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Choosing Wisely®

Society for the Advancement of Patient Blood Management

Excessive fluid administration causing hemodilution and unnecessary phlebotomy reduce hemoglobin levels and may unnecessarily trigger red blood cell transfusions based on a numeric threshold despite adequate oxygen carrying capacity. Replacing blood loss with intravenous fluids which do not contain adequate clotting factors (i.e. crystalloids, colloids and packed red blood cells) may lead to dilutional coagulopathy causing a bleeding diathesis. Routine blood draws should be avoided, and if ...

Choosing Wisely Canada

Canadian Nurses Association, Canadian Association of Critical Care Nurses

Central venous or peripherally inserted central catheters require close monitoring for signs of central line-associated bloodstream infections (CLABSI) and should be reviewed daily during multidisciplinary rounds to ensure the appropriateness of the catheter and its intended use. Peripheral intravenous catheters should be assessed daily and removed if they are not part of the continued plan of care or the lumen remains dormant for greater than 24 hours. Unless medically necessary for parenteral ...

Choosing Wisely Canada

Canadian Rheumatology Association

Periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome is a clinical diagnosis, and currently, no genetic mutations have been identified for this condition. Periodic fever genetic panel in patients with classic features of PFAPA—without any features of another periodic fever syndrome—rarely yields an alternate diagnosis and as such is costly and has no clinical benefit. However, genetic testing may be warranted if patients have atypical features at presentation, don’t ...

Choosing Wisely®

Society for the Advancement of Patient Blood Management

Cell salvage, as a part of a multimodal patient blood management strategy in pediatrics, may reduce unnecessary blood transfusions, improve outcomes and decrease costs. Expert consensus recommendations, observational reports and prospective research suggest that utilizing cell salvage decreases RBC transfusions in infants, children and adolescents undergoing craniosynostosis, spinal and cardiac surgical procedures. While prospective clinical studies are few, the evidence suggests that cell ...

Choosing Wisely Canada

Canadian Nurses Association, Canadian Association of Critical Care Nurses

In emergency situations, intravenous (IV) access can be difficult to obtain. Nurses often lose time trying to insert peripheral IVs, and insertion of central venous catheters may be initiated. However, intraosseous (IO) access is a faster and safer option, with less chance of complications, when inserted by trained personnel.