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Garcia-Castrillo L, Cadamuro J, Dodt C, Lauwaert D, Hachimi-Idrissi S, Van Der Linden C, Bergs J, Costelloe S, Grossmann F, Koca A, Palomäki A, Ruiz JL, Stonys R, Thorsteinsdottir TK, von Meyer A, Vermeersch P, Abellas Alvarez MC, Eker P, Golea A, Kurland L, Lippi G, Zhilenkova Y, Sehmi K. Recommendations for blood sampling in emergency departments from the European Society for Emergency Medicine (EUSEM), European Society for Emergency Nursing (EuSEN), and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase. Executive summary. Clin Chem Lab Med 2024; 62:1538-1547. [PMID: 38581294 DOI: 10.1515/cclm-2024-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 04/08/2024]
Abstract
AIM Blood Sampling Guidelines have been developed to target European emergency medicine-related professionals involved in the blood sampling process (e.g. physicians, nurses, phlebotomists working in the ED), as well as laboratory physicians and other related professionals. The guidelines population focus on adult patients. The development of these blood sampling guidelines for the ED setting is based on the collaboration of three European scientific societies that have a role to play in the preanalytical phase process: EuSEN, EFLM, and EUSEM. The elaboration of the questions was done using the PICO procedure, literature search and appraisal was based on the GRADE methodology. The final recommendations were reviewed by an international multidisciplinary external review group. RESULTS The document includes the elaborated recommendations for the selected sixteen questions. Three in pre-sampling, eight regarding sampling, three post-sampling, and two focus on quality assurance. In general, the quality of the evidence is very low, and the strength of the recommendation in all the questions has been rated as weak. The working group in four questions elaborate the recommendations, based mainly on group experience, rating as good practice. CONCLUSIONS The multidisciplinary working group was considered one of the major contributors to this guideline. The lack of quality information highlights the need for research in this area of the patient care process. The peculiarities of the emergency medical areas need specific considerations to minimise the possibility of errors in the preanalytical phase.
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Affiliation(s)
- Luis Garcia-Castrillo
- Emergency Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph Dodt
- Emergency Department, Universitair Ziekenhuis Brussels, Brussels, Belgium
| | - Door Lauwaert
- München Klinik gGmbH, Clinic for Acute and Emergency Care, Munich, Germany
| | - Said Hachimi-Idrissi
- Universiteit Gent Faculteit Geneeskunde en Gezondheidswetenschappen, Emergency Medicine, Gent, Belgium
- Universitair Ziekenhuis Gent, Emergency Medicine, Gent, Belgium
| | | | - Jochen Bergs
- Faculty of Medicine and Life Sciences, Research Group Healthcare & Ethics, Hasselt University, Limburg, Belgium
- Department of Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Netherlands
| | - Sean Costelloe
- Department of Clinical Biochemistry, Cork University Hospital Group, Cork, Ireland
| | | | - Ayca Koca
- Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Türkiye
| | - Ari Palomäki
- Kanta-Häme Central Hospital, Tampere Universities, Hämeenlinna, Finland
| | - Jose Luis Ruiz
- Emergency Department, Hospital Universitario de La Ribera, Valenciana, Spain
| | - Ricardas Stonys
- Center of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | - Pieter Vermeersch
- KU Leuven University Hospitals Leuven, Laboratory Medicine, Leuven, Belgium
| | | | - Pinar Eker
- Biochemistry and Clinical Biochemistry, Maltepe Universitesi Tip Fakultesi, Istanbul, Türkiye
| | - Adela Golea
- Emergency Department, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania
| | - Lisa Kurland
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Universita degli Studi di Verona, Verona, Italy
| | - Yulia Zhilenkova
- Department of Laboratory Medicine and Genetics, Almazov National Medical Research Centre, Sankt-Peterburg, Russia
| | - Kawaldip Sehmi
- International Alliance of Patients' Organizations, London, UK
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Nasu M, Khadka VS, Jijiwa M, Kobayashi K, Deng Y. Exploring Optimal Biomarker Sources: A Comparative Analysis of Exosomes and Whole Plasma in Fasting and Non-Fasting Conditions for Liquid Biopsy Applications. Int J Mol Sci 2023; 25:371. [PMID: 38203541 PMCID: PMC10779159 DOI: 10.3390/ijms25010371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 12/21/2023] [Accepted: 12/22/2023] [Indexed: 01/12/2024] Open
Abstract
The study of liquid biopsy with plasma samples is being conducted to identify biomarkers for clinical use. Exosomes, containing nucleic acids and metabolites, have emerged as possible sources for biomarkers. To evaluate the effectiveness of exosomes over plasma, we analyzed the small non-coding RNAs (sncRNAs) and metabolites extracted from exosomes in comparison to those directly extracted from whole plasma under both fasting and non-fasting conditions. We found that sncRNA profiles were not affected by fasting in either exosome or plasma samples. Our results showed that exosomal sncRNAs were found to have more consistent profiles. The plasma miRNA profiles contained high concentrations of cell-derived miRNAs that were likely due to hemolysis. We determined that certain metabolites in whole plasma exhibited noteworthy concentration shifts in relation to fasting status, while others did not. Here, we propose that (1) fasting is not required for a liquid biopsy study that involves both sncRNA and metabolomic profiling, as long as metabolites that are not influenced by fasting status are selected, and (2) the utilization of exosomal RNAs promotes robust and consistent findings in plasma samples, mitigating the impact of batch effects derived from hemolysis. These findings advance the optimization of liquid biopsy methodologies for clinical applications.
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Affiliation(s)
- Masaki Nasu
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, USA; (V.S.K.); (M.J.); (K.K.)
| | - Vedbar S. Khadka
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, USA; (V.S.K.); (M.J.); (K.K.)
| | - Mayumi Jijiwa
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, USA; (V.S.K.); (M.J.); (K.K.)
| | - Ken Kobayashi
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, USA; (V.S.K.); (M.J.); (K.K.)
| | - Youping Deng
- Department of Quantitative Health Sciences, John A. Burns School of Medicine, University of Hawaii, 651 Ilalo Street, Honolulu, HI 96813, USA; (V.S.K.); (M.J.); (K.K.)
