Evaluation of a tool to score donor vein suitability for blood donation

The development of the Western Australian Haemodialysis Vascular Access Complexity instrument

Background

The Western Australian Haemodialysis Vascular Access Classification instrument was developed to classify the cannulation complexity of the arteriovenous fistula or arteriovenous graft as simple, challenging, or complex. Although the instrument was developed by experts in haemodialysis nursing, the instrument had not undergone formal validity or reliability testing.

Objectives

Evaluate the Western Australian Haemodialysis Vascular Access Classification instrument for content validity, interrater and test–retest reliability.

Design

Prospective cohort study.

Participants

Content validity was assessed by haemodialysis nursing experts (n = 8). The reliability testing occurred in one in‐centre and one satellite haemodialysis unit in Western Australia from September to November 2019. Reliability testing was performed by 38 haemodialysis nurses in 67 patients receiving haemodialysis and 247 episodes of cannulation.

Measurements

Interrater and test–retest reliability assessment was conducted using κ, adjusted κ, Bland–Altman plots, intraclass correlation coefficient and Pearson's correlation coefficient.

Results

The final version of the instrument (n = 20 items) had individual item‐level content validity indices ranging from 0.625 to 1.00 with a scale‐level content validity index of 0.89. For both interrater (n = 172 pairs) and test–retest (n = 101 pairs), most individual variables had excellent adjusted κ (n = 33 variables), some fair to good agreement (n = 6 variables) and one variable with poor agreement. The classification of simple, challenging and complex demonstrated adjusted κ of fair to good, to excellent agreement for interrater reliability with lower levels of agreement for test–retest reliability.

Conclusions

This instrument may be used to match a competency‐assessed nurse to perform the cannulation thereby minimising the risk of missed cannulation and trauma.

Adopting a vein assessment tool improves procedural outcomes in double dose platelet collections - A prospective study

BACKGROUND

This study aims to determine the phlebotomy and procedural outcomes using a vein assessment tool (VAT) in Double Dose Platelet (DDP) collections by apheresis.

METHODS

VAT was based on assessing vein visibility, palpation and size with maximum score of 12 and the least being 0 and the scores were graded as adequate and inadequate. A vein-viewer was used for studying cubital vein patterns (type 1-5). Phlebotomy outcome was defined based on need for re-puncture. Procedural outcomes in terms of target yield attained and RBC reinfusion completed. Chi square test and Mann- Whitney U test were used to assess the vein score and pattern against phlebotomy and procedural outcome.

RESULTS

Out of 200 DDP collections, the phlebotomy was successful in 88 % with good procedural outcome in 94 % donations. The cut off in VAT scores for successful phlebotomy was ≥8 (AUC: 70 %). Median vein scores of the arm selected for phlebotomy was 9 and graded adequate in 154 (77 %) donations.Odds for successful phlebotomy was 3.7 times higher when donors had an adequate VAT grades(p = 0.003). Procedural outcomes was favourable when at least one arm had adequate VAT grade when compared to both arms being inadequate (98 % vs 82 %; p < 0.001). Phlebotomy failure was more with first time apheresis donors than repeat apheresis donors (p = 0.014).

CONCLUSION

This study indicated that a VAT score with a cut off of ≥8 had better phlebotomy and procedural outcomes in DDP collections and that donor with at least one arm having the VAT score of ≥8 are preferred for DDP collections.

Offering new and returned donors the option to give plasma: implications for donor retention and donor adverse events

BACKGROUND AND OBJECTIVES

In 2018, Australian Red Cross Lifeblood changed its plasmapheresis eligibility criteria to allow donors to donate plasma without the requirement of a prior successful whole blood donation. This study evaluated the impact of this policy change on donor retention and donor safety.

MATERIALS AND METHODS

All donors who had attempted to give their first plasma or whole blood donation from January to June 2018 were included in this retrospective cohort study. Donor characteristics and adverse events were analysed for this index donation, and the cohort was followed for 18 months to analyse time to return, subsequent donation frequency and predictors of return.

RESULTS

Male and younger donors provided a significantly greater proportion of first donation plasma than females and older donors. New donors who gave plasma had the highest rate of donor adverse events, including vasovagal reactions and phlebotomy injuries. Nevertheless, donor retention was not affected, with more new donors returning and at a greater subsequent donation frequency after a plasma donation compared to new donors donating whole blood. First-time plasma donors who had previously donated whole blood, however, had greater and quicker rates of return, and more subsequent donations.

CONCLUSION

Offering new donors the option to give plasma had a positive effect on donor return and subsequent donation frequency. Removing the requirement of a prior whole blood donation is a viable way to increase plasma collections although the combined effect of new donor status and plasmapheresis procedure on adverse event risk needs to be considered.