OPTIMIZING PHLEBOTOMY PRACTICES: IMPACT OF SMALL-VOLUME BLOOD COLLECTION TUBES ON DIAGNOSTIC BLOOD LOSS AND PATIENT OUTCOMES IN A TERTIARY CARE HOSPITAL

Abstract

Background:
Iatrogenic blood loss from frequent phlebotomy remains a major contributor to hospital-acquired anemia, particularly among critically ill and neonatal patients. The use of small-volume blood collection tubes has been proposed as an effective strategy to minimize diagnostic blood loss without compromising laboratory quality.

Objective:
To evaluate the impact of implementing small-volume blood collection tubes on blood waste, sample quality, and patient hemoglobin outcomes in a tertiary hospital setting.

Methods:
A prospective quasi-experimental study was conducted from January to June 2025 in the Clinical Laboratory Department of a tertiary care hospital in Riyadh, Saudi Arabia. A total of 300 patients were enrolled—150 before (standard tubes) and 150 after (small-volume tubes) intervention. Primary outcomes included total blood volume drawn per day and sample rejection rate. Secondary outcomes assessed hemoglobin changes, transfusion frequency, and staff compliance. Data were analyzed using t-tests and Chi-square tests with p < 0.05 considered significant.

Results:
Mean blood draw volume decreased from 33.4 ± 8.9 mL/day to 18.7 ± 6.1 mL/day (p < 0.001), representing a 44% reduction. Sample rejection rates improved from 5.3% to 2.1% (p = 0.02), and mean hemoglobin decline during ICU stay was reduced by 54% (p = 0.003). Staff compliance with new protocols exceeded 90%, with positive feedback regarding ease of use and workflow efficiency.

Conclusion:
Adoption of small-volume blood collection tubes significantly reduces diagnostic blood loss, enhances sample quality, and supports patient blood management objectives. Routine implementation of this low-cost intervention can improve clinical outcomes and laboratory sustainability in critical care environments.