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Dey S, Rai N, Bansal A, Kumari B, Das B, Kumari A. A Knowledge, Attitude, and Practice (KAP) Study on Phlebotomy Among Nurses in a Tertiary Hospital in Patna, India. Cureus 2023; 15:e50372. [PMID: 38213333 PMCID: PMC10782220 DOI: 10.7759/cureus.50372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/11/2023] [Indexed: 01/13/2024] Open
Abstract
INTRODUCTION For most clinicians and nursing officers, laboratory testing is an unfamiliar part of medical caregiving, and ignorance may lead to serious avoidable errors. Phlebotomy, the first basic step towards laboratory testing, is to be taken seriously otherwise unnecessary repeat testing becomes mandatory. We hypothesized that there are some gaps in knowledge, attitude, and practice (KAP) among these nursing officers regarding practices of phlebotomy, which may influence the quality of blood samples. This study aims to assess the overall nurses' knowledge, attitude, and practice of phlebotomy to provide a remarkable improvement in blood sampling practice in our hospital. MATERIAL AND METHODS A prospective study was conducted involving nurses posted in different wards in All India Institute of Medical Sciences (AIIMS) Patna, India. A phlebotomy questionnaire was designed based on KAP on the clinical and laboratory standards of the WHO guidelines. A total of 30 questions were distributed among the nursing staff, 10 each from knowledge, attitude, and practice. Descriptive and logistic regression analyses were used to analyze the KAP levels and their influencing factors. All continuous variables were tested for normality conditions using the Shapiro-Wilk test and P>0.05 were considered for normality. RESULTS AND CONCLUSION The total average score of knowledge among the nurses was 7.62 (95%CI: 15.77-16.56). It was found that the nurses, on average, had a very strong positive attitude (93.36%). Regarding the distribution of practices of nurses, it was found that 87% had good practice as most of the positive practice items had high responses. The knowledge of phlebotomy among nurses was found to be satisfactory, except in a few areas. An education program on phlebotomy should be developed for nurses to improve and enhance their knowledge of phlebotomy.
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Affiliation(s)
- Soma Dey
- Biochemistry, All India Institute of Medical Sciences (AIIMS) Patna, Patna, IND
| | - Neha Rai
- Biochemistry, All India Institute of Medical Sciences (AIIMS) Patna, Patna, IND
| | - Akash Bansal
- Biochemistry, All India Institute of Medical Sciences (AIIMS) Gorakhpur, Gorakhpur, IND
| | - Bandana Kumari
- Biochemistry, All India Institute of Medical Sciences (AIIMS) Patna, Patna, IND
| | - Bankim Das
- Transfusion Medicine, All India Institute of Medical Sciences (AIIMS) Patna, Patna, IND
| | - Alka Kumari
- Biochemistry, All India Institute of Medical Sciences (AIIMS) Patna, Patna, IND
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Calleja R, Mielke N, Lee R, Johnson S, Bahl A. Hemolyzed Laboratory Specimens in the Emergency Department: An Underappreciated, but Frequent Problem. J Emerg Nurs 2023; 49:744-754. [PMID: 37389514 DOI: 10.1016/j.jen.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Hemolysis of blood samples from emergency department (ED) patients leads to delays in treatment and disposition. The aim of this study is to determine the frequency of hemolysis and variables predictive of hemolysis. METHODS This observational cohort study was conducted among three institutions: academic tertiary care center and two suburban community EDs, with an annual census of over 270,000 ED visits. Data were obtained from the electronic health record. Adults requiring laboratory analysis with at least one peripheral intravenous catheter (PIVC) inserted within the ED were eligible. Primary outcome was hemolysis of lab samples and secondary outcomes included variables related to PIVC failure. RESULTS Between January 8, 2021 and May 9, 2022, 141,609 patient encounters met inclusion criteria. The average age was 55.5 and 57.5% of patients were female. Hemolysis occurred in 24,359 (17.2%) samples. In a multivariate analysis, when compared to 20-gauge catheters, smaller 22-gauge catheters had an increased odds of hemolysis (OR 1.78, 95% confidence interval (CI) 1.65-1.91; P < .001), while larger 18-gauge catheters had a lower odds of hemolysis (OR 0.94; 95% CI 0.90-0.98; P = .0046). Additionally, when compared to antecubital placement, hand/wrist placement demonstrated increased odds of hemolysis (OR 2.06; 95% CI 1.97-2.15; P < .001). Finally, hemolysis was associated with a higher rate of PIVC failure (OR 1.06; 95%CI 1.00-1.13; P = 0.043). DISCUSSION This large observational analysis demonstrates that lab hemolysis of is a frequent occurrence among ED patients. Given the added risk of hemolysis with certain placement variables, clinicians should consider catheter gauge/placement location to avoid hemolysis that may result in patient care delays and prolonged hospital stays.
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Ersoy S, Ilanbey B. A Single-Center Prospective Study of the Effects of Different Methods of Phlebotomy in the Emergency Department on Blood Sample Hemolysis Rates. J Emerg Nurs 2023; 49:134-139. [PMID: 36137822 DOI: 10.1016/j.jen.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/05/2022] [Accepted: 08/14/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Hemolysis is more commonly seen in the emergency department and causes delays in diagnosis, hospitalization, discharge, and treatment of patients. The aim of this study was to determine the most appropriate phlebotomy method and device to reduce blood sample hemolysis in the emergency department. METHODS This prospective, comparative descriptive study involved patients who presented to the emergency department with any medical condition and required blood sampling. Patients were divided into 6 groups according to the method of phlebotomy and the device used for phlebotomy. Data were analyzed with logistic regression. RESULTS A total of 715 patients participated in the study. The blood sample hemolysis rate in the emergency department was 25.7%. When the hemolysis rates were compared with a steel straight needle or intravenous catheter, it was found that the use of steel straight needle significantly reduced hemolysis. Blood drawing through a 20 G intravenous catheter with Luer-Lock access device reduces the risk of hemolysis. Male sex and difficult blood collection also have been shown to increase the risk of hemolysis. DISCUSSION Blood should be drawn with a steel straight needle instead of an intravenous catheter. However, when that is not possible, we recommend the use of a 20 G intravenous catheter with Luer-Lock access device if a blood sample is to be drawn from intravenous line.
