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Randomized trial of 792 emergency patients demonstrates early tourniquet deflation reduces blood sample hemolysis from 26.1% to 17.2%

Medicina (Kaunas, Lithuania) (PubMed)Oct 17, 2026

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Brief summary

The TOURNI-ED randomized controlled trial in 792 emergency department patients found that initiating cuff deflation as blood enters the first collection tube significantly reduced specimen hemolysis from 26.1% to 17.2% compared with late release.

What NurseJet pulled from the source

In vitro hemolysis represents the leading preanalytical error in emergency department blood testing, frequently requiring specimen redraws and delaying critical diagnostic decisions. The single-center, parallel-group TOURNI-ED randomized trial (ClinicalTrials.gov NCT07617103) evaluated 792 adults triaged as Emergency Severity Index (ESI) 3 to 5 who underwent standardized direct 21-gauge venipuncture with 60 mm Hg cuff pressure. Participants were randomized 1:1 to early release (initiating cuff deflation when blood entered the first tube and completing deflation as that tube filled, n = 396) or late release (deflation after the final tube filled, n = 396). The primary complete-case analysis included 790 participants. Specimen hemolysis (hemolysis index >= 1+ in serum separator gel tubes) occurred in 17.2% (68/395) of the early-release group versus 26.1% (103/395) of the late-release group, demonstrating a statistically significant absolute risk reduction of 8.9 percentage points (95% CI: 3.1–14.5; p = 0.003; number needed to treat = 11.3; adjusted OR 0.58, 95% CI: 0.41–0.82). No early-release participant experienced venous stasis exceeding 60 seconds, compared with 29.0% in the late-release group. Phlebotomy-related complications occurred in 8.1% of early-release vs 5.6% of late-release patients (risk difference +2.5 points, 95% CI: -1.0 to 6.1).

Why this matters for nurses

Emergency nurses and technicians draw dozens of blood specimens per shift under high-pressure conditions. Specimen hemolysis delays potassium, troponin, and coagulation results, necessitates repeat venipunctures, prolongs ED length of stay, and frustrates patients. Demonstrating that an immediate, cost-free workflow adjustment—releasing venous stasis as the first collection tube begins filling—substantially reduces specimen rejection gives bedside emergency nurses an actionable, evidence-based phlebotomy technique.

Bedside takeaway

In a randomized trial of 792 emergency patients, releasing tourniquet pressure once blood entered the first tube cut sample hemolysis from 26.1% to 17.2% (NNT = 11.3).

Key takeaways

Single-center parallel-group RCT analyzed 790 adult emergency department patients triaged as ESI 3 to 5.
Early tourniquet deflation upon blood entering the first tube reduced hemolysis from 26.1% to 17.2% (p = 0.003).
Absolute risk reduction was 8.9 percentage points with a number needed to treat of 11.3 to avoid one hemolyzed sample.
Prolonged venous stasis (>60 seconds) was eliminated in the early release group (0% vs 29.0%).
Findings apply to direct 21-gauge venipuncture under 60 mm Hg cuff pressure and cannot be generalized to IV catheter blood draws or uncalibrated elastic bands.

Practice implications

When performing routine direct venipuncture in non-critical emergency patients, initiate tourniquet deflation immediately once blood flow is established into the primary tube rather than waiting until all collection tubes have filled.

Limitations & cautions

Single-center design restricted to non-critical acuity (ESI 3–5) undergoing direct 21-gauge venipuncture under 60 mm Hg sphygmomanometer pressure; findings cannot be generalized to resuscitation patients (ESI 1–2), blood draws through peripheral IV catheters, winged infusion sets, or standard elastic tourniquets.
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Citations

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Medicina (Kaunas, Lithuania) (PubMed)

Medicina (Kaunas, Lithuania) (PubMed). Effect of Early Tourniquet Release on Hemolysis in Emergency Department Phlebotomy: The TOURNI-ED Randomized Trial.

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https://pubmed.ncbi.nlm.nih.gov/42942540/

Professional education only

This summary does not replace clinical judgment, facility policy, provider orders, or official guidelines. Verify practice changes against the original source and local protocol.

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JAMA (PubMed)Oct 24, 2026Systematic Review

A systematic review and meta-analysis of 85 randomized controlled trials encompassing 70,543 participants found that SGLT2 inhibitor therapy was associated with small, statistically significant increases in hemoglobin (+0.60 g/dL), hematocrit (+2.36%), and erythropoietin (+2.11 mIU/mL).

