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Impact of Phlebotomy Tourniquet Use on Blood Lactate Levels in Acutely Ill Patients

  • Vamsi Balakrishnan (a1), John Wilson (a1), Brent Taggart (a1), James Cipolla (a2) and Rebecca Jeanmonod (a1)...

Abstract

Objective

Lactate levels are increasingly used to guide resuscitation efforts. Some surgical literature suggests that tourniquet use during phlebotomy falsely elevates results, although studies in healthy volunteers have not demonstrated this. The purpose of this study was to determine in clinical practice whether tourniquet use during the drawing of a lactate results in significantly altered levels compared to the result of a level drawn without a tourniquet.

Methods

A prospective cohort study was carried out on emergency department patients whose clinical presentation led a physician to order a lactate level. Written informed consent was obtained from patients or their proxies. Study lactates were obtained using a tourniquet during the draw sequence of other laboratory studies. Lactate levels for clinical use were drawn per hospital protocol with no tourniquet. The time of lactate measurements and patient demographic information were recorded. Lactate levels for each patient were compared with the Wilcoxon Rank-Sum Test.

Results

40 patients were consented and enrolled. The median clinical lactate level was 1.9 (interquartile range 1.5-2.6), and the median study lactate level was 1.9 (interquartile range 1.4-2.7). There was no difference between paired lactate values (p=0.95).

Conclusions

Tourniquet use appears to have no impact on measured lactate levels. Our findings suggest that current practices at many institutions regarding lactate collection are likely too stringent and should be changed.

Objectif

Le taux de lactate sert de plus en plus à guider les efforts de réanimation. D’après certains travaux de recherche en chirurgie, l’utilisation du garrot durant la ponction veineuse augmenterait erronément le taux de lactate, bien que certaines études réalisées chez des témoins en bonne santé ne soient pas arrivées à la même conclusion. L’étude décrite ici avait donc pour but de déterminer si l’utilisation du garrot en clinique durant les prélèvements de sang en vue de la mesure du taux de lactate avait pour effet de modifier considérablement le taux par rapport aux prélèvements de sang effectués sans garrot.

Méthode

Une étude de cohorte, prospective a été menée chez des patients traités au service des urgences dont le tableau clinique justifiait, selon le médecin, une mesure du taux de lactate. Les malades ou leur représentant ont donné par écrit leur consentement éclairé. Les prélèvements de sang faits pour la mesure du taux de lactate aux fins de l’étude ont été effectués avec garrot, en même temps que ceux faits pour d’autres examens de laboratoire. Les prélèvements de sang faits pour la mesure du taux de lactate aux fins cliniques ont été effectués sans garrot, selon le protocole en vigueur à l’hôpital. Ont été consignées l’heure de la mesure des taux de lactate ainsi que des données démographiques sur les patients. Il y a eu comparaison des taux de lactate de chaque patient selon le test de Wilcoxon.

Résultats

Quarante patients ont participé à l’étude après avoir donné leur consentement. Le taux médian de lactate, mesuré aux fins cliniques était de 1,9 (intervalle interquartile : 1,5-2,6) et le taux médian de lactate, mesuré aux fins de l’étude était de 1,9 (intervalle interquartile : 1,4-2,7). Aucun écart n’a donc été enregistré entre les valeurs appariées de lactate (p=0,95).

Conclusions

Il semble donc que l’utilisation du garrot n’ait aucune incidence sur la mesure du taux de lactate. Les résultats de l’étude portent à croire que les pratiques en vigueur dans bon nombre d’établissements en ce qui concerne les prélèvements de sang pour la mesure du taux de lactate sont trop restrictives et qu’il faudrait les changer.

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Copyright

Corresponding author

Correspondence to: Rebecca Jeanmonod, Department of Emergency Medicine, St. Luke’s University Hospital, 801 Ostrum St., Bethlehem, PA 18015, USA. Email: rebeccajeanmonod@yahoo.com

References

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Keywords

Impact of Phlebotomy Tourniquet Use on Blood Lactate Levels in Acutely Ill Patients

  • Vamsi Balakrishnan (a1), John Wilson (a1), Brent Taggart (a1), James Cipolla (a2) and Rebecca Jeanmonod (a1)...

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