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Bestwick JP, Sharman M, Whitley NT, Kisielewicz C, Skelly BJ, Tappin S, Kellett‐Gregory L, Seth M. The use of high-dose immunoglobulin M-enriched human immunoglobulin in dogs with immune-mediated hemolytic anemia. J Vet Intern Med 2022; 36:78-85. [PMID: 34779044 PMCID: PMC8783326 DOI: 10.1111/jvim.16315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 10/31/2021] [Accepted: 11/03/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The IV use of human immunoglobulin (hIVIG) in dogs with primary immune-mediated hemolytic anemia (IMHA) has been described previously, but herein we describe the use of high-dose IgM-enriched hIVIG (Pentaglobin). HYPOTHESIS/OBJECTIVES Dogs treated with high-dose Pentaglobin will experience shorter time to remission and hospital discharge and have decreased transfusion requirements compared to dogs receiving standard treatment alone. ANIMALS Fourteen client-owned dogs diagnosed with primary IMHA at specialist referral hospitals in the United Kingdom. METHODS All prospectively enrolled dogs received prednisolone, dexamethasone or both along with clopidogrel. Patients were randomized to receive Pentaglobin at 1 g/kg on up to 2 occasions, or to serve as controls. No additional immunosuppressive drugs were allowed within the first 7 days of treatment. Remission was defined as stable PCV for 24 hours followed by an increase in PCV. RESULTS Ten of 11 dogs from the treatment group and 2 of 3 dogs from the control group achieved remission and survived until hospital discharge. Survival and time to remission were not significantly different between groups. The volume of packed red blood cells transfused, normalized for body weight, was not significantly different between groups. Potential adverse reactions to Pentaglobin occurred in 2 dogs, but their clinical signs may have been related to the underlying disease. CONCLUSIONS AND CLINICAL IMPORTANCE Treatment with high-dose Pentaglobin was well tolerated by dogs with primary IMHA but no significant advantage was found in this small study. Additional studies examining larger groups and subpopulations of dogs with primary IMHA associated with a poorer prognosis are warranted.
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Affiliation(s)
- Jason P. Bestwick
- Animal Health TrustSuffolkUnited Kingdom
- Present address:
Department of Veterinary MedicineUniversity of CambridgeMadingley Road, Cambridge, CB3 0ESUnited Kingdom
| | - Mellora Sharman
- Animal Health TrustSuffolkUnited Kingdom
- Present address:
VetCT, St John's Innovation CentreCowley Road, Cambridge, CB4 0WSUnited Kingdom
| | - Nat T. Whitley
- Davies Veterinary SpecialistsHertfordshireUnited Kingdom
| | - Caroline Kisielewicz
- Pride Veterinary CentreDerbyUnited Kingdom
- Present address:
Vet Oracle Telemedicine, CVS GroupOwen Road, Diss, Norfolk, IP22 4ERUnited Kingdom
| | | | - Simon Tappin
- Dick White Referrals, Station FarmCambridgeshireUnited Kingdom
| | - Lindsay Kellett‐Gregory
- Queen Mother Hospital for Animals, The Royal Veterinary CollegeHertfordshireUnited Kingdom
- Present address:
Dick White Referrals, Station FarmLondon Road, Six Mile Bottom, Cambridgeshire, CB8 0UHUnited Kingdom
| | - Mayank Seth
- Animal Health TrustSuffolkUnited Kingdom
- Present address:
Dick White Referrals, Station FarmLondon Road, Six Mile Bottom, Cambridgeshire, CB8 0UHUnited Kingdom
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A Comparative Study of Blood Sampling From Venipuncture and Short Peripheral Catheters in Pediatric Inpatients. JOURNAL OF INFUSION NURSING 2019; 42:237-247. [PMID: 31464832 DOI: 10.1097/nan.0000000000000338] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This prospective, comparative study examined blood test results, hemolysis rates, and patient perceptions related to 2 blood sampling methods in pediatric inpatients (N = 95). Blood specimens were drawn via venipuncture and a short peripheral catheter used for fluid administration. Results revealed no significant differences in potassium and glucose levels. No clinically significant difference in hemoglobin was noted. Hemolysis rates were 4% for venipuncture samples and 15% when drawn from peripheral catheters. One catheter became occluded after a blood draw. Patients/parents rated distress and dissatisfaction with venipuncture as significantly greater compared with short peripheral catheter blood sampling (P < .001).
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Garden OA, Kidd L, Mexas AM, Chang YM, Jeffery U, Blois SL, Fogle JE, MacNeill AL, Lubas G, Birkenheuer A, Buoncompagni S, Dandrieux JRS, Di Loria A, Fellman CL, Glanemann B, Goggs R, Granick JL, LeVine DN, Sharp CR, Smith-Carr S, Swann JW, Szladovits B. ACVIM consensus statement on the diagnosis of immune-mediated hemolytic anemia in dogs and cats. J Vet Intern Med 2019; 33:313-334. [PMID: 30806491 PMCID: PMC6430921 DOI: 10.1111/jvim.15441] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 01/18/2019] [Indexed: 12/21/2022] Open
Abstract
Immune-mediated hemolytic anemia (IMHA) is an important cause of morbidity and mortality in dogs. IMHA also occurs in cats, although less commonly. IMHA is considered secondary when it can be attributed to an underlying disease, and as primary (idiopathic) if no cause is found. Eliminating diseases that cause IMHA may attenuate or stop immune-mediated erythrocyte destruction, and adverse consequences of long-term immunosuppressive treatment can be avoided. Infections, cancer, drugs, vaccines, and inflammatory processes may be underlying causes of IMHA. Evidence for these comorbidities has not been systematically evaluated, rendering evidence-based decisions difficult. We identified and extracted data from studies published in the veterinary literature and developed a novel tool for evaluation of evidence quality, using it to assess study design, diagnostic criteria for IMHA, comorbidities, and causality. Succinct evidence summary statements were written, along with screening recommendations. Statements were refined by conducting 3 iterations of Delphi review with panel and task force members. Commentary was solicited from several professional bodies to maximize clinical applicability before the recommendations were submitted. The resulting document is intended to provide clinical guidelines for diagnosis of, and underlying disease screening for, IMHA in dogs and cats. These should be implemented with consideration of animal, owner, and geographical factors.