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Sodium-glucose cotransporter 2 (SGLT2) inhibitors are widely prescribed across chronic heart failure, type 2 diabetes, and chronic kidney disease, where retrospective observations frequently note concurrent elevations in red blood cell indices. In this systematic review and meta-analysis searching PubMed, Web of Science, and CENTRAL through July 22, 2026, researchers pooled data from 85 double-masked randomized clinical trials (median duration 24 weeks; IQR 12–32 weeks) covering 70,543 patients (mean age 62.4 +/- 9.4 years; 35.9% female). Seventy-eight trials compared SGLT2 inhibitors against placebo, and seven utilized active comparators (primarily sitagliptin). From baseline to follow-up, hemoglobin increased by 0.55 g/dL with SGLT2 inhibitors versus a 0.08 g/dL decrease in control cohorts (net between-group difference 0.60 g/dL, 95% CI: 0.55–0.66 g/dL; p < 0.001). Hematocrit changed by +2.17% versus -0.13% in controls (difference 2.36%, 95% CI: 2.19%–2.52%; p < 0.001). Analysis of secondary erythropoietic and iron parameters demonstrated a significant increase in serum erythropoietin (difference 2.11 mIU/mL, 95% CI: 0.50–3.71; p = 0.01) and a significant reduction in transferrin saturation (difference -0.84%, 95% CI: -1.21% to -0.47%; p < 0.001).

Key takeaways

Systematic review analyzed 85 double-masked RCTs encompassing 70,543 patients across cardiology, nephrology, and endocrinology.
SGLT2 inhibitors produced modest but statistically significant increases in hemoglobin (+0.60 g/dL) and hematocrit (+2.36%).
Therapy was associated with stimulated erythropoiesis, evidenced by an increase in serum erythropoietin (+2.11 mIU/mL, p = 0.01).
Transferrin saturation decreased slightly (-0.84%, p < 0.001), reflecting increased iron utilization during erythropoiesis.
Authors emphasized that clinical significance remains uncertain and SGLT2 inhibitors should not be prescribed for the primary intent of treating anemia.

Why this matters on shift

Nurses administer SGLT2 inhibitors (such as empagliflozin, dapagliflozin, and canagliflozin) daily on medical-surgical, cardiac, and renal units. When reviewing routine complete blood count panels, nurses observing slight elevations in hemoglobin or hematocrit must recognize this as a known physiologic class effect mediated by hemoconcentration and mild erythropoietin stimulation, rather than misinterpreting it as acute dehydration or treating SGLT2 inhibitors as an anemia cure.

Bedside takeaway

In a meta-analysis of 85 RCTs and 70,543 patients, SGLT2 inhibitors led to small increases in hemoglobin (+0.60 g/dL) and erythropoietin (+2.11 mIU/mL), though clinical significance is unclear.

Nursing implications

Anticipate modest increases in hemoglobin and hematocrit when monitoring patients on SGLT2 inhibitors; differentiate expected class-related hemoconcentration and erythropoietin stimulation from acute volume depletion, and continue reinforcing fluid balance and medication adherence.

Limitations & cautions

The observed hematologic elevations were small (+0.60 g/dL hemoglobin), and the clinical importance of these changes remains unproven; trials were not designed to test clinical anemia endpoints or symptomatic benefit; SGLT2 inhibitors are not approved for anemia therapy.
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Citations · exact source links

JAMA (PubMed). Sodium-Glucose Cotransporter 2 Inhibitor Use and Levels of Hemoglobin, Markers of Iron Metabolism, and Erythropoiesis: A Systematic Review and Meta-Analysis of Randomized Clinical Trials.

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JAMA internal medicine (PubMed)Oct 22, 2026Research Article

The VIDEO-KD randomized controlled trial of 453 older adults (mean age 78.8 years) with advanced kidney disease found that viewing a video decision aid combined with a patient declaration increased electronic health record advance care planning documentation from 40.0% to 56.6%.

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Older adults facing end-stage kidney failure must navigate complex, consequential decisions between hemodialysis, peritoneal dialysis, and conservative kidney management, yet advance care planning (ACP) remains underdocumented in routine ambulatory nephrology care. The multicenter VIDEO-KD parallel-group randomized clinical trial (ClinicalTrials.gov NCT04347629) enrolled 453 adults aged 65 years or older (mean age 78.8 +/- 6.4 years; 41.9% women) with advanced chronic kidney disease across 12 ambulatory clinics from June 2021 through March 2025. Participants were randomized to receive usual medical care (n = 225) or view a certified video decision aid detailing dialysis modalities and conservative kidney management paired with creating a personal goal declaration delivered to treating clinicians (n = 228). At 12-month follow-up, electronic health record ACP documentation confirmed by NLP-assisted human adjudication was significantly higher in the intervention cohort (56.6% vs 40.0%; rate difference 16.6%, 95% CI: 7.5%–25.7%; p < 0.001). Documented discussions of treatment options also increased significantly (46.1% vs 31.6%; rate difference 14.5%, 95% CI: 5.6%–23.4%; p = 0.001). Following the video intervention, the proportion of undecided patients fell from 41.3% to 13.2%, and 50.7% expressed a preference for conservative management versus 31.8% of controls (p < 0.001).

Key takeaways

Multicenter RCT enrolled 453 older adults (mean age 78.8 years) with advanced CKD across 12 outpatient clinics.
Video decision aid plus patient declarations significantly increased 12-month ACP documentation from 40.0% to 56.6% (p < 0.001).
Documented clinician discussions of kidney failure modalities increased by 14.5 percentage points (46.1% vs 31.6%, p = 0.001).
Intervention reduced undecided patients from 41.3% to 13.2% and increased preference for conservative kidney management (50.7% vs 31.8%).
Structured video decision tools provide an accessible platform to elicit older patients values before acute dialysis crises arise.

