• Deborah M Siegal, Emilie P Belley-Côté, Shun Fu Lee, Tara Robertson, Stephen Hill, Pamela Benoit, Brandi Meeks, Julian Owen, Tanya Roglich, Elena Zotova, and Stuart J Connolly.
• Department of Medicine, McMaster University, Hamilton, ON, Canada. dsiegal@toh.ca.
• Can J Anaesth. 2023 Nov 1; 70 (11): 179718061797-1806.

PurposeBlood sampling for diagnostic testing causes blood loss. Small-volume tubes have the same cost, dimensions, and blood-draw techniques as standard-volume tubes, and are compatible with laboratory equipment; however, they are not commonly used. We sought to assess the feasibility of a stepped-wedge cluster trial to determine whether small-volume tubes reduce transfusion compared with standard-volume tubes in intensive care unit (ICU) patients.MethodsWe conducted a prospective mixed-methods pilot study (before-after design) in one ICU with a six-week control period (standard-volume tubes) and a six-week intervention period (small-volume tubes). All patients admitted to the ICU were included. Feasibility was assessed as successful switch to small-volume tubes; adherence to tube size; sufficient volume for testing; user acceptance; barriers and facilitators to implementation; and 95% transfusion collection. We explored end-user acceptability using focus groups.ResultsOne hundred and sixty-five patients were included in the standard-volume and 204 in the small-volume periods. Transition to small-volume tubes was successful. Random audits showed 100% compliance. The proportion of samples with inadequate volume for testing was the same for both groups (both, 0.2%). Based on ten focus groups, small-volume tubes were acceptable with no barriers identified. Transfusion data collection was 100%. Median [interquartile range] estimated blood loss due to laboratory testing per patient per day in ICU was 11 [8-17] mL with standard-volume and 6 [4-8] mL with small-volume tubes.ConclusionSmall-volume tubes can be implemented with acceptability to end-users and without barriers. They did not result in an increased frequency of inadequate samples. These results inform a trial to determine whether small-volume tubes reduce transfusion.Study RegistrationClinicalTrials.gov (NCT03284944); registered 15 September 2017.© 2023. Canadian Anesthesiologists' Society.

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