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Affiliation(s)
- Oliver A Garden
- School of Veterinary Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Linda Kidd
- College of Veterinary Medicine, Western University of Health Sciences, Pomona, California
| | - Angela M Mexas
- College of Veterinary Medicine, Midwestern University, Downers Grove, Illinois
| | - Yu-Mei Chang
- Royal Veterinary College, University of London, London, United Kingdom
| | - Unity Jeffery
- College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, Texas
| | - Shauna L Blois
- Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Jonathan E Fogle
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Amy L MacNeill
- College of Veterinary Medicine and Biomedical Sciences, Colorado State University, Fort Collins, Colorado
| | - George Lubas
- Department of Veterinary Sciences, University of Pisa, Pisa, Italy
| | - Adam Birkenheuer
- College of Veterinary Medicine, North Carolina State University, Raleigh, North Carolina
| | - Simona Buoncompagni
- Internal Medicine Service, Central Oklahoma Veterinary Specialists, Oklahoma City, Oklahoma
| | - Julien R S Dandrieux
- Faculty of Veterinary and Agricultural Sciences, Melbourne Veterinary School, University of Melbourne, Melbourne, Australia
| | - Antonio Di Loria
- Department of Veterinary Medicine and Animal Production, University of Napoli Federico II, Napoli, Italy
| | - Claire L Fellman
- Cummings School of Veterinary Medicine, Tufts University, Massachusetts
| | - Barbara Glanemann
- Royal Veterinary College, University of London, London, United Kingdom
| | - Robert Goggs
- College of Veterinary Medicine, Cornell University, Ithaca, New York
| | - Jennifer L Granick
- College of Veterinary Medicine, University of Minnesota, Saint Paul, Minnesota
| | - Dana N LeVine
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, Iowa State University, Ames, Iowa
| | - Claire R Sharp
- College of Veterinary Medicine, School of Veterinary and Life Sciences, Murdoch University, Perth, Australia
| | | | - James W Swann
- Kennedy Institute of Rheumatology, University of Oxford, Oxford, United Kingdom
| | - Balazs Szladovits
- Royal Veterinary College, University of London, London, United Kingdom
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Causes, consequences and management of sample hemolysis in the clinical laboratory. Clin Biochem 2017; 50:1317-1322. [DOI: 10.1016/j.clinbiochem.2017.09.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 12/15/2022]
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Li L, Vecellio E, Gay S, Lake R, Mackay M, Burnett L, Chesher D, Braye S, Badrick T, Westbrook JI, Georgiou A. Making sense of a haemolysis monitoring and reporting system: a nationwide longitudinal multimethod study of 68 Australian laboratory participant organisations. ACTA ACUST UNITED AC 2017; 56:565-573. [DOI: 10.1515/cclm-2017-0056] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2017] [Accepted: 08/09/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
The key incident monitoring and management systems (KIMMS) quality assurance program monitors incidents in the pre- and postanalytical phases of testing in medical laboratories. Haemolysed specimens have been found to be the most frequent preanalytical error and have major implications for patient care. The aims of this study were to assess the suitability of KIMMS for quality reporting of haemolysis and to devise a meaningful method for reporting and monitoring haemolysis.
Methods:
A structured survey of 68 Australian KIMMS laboratory participant organisations was undertaken. Quarterly haemolysis reports (2011–2014) were analysed.
Results:
Among 110 million accessions reported, haemolysis rates varied according to the reporting methods that participants used for assigning accessions (16% of participants reported haemolysis by specimen and 83% reported by episode) and counting haemolysis rejections (61% by specimen, 35% by episode and 3% by test). More than half of the participants (56%) assigned accessions by episode and counted rejections by specimen. For this group, the average haemolysis rate per 100,000 episodes was 177 rejected specimens with the average rate varying from 100 to 233 over time. The majority of participants (91%) determined rejections using the haemolysis index. Two thirds of participants (66%) recorded the haemolysis manually in laboratory information systems.
Conclusions:
KIMMS maintains the largest longitudinal haemolysis database in the world. However, as a means of advancing improvements in the quality of the preanalytical laboratory process, there is a need to standardise reporting methods to enable robust comparison of haemolysis rejection rates across participant laboratories.
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Affiliation(s)
- Ling Li
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
| | - Elia Vecellio
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
- South Eastern Area Laboratory Services, NSW Health Pathology , Sydney, NSW , Australia
| | - Stephanie Gay
- Royal College of Pathologists Australasia Quality Assurance Programs , St. Leonards, NSW , Australia
| | - Rebecca Lake
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
| | - Mark Mackay
- Royal College of Pathologists Australasia Quality Assurance Programs , St. Leonards, NSW , Australia
| | - Leslie Burnett
- Genome.One, Garvan Institute of Medical Research , Darlinghurst, NSW , Australia
- Northern Clinical School, Sydney Medical School , University of Sydney , NSW , Australia
| | - Douglas Chesher
- Northern Clinical School, Sydney Medical School , University of Sydney , NSW , Australia
- Pathology North, NSW Health Pathology, Royal North Shore Hospital , St. Leonards, NSW , Australia
| | - Stephen Braye
- Pathology North, NSW Health Pathology, Royal North Shore Hospital , St. Leonards, NSW , Australia
- Pathology North, NSW Health Pathology , Newcastle, NSW , Australia
| | - Tony Badrick
- Royal College of Pathologists Australasia Quality Assurance Programs , St. Leonards, NSW , Australia
| | - Johanna I. Westbrook
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
| | - Andrew Georgiou
- Centre for Health Systems and Safety Research , Australian Institute of Health Innovation , Macquarie University , Sydney, NSW , Australia
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McCaughey EJ, Vecellio E, Lake R, Li L, Burnett L, Chesher D, Braye S, Mackay M, Gay S, Badrick T, Westbrook J, Georgiou A. Key factors influencing the incidence of hemolysis: A critical appraisal of current evidence. Crit Rev Clin Lab Sci 2016; 54:59-72. [PMID: 28013559 DOI: 10.1080/10408363.2016.1250247] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Hemolysis is a leading cause of pre-analytical laboratory errors. The identification of contributing factors is an important step towards the development of effective practices to reduce and prevent hemolysis. We performed a review of PUBMED, Embase, Medline and CINAHL to identify articles published between January 2000 and August 2016 that identified factors influencing in vitro hemolysis rates. The 40 studies included in this review provide excellent evidence that hemolysis rates are higher in Emergency Departments (EDs), for non-antecubital draws, for specimens drawn using an intravenous catheter compared to venipuncture and for samples transported by pneumatic tube compared to by hand. There is also good evidence that hemolysis rates are higher when specimens are not collected by professional phlebotomists, larger volume specimen tubes are used, specimen tubes are filled less than halfway and tourniquet time is greater than one minute. The results of this review suggest that hospitals and clinical laboratories should consider deploying phlebotomists in EDs, drawing all blood through a venipuncture, using the antecubital region as the optimum blood collection site and transporting specimens by laboratory assistant/other personnel, or if this in not practical, ensuring that pneumatic transport systems are validated, maintained and monitored. Studies also recommend making hemolysis a hospital-wide issue and ensuring high-quality staff training and adherence to standard operating procedures to reduce hemolysis rates. Awareness of the factors that influence hemolysis rates, and adoption of strategies to mitigate these risk factors, is an important step towards creating quality practices to reduce hemolysis rates and improve the quality of patient care.