Why this matters on shift

Geriatric, nephrology, and ambulatory care nurses frequently care for frail older adults who feel unprepared when kidney failure progresses, leading to emergent hemodialysis initiations that conflict with patient preferences. Demonstrating that an evidence-based video decision tool accompanied by patient-recorded goal statements substantially increases formal EHR advance care planning documentation empowers nurses to integrate multimedia decision aids into clinic visits, ensuring older adults treatment values are clarified and honored.

Bedside takeaway

In a 453-patient RCT of older adults with advanced kidney disease, a video decision aid increased electronic advance care planning documentation from 40.0% to 56.6% (p < 0.001).

Nursing implications

Screen older adults with advanced renal disease for advance care planning status; offer validated decision aids to clarify goals regarding dialysis versus conservative care, and confirm that resulting preferences are formally documented in the electronic medical record.

Limitations & cautions

Outcome focused on electronic medical record documentation rather than longitudinal healthcare utilization, symptom burden, or goal-concordant end-of-life care; 82.8% of participants were White, requiring further evaluation in more diverse populations.
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Citations · exact source links

JAMA internal medicine (PubMed). Video Decision Support and Advance Care Planning in Older Adults With Advanced Kidney Disease: The VIDEO-KD Randomized Clinical Trial.

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Critical care medicine (PubMed)Oct 21, 2026Research Article

A randomized controlled trial of 100 adult ICU patients undergoing ventilator weaning found that daily individualized 25-minute music therapy significantly improved RASS sedation scores, reduced propofol requirements, and reduced tracheostomy rates by 14%.

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Ventilator weaning in the intensive care unit is often complicated by severe patient distress, agitation, and escalating sedative requirements that paradoxically lengthen mechanical ventilation. In a parallel-group randomized controlled trial conducted in a general adult ICU, 100 critically ill patients ventilated for at least 48 hours were randomized to standard weaning care alone or standard care with daily individualized music therapy. The intervention consisted of daily sessions averaging 25 minutes delivered by a music therapist, incorporating music-assisted relaxation, guided listening, and clinical improvisation tailored to patient preferences. The primary outcome—ventilator weaning duration—did not differ significantly between groups (p = 0.97). However, patients receiving music therapy exhibited significant reductions in agitation and sedation instability on the Richmond Agitation-Sedation Scale (RASS) on days 1 and 3 (p = 0.048, 0.005, and 0.024). Significantly fewer music therapy patients required propofol infusions during weaning (p = 0.028), and tracheostomy placement was significantly reduced (14% rate reduction, p = 0.025). Perceived pain and vital signs showed no significant differences.

Key takeaways

Parallel-group RCT evaluated 100 adult ICU patients receiving mechanical ventilation for >=48 hours during weaning.
Ventilator weaning duration showed no significant difference between the music therapy and control cohorts (p = 0.97).
Daily 25-minute individualized music therapy significantly stabilized RASS agitation/sedation scores on days 1 and 3 (p < 0.05).
Music therapy significantly reduced the proportion of patients requiring propofol infusions during weaning (p = 0.028).
Tracheostomy incidence was significantly reduced by 14% (p = 0.025) in the music therapy intervention group.

Why this matters on shift

ICU nurses frequently manage acute agitation, ventilator dyssynchrony, and distress while trying to liberate patients from invasive mechanical ventilation without oversedating them. Demonstrating that tailored bedside music therapy decreases agitation and lowers propofol dependence provides a validated, non-pharmacologic adjunctive strategy to prevent delirium, support the ABCDEF bundle, and decrease tracheostomy risks.

Bedside takeaway

In a 100-patient ICU trial, daily 25-minute music therapy during ventilator weaning did not shorten weaning duration (p=0.97) but improved RASS scores (p<0.05), cut propofol need (p=0.028), and reduced tracheostomies (p=0.025).

Nursing implications

Coordinate individualized music relaxation sessions during ventilator weaning trials; monitor RASS scores and assess whether calming auditory interventions can facilitate sedative de-escalation while maintaining patient comfort.

Limitations & cautions

Single-center design with 100 participants; weaning duration was unchanged; blinding of bedside clinicians to music therapy was not feasible.
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Citations · exact source links

Critical care medicine (PubMed). Music Therapy During Weaning From Invasive Mechanical Ventilation in the ICU: A Randomized Controlled Trial.

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AI-summarized from the linked source. Review the original article before applying to practice.

Key takeaways

Practice implications

Limitations & cautions

Exact source links

More updates for this clinical area

Meta-analysis of 85 randomized trials and 70,543 patients links SGLT2 inhibitors to small increases in hemoglobin and erythropoietin

Randomized clinical trial of 453 older adults with advanced kidney disease finds video decision aid increases advance care planning documentation to 56.6%

Randomized trial of 100 mechanically ventilated ICU patients finds daily music therapy curbs agitation, lowers propofol requirements, and cuts tracheostomy rates