Impact of the phlebotomy training based on CLSI/NCCLS H03-A6 – procedures for the collection of diagnostic blood

Abstract

Introduction:The activities involving phlebotomy, a critical task for obtaining diagnostic blood samples, are poorly studied as regards the major sources of errors and the procedures related to laboratory quality control. The aim of this study was to verify the compliance with CLSI documents of clinical laboratories from South America and to assess whether teaching phlebotomists to follow the exact procedure for blood collection by venipuncture from CLSI/NCCLS H03-A6 - Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture might improve the quality of the process.Materials and methods:A survey was sent by mail to 3674 laboratories from South America to verify the use of CLSI documents. Thirty skilled phlebotomists were trained with the CLSI H03-A6 document to perform venipuncture procedures for a period of 20 consecutive working days. The overall performances of the phlebotomists were further compared before and after the training program.Results:2622 from 2781 laboratories that did answer our survey used CLSI documents to standardize their procedures and process. The phlebotomists’ training for 20 days before our evaluation completely eliminated non-conformity procedures for: i) incorrect friction of the forearm, during the cleaning of the venipuncture site to ease vein location; ii) incorrect sequence of vacuum tubes collection; and iii) inadequate mixing of the blood in primary vacuum tubes containing anticoagulants or clot activators. Unfortunately the CLSI H03-A6 document does not caution against both unsuitable tourniquet application time (i.e., for more than one minute) and inappropriate request to clench the fist repeatedly. These inadequate procedures were observed for all phlebotomists.Conclusion:We showed that strict observance of the CLSI H03-A6 document can remarkably improve quality, although the various steps for collecting diagnostic blood specimens are not a gold standard, since they may still permit errors. Tourniquet application time and forearm clench should be verified by all quality laboratory managers in the services. Moreover, the procedure for collecting blood specimens should be revised to eliminate this source of laboratory variability and safeguard the quality.

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)

“…The median number of audits per country was 33 (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36). The total number of audits was 336.…”

“…External factors such as a lack of support from others in the hospital environment can also have an impact [18]. Changes in laboratory methods can lead to a need to adapt phlebotomy procedures, and training can help to improve practices [19,20]. Currently, there is a wide range of different professions with varying level of experience and education who are involved in blood sample collection procedures at the European level.…”

Burden of Malarial Parasitemia; Among Healthy Population of Lahore

“…12 The screening of all samples for presence of malaria parasite antigen was performed by using rapid immunechromatographic (ICT) technique, as described in Table I. The technique is rapid, cheap, simple and easily interpretable. The results would displayed by development of color on the immunochromatography device.…”

Patient identification and tube labelling – a call for harmonisation

“…Feedback, discussions and reflection amongst phlebotomy personnel seem to be the best way to implement and sustain adherence to phlebotomy guideline practice and lead to long-term improvements in patient safety [25].…”