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Affiliation(s)
- Euan James McCaughey
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney , NSW , Australia
| | - Elia Vecellio
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney , NSW , Australia.,b South Eastern Area Laboratory Services, NSW Health Pathology, Prince of Wales Hospital , Randwick , NSW , Australia
| | - Rebecca Lake
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney , NSW , Australia
| | - Ling Li
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney , NSW , Australia
| | - Leslie Burnett
- b South Eastern Area Laboratory Services, NSW Health Pathology, Prince of Wales Hospital , Randwick , NSW , Australia.,c Pathology North, NSW Health Pathology, Royal North Shore Hospital , St Leonards , NSW , Australia.,d Northern Clinical School, Sydney Medical School, University of Sydney , NSW , Australia
| | - Douglas Chesher
- c Pathology North, NSW Health Pathology, Royal North Shore Hospital , St Leonards , NSW , Australia.,d Northern Clinical School, Sydney Medical School, University of Sydney , NSW , Australia
| | - Stephen Braye
- c Pathology North, NSW Health Pathology, Royal North Shore Hospital , St Leonards , NSW , Australia.,e Pathology North, NSW Health Pathology , Newcastle , NSW , Australia , and
| | - Mark Mackay
- f Royal College of Pathologists Australasia Quality Assurance Program , St Leonards , NSW , Australia
| | - Stephanie Gay
- f Royal College of Pathologists Australasia Quality Assurance Program , St Leonards , NSW , Australia
| | - Tony Badrick
- f Royal College of Pathologists Australasia Quality Assurance Program , St Leonards , NSW , Australia
| | - Johanna Westbrook
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney , NSW , Australia
| | - Andrew Georgiou
- a Centre for Health Systems and Safety Research, Australian Institute of Health Innovation, Macquarie University , Sydney , NSW , Australia
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12
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Bel-Peña N, Mérida-de la Torre FJ. [Influence of an observer in the haemolysis produced during the extraction of blood samples in primary care]. ACTA ACUST UNITED AC 2015; 30:297-301. [PMID: 26546170 DOI: 10.1016/j.cali.2015.07.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2015] [Revised: 07/13/2015] [Accepted: 07/14/2015] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To check whether an intervention based on direct observation and complementary information to nurses helps reduce haemolysis when drawing blood specimens. MATERIAL AND METHODS Random sampling study in primary care centres in the serrania de Málaga health management area, using a cross-sectional, longitudinal pre- and post-intervention design. The study period was from August 2012 to January 2015. The level of free haemoglobin was measured by direct spectrophotometry in the specimens extracted. It was then checked whether the intervention influenced the level of haemolysis, and if this was maintained over time. RESULTS The mean haemolysis measured pre-intervention was 17%, and after intervention it was 6.1%. A year later and under the same conditions, the frequency of haemolysis was measured again the samples analysed, and the percentage was 9% These results are low when compared to the level obtained pre-intervention, but are higher when compared to the levels obtained immediately after the intervention. The transport and analysis conditions were the same. CONCLUSIONS An intervention based on a direct and informative observation in the process of collecting blood samples contributes significantly to reduce the level of haemolysis. This effect is maintained in time. This intervention needs to be repeated to maintain its effectiveness. Audits and continuing education programs are useful for quality assurance procedures, and maintain the level of care needed for a good quality of care.
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Affiliation(s)
- N Bel-Peña
- Laboratorio Clínico, Hospital de la Serranía, Área de Gestión Sanitaria Serranía de Málaga, Ronda, Málaga, España
| | - F J Mérida-de la Torre
- Laboratorio Clínico, Hospital de la Serranía, Área de Gestión Sanitaria Serranía de Málaga, Ronda, Málaga, España.
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Taghizadeganzadeh M, Yazdankhahfard M, Farzaneh M, Mirzaei K. Blood Samples of Peripheral Venous Catheter or The Usual Way: Do Infusion Fluid Alters the Biochemical Test Results? Glob J Health Sci 2015; 8:93-9. [PMID: 26925892 PMCID: PMC4965683 DOI: 10.5539/gjhs.v8n7p93] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2015] [Revised: 09/28/2015] [Accepted: 09/28/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Most blood tests require venous blood samples. Puncturing the vein also causes pain, infection, or damage to the blood, and lymph flow, or long-term healing. This study aimed to determine and compare the biochemical laboratory value of the blood samples that were provided through: peripheral vein infusion (PVI) receiving continuous intravenous fluid; and the usual method of blood sampling. METHODS This is an interventional, quasi-experimental, and controlled study. The selected study sample included 60 patients, who were hospitalized during 2014, in the Internal Medicine, part of Martyrs of Persian Gulf, teaching hospital at Bushehr. Three blood samples were taken from each patient that were provided through PVI line (5 ml blood collected at beginning of IVC and then another 5 cc), and another case was prepared by common blood sampling (control). All the samples were analyzed in terms of sodium, potassium, urea and creatinine using SPSS Ver.19 software, by paired t-test and Pearson's correlation coefficients. RESULTS There was a statistically significant difference between the amount of sodium and potassium in the first blood samples taken from the intravenous infusion line and vein puncture .However, no significant differences were found among the biochemical amount in the second blood samples taken from the intravenous infusion line and vein puncture. CONCLUSIONS We can use blood samples taken from peripheral intravenous infusion lines after 5cc discarding from the first part of the sample for measuring the value of sodium, potassium, urea and creatinine.
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Milutinović D, Andrijević I, Ličina M, Andrijević L. Confidence level in venipuncture and knowledge on causes of in vitro hemolysis among healthcare professionals. Biochem Med (Zagreb) 2015; 25:401-9. [PMID: 26527124 PMCID: PMC4622195 DOI: 10.11613/bm.2015.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 09/08/2015] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION This study aimed to assess confidence level of healthcare professionals in venipuncture and their knowledge on the possible causes of in vitro hemolysis. MATERIALS AND METHODS A sample of 94 healthcare professionals (nurses and laboratory technicians) participated in this survey study. A four-section questionnaire was used as a research instrument comprising general information for research participants, knowledge on possible causes of in vitro hemolysis due to type of material used and venipuncture technique and specimen handling, as well as assessment of healthcare professionals' confidence level in their own ability to perform first and last venipuncture. RESULTS The average score on the knowledge test was higher in nurses' than in laboratory technicians (8.11±1.7, and 7.4±1.5, respectively). The difference in average scores was statistically significant (P=0.035) and Cohen's d in the range of 0.4 indicates that there is a moderate difference on the knowledge test among the health care workers. Only 11/94 of healthcare professionals recognized that blood sample collection from cannula and evacuated tube is method which contributes most to the occurrence of in vitro hemolysis, whereas most risk factors affecting occurrence of in vitro hemolysis during venipuncture were recognized. There were no significant differences in mean score on the knowledge test in relation to the confidence level in venipuncture (P=0.551). CONCLUSION Confidence level at last venipuncture among both profiles of healthcare staff was very high, but they showed insufficient knowledge about possible factors affecting hemolysis due to materials used in venipuncture compared with factors due to venipuncture technique and handling of blood sample.
