Pharmacotherapy, 2004. 24(2): p. 229-47.

32. De Gaudio, A.R. and A. Di Filippo, Device-related infections in critically ill patients. Part I: Prevention of catheter-related bloodstream infections. J Chemother, 2003. 15(5): p. 419-27.

33. Crow, S., et al., Microbial contamination of arterial infusions used for hemodynamic monitoring: a randomized trial of contamination with sampling through conventional stopcocks versus a novel closed system. Infection control and hospital epidemiology: the offi cial journal of the Society of Hospital Epidemiologists of America, 1989. 10(12): p. 557-61.

34. Moron N., J.E., Moreno I., Lazaro A., Dispositivo VAMP Benefi cis para el paciente critico. Rev ROL Enf, 2003. 26(9): p. 591-594.

35. Shander, A., et al., Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion, 2010. 50(4): p. 753-65.

36. Society for the Advancement of Blood Management, Professional Defi nition of Patient Blood Management (PBM) on homepage, http://sabm.org, retrieved April 17, 2015.

37. Edwards Lifesciences Data on File, 2013.

References for the EdwardsClosed Blood Sampling brochure

Edwards Lifesciences | edwards.comOne Edwards Way | Irvine, California 92614 USA Switzerland | Japan | China | Brazil | Australia | India

Edwards, Edwards Lifesciences, and the stylized E logo are trademarks of Edwards Lifesciences Corporation or its affi liates. All other trademarks are the property of their respective owners.

© 2015 Edwards Lifesciences Corporation. All rights reserved. AR12970