Croatian Society of Medical Biochemistry and Laboratory Medicine: national recommendations for venous blood sampling

Abstract

Phlebotomy is one of the most complex medical procedures in the diagnosis, management and treatment of patients in healthcare. Since laboratory test results are the basis for a large proportion (60–80%) of medical decisions, any error in the phlebotomy process could have serious consequences. In order to minimize the possibility of errors, phlebotomy procedures should be standardised, well-documented and written instructions should be available at every workstation. Croatia is one of the few European countries that have national guidelines for phlebotomy, besides the universally used CLSI (Clinical Laboratory Standards Institute) H3-A6 Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture; approved Standard-Sixth Edition (CLSI, 2007) and WHO (World Health Organization) guidelines on drawing blood: best practices in phlebotomy (WHO, 2010). However, the growing body of evidence in importance of preanalytical phase management resulted in a need for evidence based revision and expansion of existing recommendations.The Croatian Society for Medical Biochemistry and Laboratory Medicine, Working Group for the Preanalytical Phase issued this recommendation. This document is based on the CLSI guideline H3-A6, with significant differences and additional information.

Preanalytical quality improvement. In pursuit of harmony, on behalf of European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working group for Preanalytical Phase (WG-PRE)

“…Instead of being evidence based, those criteria are unfortunately quite often based on manufacturer's declarations, expert opinion or historical reasons. They are only limited examples of sharing acceptance criteria on a national basis [87,88]. Therefore, the crucial question is to establish whether those criteria are correct or not, and if they really fit for the purpose.…”

Compliance of blood sampling procedures with the CLSI H3-A6 guidelines: An observational study by the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) working group for the preanalytical phase (WG-PRE)

“…Whilst guidelines on correct practice are available, including the H3-A6 guideline issued by the Clinical Laboratory Standards Institute (CLSI) in 2007 [14], recommendations issued by national societies [15], or the guidelines on drawing blood published by the World Health Organization in 2010 [16], the complexity and large number of blood collections, in conjunction with their locations, make assessments of adherence to guidelines challenging. There are many reasons for which blood collections do not conform to published guidelines, including the lack of understanding the impact of using incorrect procedures, not being familiar with the relevant guidelines, an unwillingness to follow the guidelines, workload or insufficient time [17].…”

Patient identification and tube labelling – a call for harmonisation

“…It involves several distinct processes, all of which are vulnerable to errors [1,2] potentially putting the patient safety at risk. Guidelines on the correct practice of phlebotomy are available, including the H3-A6 guideline issued by the Clinical Laboratory Standards Institute (CLSI) in 2007 [3], recommendations issued by national societies [4,5], or the guidelines on drawing blood published by the World Health Organisation (WHO) in 2010 [6].…”

“…Otherwise, there is a risk that the tube will be left unlabelled and possibly mislabelled [4]. Actually, pre-labelling the tubes may even be more convenient since it allows that patient and sample identity are checked by comparing the information from the label with the patient identity, in the presence of the patient.…”