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Affiliation(s)
| | - Ilija Andrijević
- University of Novi Sad; Faculty of Medicine; Department of Nursing, Serbia ; The Institute for Pulmonary Diseases of Vojvodina, Sremska Kamenica, Serbia
| | - Milijana Ličina
- University of Novi Sad; Faculty of Medicine; Department of Nursing, Serbia
| | - Ljiljana Andrijević
- University of Novi Sad; Faculty of Medicine; Department of Biochemistry, Serbia ; The Institute for Oncology of Vojvodina, Sremska Kamenica, Serbia
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15
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Howanitz PJ, Lehman CM, Jones BA, Meier FA, Horowitz GL. Clinical Laboratory Quality Practices When Hemolysis Occurs. Arch Pathol Lab Med 2015; 139:901-6. [DOI: 10.5858/arpa.2014-0252-cp] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Context
Hemolyzed specimens delay clinical laboratory results, proliferate unnecessary testing, complicate physician decisions, injure patients indirectly, and increase health care costs.
Objective
To determine quality improvement practices when hemolysis occurs.
Design
We used the College of American Pathologists (CAP) Survey Program to distribute a Q-Probes–type questionnaire about hemolysis practices to CAP Chemistry Survey participants.
Results
Of 3495 participants sent the questionnaire, 846 (24%) responded. Although 85%, 69%, and 55% of participants had written hemolysis policies for potassium, lactate dehydrogenase, and glucose, respectively, only a few (46%, 40%, and 40%) had standardized hemolysis reports between their primary and secondary chemistry analyzers for these 3 analytes. Most participants (70%) had not attempted to validate the manufacturers' hemolysis data for these 3 analytes; however, essentially all who tried, succeeded. Forty-nine percent of participants had taken corrective action to reduce hemolysis during the past year and used, on average, 2.4 different actions, with collection and distribution of hemolysis data to administrative leadership (57%), troubleshooting outliers (55%), retraining phlebotomist (53%), and establishment of quality improvement teams among the laboratory and at problem locations (37%) being the most common actions. When asked to assess their progress in reducing hemolysis, 70% noted slow to no progress, and 2% gave up on improvement. Upon measuring potassium, lactate dehydrogenase, and glucose, approximately 60% of participants used the same specimen flag for hemolysis as for lipemia and icterus.
Conclusions
Hemolysis decreases the quality and increases the cost of health care. Practices for measuring, reporting, and decreasing hemolysis rates need improvement.
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Affiliation(s)
| | | | | | | | - Gary L. Horowitz
- From the Department of Pathology at SUNY Downstate, Brooklyn, New York (Dr Howanitz)
- the Department of Pathology, University of Utah, Salt Lake City (Dr Lehman)
- the Department of Pathology and Laboratory Medicine, Henry Ford Health System, Detroit, Michigan (Drs Jones and Meier)
- and the Department of Pathology, Beth Israel Deaconess Medical Center, Boston, Massachusetts (Dr Horowitz)
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16
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Makhumula-Nkhoma N, Whittaker V, McSherry R. Level of confidence in venepuncture and knowledge in determining causes of blood sample haemolysis among clinical staff and phlebotomists. J Clin Nurs 2014; 24:370-85. [DOI: 10.1111/jocn.12607] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Vicki Whittaker
- School of Health and Social Care; Teesside University; Middlebrough UK
| | - Robert McSherry
- Nursing and Practice Development; Teesside University; Middlesbrough UK
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17
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Greenwell CM, Epstein SE, Brain PH. Influence of needle gauge used for venipuncture on automated platelet count and coagulation profile in dogs. Aust Vet J 2014; 92:71-4. [DOI: 10.1111/avj.12150] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2013] [Indexed: 11/28/2022]
Affiliation(s)
- CM Greenwell
- Small Animal Specialist Hospital; 1 Richardson Place North Ryde New South Wales 2213 Australia
| | - SE Epstein
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine; University of California; Davis California USA
| | - PH Brain
- Small Animal Specialist Hospital; 1 Richardson Place North Ryde New South Wales 2213 Australia
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Bölenius K, Lindkvist M, Brulin C, Grankvist K, Nilsson K, Söderberg J. Impact of a large-scale educational intervention program on venous blood specimen collection practices. BMC Health Serv Res 2013; 13:463. [PMID: 24192426 PMCID: PMC4228245 DOI: 10.1186/1472-6963-13-463] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 10/29/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Phlebotomy performed with poor adherence to venous blood specimen collection (VBSC) guidelines jeopardizes patient safety and may lead to patient suffering and adverse events. A first questionnaire study demonstrated low compliance to VBSC guidelines, motivating an educational intervention of all phlebotomists within a county council. The aim was to evaluate the impact of a large-scale educational intervention program (EIP) on primary health care phlebotomists' adherence to VBSC guidelines. We hypothesised that the EIP would improve phlebotomists' VBSC practical performance. METHODS The present study comprise primary health care centres (n = 61) from two county councils in northern Sweden. The final selected study group consisted of phlebotomists divided into an intervention group (n = 84) and a corresponding control group (n = 79). Both groups responded to a validated self-reported VBSC questionnaire twice. The EIP included three parts: guideline studies, an oral presentation, and an examination. Non-parametric statistics were used for comparison within and between the groups. RESULTS Evaluating the EIP, we found significant improvements in the intervention group compared to the control group on self-reported questionnaire responses regarding information search (ES = 0.23-0.33, p < 0.001-0.003), and patient rest prior to phlebotomy (ES = 0.27, p = 0.004). Test request management, patient identity control, release of venous stasis, and test tube labelling had significantly improved in the intervention group but did not significantly differ from the control group (ES = 0.22- 0.49, p = < 0.001- 0.006). The control group showed no significant improvements at all (ES = 0-0.39, p = 0.016-0.961). CONCLUSIONS The present study demonstrated several significant improvements on phlebotomists' adherence to VBSC practices. Still, guideline adherence improvement to several crucial phlebotomy practices is needed. We cannot conclude that the improvements are solely due to the EIP and suggest future efforts to improve VBSC. The program should provide time for reflections and discussions. Furthermore, a modular structure would allow directed educational intervention based on the specific VBSC guideline flaws existing at a specific unit. Such an approach is probably more effective at improving and sustaining adherence to VBSC guidelines than an EIP containing general pre-analytical practices.
