The impact of venepuncture training on the reduction of pre‐analytical blood sample haemolysis rates: A systematic review

Abstract

Background Venepuncture involves the introduction of a needle into a vein to collect a representative blood sample for laboratory testing. In the pre‐analytical phase, haemolysis (the rupturing of erythrocytes and release of their contents into the extracellular compartment) has safety, quality and cost implications. Training in correct venepuncture practice has the potential to reduce in vitro haemolysis rates, but the evidence for this notion has yet to be synthesised. Design Systematic review (PRISMA Checklist). Methods Published studies on the effectiveness of venepuncture training on haemolysis rates were searched in relevant databases. The McMaster critical appraisal tool was used to assess methodological quality. The GRADE tool was used to evaluate the body of evidence in relation to the research questions. Implementation fidelity was also scrutinised in each study. Results Eight out of 437 retrieved studies met the inclusion criteria. None were randomised controlled trials (RCT). Between‐study heterogeneity in design, intervention characteristics and the biochemical threshold for haemolysis precluded a meta‐analysis. Post‐training reductions in haemolysis rates of between 0.4%–19.8% were reported in four of the studies, which developed their intervention according to a clear evidence base and included mentoring in the intervention. Rises in haemolysis rates of between 1.3%–1.9% were reported in two studies, while the intervention effect was inconsistent within two other studies. Conclusion There are no RCTS on the effectiveness of venepuncture training for reducing haemolysis rates, and findings from the existing uncontrolled studies are unclear. For a more robust evidence base, we recommend more RCTs with standardisation of haemolysis thresholds and training‐related factors. Relevance to clinical practice While venepuncture training is an important factor influencing quality of blood sample in clinical practice, more robust evidence is needed to make specific recommendations about training content for reduction of haemolysis rates. Standardisation of haemolysis thresholds would also enable future meta‐analyses.

Benefits of the application of heat and pressure on peripheral venous cannulation in adults: A randomized controlled trial

“…Also, pain did not have an impact on haemolysis. These results show that our interventions allow an adequate blood sample collection for subsequent blood tests and equivalent suitability as current clinical procedure for blood extraction (Makhumula-Nkhoma et al, 2019).…”

“…Additional factors have been considered due to their potential worsening of vein perception and cannulation such as obese, the extremes of age, chronic patients, receiving chemotherapy infusion, rolled veins, low visibility/palpability veins, inadequate skill level in the technique (De la Torre-Montero et al, 2014;Yamagami et al, 2017) and different skin types such as dark (Eilers et al, 2013;Fink et al, 2009;Sachdeva, 2009). Venipuncture is performed for obtaining blood samples that are used for the analysis of different parameters such as potassium (Makhumula-Nkhoma et al, 2019), cholesterol, aspartate aminotransferase (Thomas, 2002), creatinine,, iron, lactate dehydrogenase, billirrubin and glucose (Lippi et al, 2008). The extraction method was described as the major contributor for haemolysis (Plumhoff et al, 2008), which affects the accuracy of some diagnostically relevant analytical determinations that are based on 60%-80% of medical decision-making, therefore of patient safety (Farrell & Carter, 2016;WHO, 2002).…”

“…Venipuncture is performed for obtaining blood samples that are used for the analysis of different parameters such as potassium (Makhumula‐Nkhoma et al., 2019), cholesterol, aspartate aminotransferase (Thomas, 2002), creatinine,, iron, lactate dehydrogenase, billirrubin and glucose (Lippi et al., 2008). The extraction method was described as the major contributor for haemolysis (Plumhoff et al., 2008), which affects the accuracy of some diagnostically relevant analytical determinations that are based on 60%–80% of medical decision‐making, therefore of patient safety (Farrell & Carter, 2016; WHO, 2002).…”

Multicenter Study of Needle-Free Blood Collection System for Reducing Specimen Error and Intravenous Catheter Replacement

“…[16][17][18] In standard venipuncture, there are differences in blood specimen collection confidence and quality among healthcare professionals. 19,20 When performing standard venipuncture, healthcare professionals with different types of training (e.g., nurses vs. phlebotomists) yield different specimen qualities and also experience different degrees of confidence in performing the procedure. As the use of PIVO expands, future studies will assess whether PIVO proficiency could bridge this difference among healthcare professionals.…”