Every Drop Counts

Children in PICU do need blood tests, but not all of them need all tests every day!

Please follow this decision making tool and think if the result of the test is going to influence the management of the patient.

This tool has helped us reduce the cost and number of blood tests by nearly 20%. This can save £25,000 per year and improve patient experience. Let’s keep up the good work.

Patient group

Support level

Haematology Tests

Biochemistry Tests

Frequency

On Admission

All patients admitted to PICU, irrespective of level of support

FBC, clotting,
Cross match

U&E, Mg/Ca/ PO4 and LFT’s.

PCT if suspected infection

On admission if not done in the preceding 6 hours or if there are significant changes since

Red group:

Unstable:
Ventilation + 2 or more inotropes
Ventilation + Nitric oxide
ECMO
CVVH + inotrope or ventilation
Neuroprotection with unstable ICP

FBC, clotting

U&E, Mg/ Ca/PO4

12 hourly

LFT’s
CRP or PCT

Once daily

Blue group:

High Support Level:
HFOV +/- 1 inotrope
Ventilation + 1 inotrope
CVVH if stable and no other organ failure
Neuroprotection with stable ICP
Patients who had surgery in the preceding 48 hours

FBC, clotting

U&E, Mg/ Ca/PO4

Once daily

LFT
CRP or PCT

On Consultant request

Yellow group:

Stable:
Ventilation only
NIV +/- 1 inotrope
Self-ventilating / Vapotherm on 1 inotrope

FBC

U&E

Once daily for first 2 days.

Twice weekly once stable and on enteral feeds

Green group:

HDU level:
Stable on Vapotherm
Patients on no organ support
And tolerating more than 50% enteral feeds

These patients don’t need routine blood tests,EXCEPT for:

- patients who had surgery in the preceding 48 hours - Blue group

- patients tolerating less than 50% enteral feeds - check daily U/E

White group:

Long term stable patients:

Stable on PICU > 14 days on single organ support

These patients don’t need routine blood tests

Request tests as clinically indicated

Patient on PN

Minimum testing frequency. If patient needs more frequent testing based on support level please follow guidance for the appropriate group

See PN Monitoring guideline for patients on PN beyond 4 weeks

U&E, Mg, PO4, Ca

Once daily if abnormal. Twice weekly once stable

FBC

LFTs

Twice weekly

Triglycerides

Once weekly

Patients admitted following liver / kidney transplantation

Please follow liver / renal transplantation protocol for frequency of blood tests