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Affiliation(s)
- Karin Bölenius
- Department of Nursing, Umeå University, Building A, 4th floor, 901 87 Umeå, Sweden.
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Heyer NJ, Derzon JH, Winges L, Shaw C, Mass D, Snyder SR, Epner P, Nichols JH, Gayken JA, Ernst D, Liebow EB. Effectiveness of practices to reduce blood sample hemolysis in EDs: a laboratory medicine best practices systematic review and meta-analysis. Clin Biochem 2013; 45:1012-32. [PMID: 22968086 DOI: 10.1016/j.clinbiochem.2012.08.002] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2012] [Revised: 08/01/2012] [Accepted: 08/02/2012] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To complete a systematic review of emergency department (ED) practices for reducing hemolysis in blood samples sent to the clinical laboratory for testing. RESULTS A total of 16 studies met the review inclusion criteria (12 published and 4 unpublished). All 11 studies comparing new straight needle venipuncture with IV starts found a reduction in hemolysis rates, [average risk ratio of 0.16 (95% CI=0.11-0.24)]. Four studies on the effect of venipuncture location showed reduced hemolysis rates for the antecubital site [average risk ratio of 0.45 (95% CI=0.35-0.57]. CONCLUSIONS Use of new straight needle venipuncture instead of IV starts is effective at reducing hemolysis rates in EDs, and is recommended as an evidence-based best practice. The overall strength of evidence rating is high and the effect size is substantial. Unpublished studies made an important contribution to the body of evidence. When IV starts must be used, observed rates of hemolysis may be substantially reduced by placing the IV at the antecubital site.
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Affiliation(s)
- Nicholas J Heyer
- Battelle Centers for Public Health Research and Evaluation, USA.
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Simundic AM, Cornes M, Grankvist K, Lippi G, Nybo M, Kovalevskaya S, Sprongl L, Sumarac Z, Church S. Survey of national guidelines, education and training on phlebotomy in 28 European countries: an original report by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PA). Clin Chem Lab Med 2013; 51:1585-93. [DOI: 10.1515/cclm-2013-0283] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2013] [Accepted: 04/18/2013] [Indexed: 12/13/2022]
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Bölenius K, Söderberg J, Hultdin J, Lindkvist M, Brulin C, Grankvist K. Minor improvement of venous blood specimen collection practices in primary health care after a large-scale educational intervention. Clin Chem Lab Med 2013; 51:303-10. [DOI: 10.1515/cclm-2012-0159] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2012] [Accepted: 07/03/2012] [Indexed: 11/15/2022]
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Lippi G, Cervellin G, Mattiuzzi C. Critical review and meta-analysis of spurious hemolysis in blood samples collected from intravenous catheters. Biochem Med (Zagreb) 2013; 23:193-200. [PMID: 23894864 PMCID: PMC3900066 DOI: 10.11613/bm.2013.022] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 05/01/2013] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND A number of preanalytical activities strongly influence sample quality, especially those related to sample collection. Since blood drawing through intravenous catheters is reported as a potential source of erythrocyte injury, we performed a critical review and meta-analysis about the risk of catheter-related hemolysis. MATERIALS AND METHODS We performed a systematic search on PubMed, Web of Science and Scopus to estimate the risk of spurious hemolysis in blood samples collected from intravenous catheters. A meta-analysis with calculation of Odds ratio (OR) and Relative risk (RR) along with 95% Confidence interval (95% CI) was carried out using random effect mode. RESULTS Fifteen articles including 17 studies were finally selected. The total number of patients was 14,796 in 13 studies assessing catheter and evacuated tubes versus straight needle and evacuated tubes, and 1251 in 4 studies assessing catheter and evacuated tubes versus catheter and manual aspiration. A significant risk of hemolysis was found in studies assessing catheter and evacuated tubes versus straight needle and evacuated tubes (random effect OR 3.4; 95% CI = 2.9-3.9 and random effect RR 1.07; 95% CI = 1.06-1.08), as well as in studies assessing catheter and evacuated tubes versus catheter and manual aspiration of blood (OR 3.7; 95% CI = 2.7-5.1 and RR 1.32; 95% CI = 1.24-1.40). CONCLUSIONS Sample collection through intravenous catheters is associated with significant higher risk of spurious hemolysis as compared with standard blood drawn by straight needle, and this risk is further amplified when intravenous catheter are associated with primary evacuated blood tubes as compared with manual aspiration.
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Affiliation(s)
- Giuseppe Lippi
- Unità Operativa Diagnostica Ematochimica, Dipartimento di Patologia e Medicina di Laboratorio, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
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23
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Sung YH, Hwang MS, Lee JH, Park HD, Ryu KH, Cho MS, Yi YH, Song S. [A comparison of the rates of hemolysis and repeated blood sampling using syringe needles versus vacuum tube needles in the emergency department]. J Korean Acad Nurs 2012; 42:443-51. [PMID: 22854557 DOI: 10.4040/jkan.2012.42.3.443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to compare the rates of hemolysis and repeated sampling in blood samples obtained by a syringe needle versus a vacuum tube needle. METHODS A randomized, prospective study was used to evaluate the differences between the two blood sampling methods. The study group consisted of patients seen in the emergency department (ED) for blood sampling to determine electrolyte level. ED patients were randomly assigned to either the syringe group or the vacuum tube group. All blood samples were collected by experienced ED nurses and hemolysis was determined by experienced laboratory technologists. Data were analyzed using Fisher's exact test and binary logistic regression. RESULTS One hundred forty-five valid samples were collected (74 in the syringe group versus 71 in the vacuum tube group). 5 of 74 (6.8%) blood samples in the syringe group and 8 of 71 (11.3%) in the vacuum tube group hemolyzed. Repeated blood sampling occurred for 2 of 74 (2.7%) and 3 of 71 (4.2%) in each group respectively. There were no significant differences in rates of hemolysis and repeated sampling between two groups (B=1.97, p=.204; B=2.36, p=.345). CONCLUSION Venipuncture with syringe needles can be recommended for ED nurses to obtain blood samples.
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Affiliation(s)
- Young Hee Sung
- Department of Clinical Nursing Science, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Testing the effects of educational toilet posters: a novel way of reducing haemolysis of blood samples within ED. ACTA ACUST UNITED AC 2012; 15:31-6. [PMID: 22813621 DOI: 10.1016/j.aenj.2011.11.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2011] [Revised: 10/21/2011] [Accepted: 11/14/2011] [Indexed: 11/20/2022]
Abstract
UNLABELLED Haemolysed blood samples are an unnecessary burden on Emergency Departments (ED) as they increase workloads and drive down efficiencies. Little empirical data exists that demonstrates the effectiveness of educational posters displayed in staff toilet cubicles. This study explored the impact educational toilet posters have on reducing haemolysis rates within the ED. METHODS A time series study of the clinical effect of educational toilet posters on reducing haemolysis rates throughout a 12 month period at the Gold Coast Hospital ED was undertaken. The GCH ED is a tertiary emergency service that has approximately 66,000 patient presentations per year. Data was collected prospectively. Analysis was undertaken to investigate the effects on total number of haemolysed samples and those clinically significant samples with a haemolytic index >3. Further investigation explored the specific effects on medical and nursing staff. RESULTS Analysis undertaken using an independent t-test found that the pre-intervention data demonstrates a medium haemolysis rate of 4.92% (SD=1.04). This is a statistically significantly different (t=3.56, df=50, p=0.001) from the median post intervention data of 3.95% (SD=0.84). The difference of 0.97% (95%CI=0.42, 1.52) represents a 19.72% reduction in clinically significant haemolysed samples over the study period. CONCLUSION This study reveals that the use of educational toilet posters had a positive impact on reducing the rates of haemolysed samples collected within the ED. This simple and cost effective educational initiative changed the behaviour of clinical staff. Further investigation is warranted to examine the impact of educational toilet posters on additional clinical scenarios.
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Bölenius K, Brulin C, Grankvist K, Lindkvist M, Söderberg J. A content validated questionnaire for assessment of self reported venous blood sampling practices. BMC Res Notes 2012; 5:39. [PMID: 22260505 PMCID: PMC3342148 DOI: 10.1186/1756-0500-5-39] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2011] [Accepted: 01/19/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Venous blood sampling is a common procedure in health care. It is strictly regulated by national and international guidelines. Deviations from guidelines due to human mistakes can cause patient harm. Validated questionnaires for health care personnel can be used to assess preventable "near misses"--i.e. potential errors and nonconformities during venous blood sampling practices that could transform into adverse events. However, no validated questionnaire that assesses nonconformities in venous blood sampling has previously been presented. The aim was to test a recently developed questionnaire in self reported venous blood sampling practices for validity and reliability. FINDINGS We developed a questionnaire to assess deviations from best practices during venous blood sampling. The questionnaire contained questions about patient identification, test request management, test tube labeling, test tube handling, information search procedures and frequencies of error reporting. For content validity, the questionnaire was confirmed by experts on questionnaires and venous blood sampling. For reliability, test-retest statistics were used on the questionnaire answered twice. The final venous blood sampling questionnaire included 19 questions out of which 9 had in total 34 underlying items. It was found to have content validity. The test-retest analysis demonstrated that the items were generally stable. In total, 82% of the items fulfilled the reliability acceptance criteria. CONCLUSIONS The questionnaire could be used for assessment of "near miss" practices that could jeopardize patient safety and gives several benefits instead of assessing rare adverse events only. The higher frequencies of "near miss" practices allows for quantitative analysis of the effect of corrective interventions and to benchmark preanalytical quality not only at the laboratory/hospital level but also at the health care unit/hospital ward.
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Affiliation(s)
- Karin Bölenius
- Department of Nursing, Umeå University, Umeå, Sweden
- Department of Nursing, Umeå University, 901 87 Umeå, Sweden
| | | | - Kjell Grankvist
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
| | | | - Johan Söderberg
- Department of Medical Biosciences, Clinical Chemistry, Umeå University, Umeå, Sweden
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Stauss M, Sherman B, Pugh L, Parone D, Looby-Rodriguez K, Bell A, Reed CR. Hemolysis of coagulation specimens: a comparative study of intravenous draw methods. J Emerg Nurs 2010; 38:15-21. [PMID: 22226132 DOI: 10.1016/j.jen.2010.08.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Revised: 08/02/2010] [Accepted: 08/10/2010] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Hemolysis of blood samples creates significant delays in the treatment and disposition of patients in the emergency department. The purpose of this study was to compare the hemolysis rates of coagulation blood samples obtained during insertion of an intravenous (IV) catheter without (group 1) or with (group 2) extension tubing connected to the IV catheter hub. A secondary purpose of this study was to determine whether the investigators could predict whether a coagulation sample was hemolyzed based on visual observation during the specimen withdrawal process. METHODS A prospective, 2-group randomized comparative design was used to determine which method of blood collection for coagulation specimens provided the lowest hemolysis rate. This study was conducted in an urban level I emergency department averaging 58,000 visits per year. The sample consisted of 121 adult ED patients randomly assigned to 1 of the 2 groups. Data collectors were trained in the 2 methods of coagulation sample collection and followed a strict protocol. The clinical laboratory used a standardized color-coded scale to determine hemolysis. RESULTS Pearson χ(2) analysis was used to test for differences between all nominal variables. The level of significance for all tests was P < .05. There was no significant difference in hemolysis rates between the groups by use of χ(2) analysis (P = .84). Nurses were significantly more likely to predict that a sample was hemolyzed when it was not and to think that it was not hemolyzed when in fact it was (P < .001). DISCUSSION High hemolysis rates occurred equally when coagulation blood samples were drawn via a peripheral IV catheter either at the hub or through extension tubing. Emergency nurse investigators could not accurately predict by visualization whether a coagulation sample was hemolyzed at the time of blood withdrawal. Venipuncture as the preferred method of blood draw is an industry recommendation. This method has been shown in prior experimental studies to reduce hemolysis rates to less than 4%. Therefore, if hemolysis rates are a concern, one should consider obtaining blood whenever possible through a venipuncture rather than through an IV catheter. Replication studies are needed to determine whether the findings of this study can be generalized to the larger population.
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Söderberg J, Jonsson PA, Wallin O, Grankvist K, Hultdin J. Haemolysis index – an estimate of preanalytical quality in primary health care. Clin Chem Lab Med 2009; 47:940-4. [DOI: 10.1515/cclm.2009.227] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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