Use of separate venipunctures for IV access and laboratory studies decreases hemolysis rates

Straszewski, Shannon; Sánchez, León D.; McGillicuddy, Daniel C.; Boyd, Kirsten; DuFresne, Jane; Joyce, Nina R.; Wolfe, Richard; Lee, Alice W.; Fisher, Jonathan; Mottley, J. Lawrence

doi:10.1007/s11739-011-0568-9

Cited by 16 publications

(9 citation statements)

References 10 publications

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“…there is no additional clinical rationale), then best practice would be to not insert a PIVC. In support of their case, blood aspiration through PIVCs is associated with increased haemolysis compared with direct venepuncture . Haemolysis accounts for 40–60% of blood specimen rejections, leading to inaccurate results and repeated draws that cause pain, delay treatment decisions and increase in length of stay .…”

Section: Introductionmentioning

confidence: 99%

Review article: Idle ‘just‐in‐case’ peripheral intravenous cannulas in the emergency department: Is something wrong?

Gledstone-Brown

McHugh

2017

Emerg Medicine Australasia

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Peripheral intravenous cannula (PIVC) placement is often an essential emergency medicine precursor to lifesaving treatment, but it is not harmless. Patients frequently and without proper consideration of the consequences receive a 'just-in-case' PIVCs as part of their assessment and admission, which, in a not insignificant number of patients, remains unused or idle in situ. We reviewed the literature and performed a thematic analysis of data collated from 21 articles published in the past 24 years regarding redundant PIVCs. The following five common themes emerged: heterogeneous prevalence data on post-insertion PIVC usage, preventable intravascular complications, financial burden, loss of time and a culture of over-investigating. The prevalence of PIVC insertions and idle PIVCs was heterogeneous among these publications; the median ED idle PIVC prevalence value was 32.4%. This practice is associated with compromised patient safety, squandered finances and misdirected practitioner time. Cultures of convenience and shortfalls in PIVC-related education facilitate the prevalence of idle PIVCs.

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Section: Introductionmentioning

confidence: 99%

Review article: Idle ‘just‐in‐case’ peripheral intravenous cannulas in the emergency department: Is something wrong?

Gledstone-Brown

McHugh

2017

Emerg Medicine Australasia

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“…The findings from our study of an independent association between device and hemolysis suggest that changing the method for drawing blood from IV catheter to butterfly needle can reduce the rate of hemolysis without requiring any other modifications to phlebotomy method. This inference is supported by results from an interventional study that compared the hemolysis rate before and after initiation of a policy requiring use of a butterfly needle to collect blood for laboratory analysis . The investigators found the rate of all hemolysis fell from 23% in a 1‐week observation period when blood was drawn via IV catheters to 6.6% in the 4 weeks after the change in policy.…”

Section: Discussionmentioning

confidence: 90%

“…Previous investigations of ED phlebotomy have sought to identify remediable factors associated with in vitro hemolysis, including the role of straight needles (variably referred to as straight needles, butterfly needles, or steel needles) versus intravenous (IV) catheters, the gauge of the IV catheter, use of vacuum tube collection system or syringe, extension sets, anatomic location of the phlebotomy, perceived difficulty of blood draw, specimen tube size, fullness of the tube, and the method of tube delivery to the laboratory . The strongest finding was that the rate of hemolysis is higher when blood is drawn through IV catheters than through straight needles.…”

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confidence: 99%

Use of Butterfly Needles to Draw Blood Is Independently Associated With Marked Reduction in Hemolysis Compared to Intravenous Catheter

et al. 2013

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Objectives: Hemolysis of blood samples drawn in the emergency department (ED) is a common problem that can interfere with timely diagnosis and appropriate treatment. The objective of this study was to identify the smallest number of remediable factors that independently increases the risk of hemolysis to design an effective strategy to address this issue.Methods: This was a prospective, observational, cross-sectional study of blood specimens obtained by ED staff in an urban, academic, adult ED in a tertiary care center. The staff member who drew the specimen recorded data on a standardized data collection instrument about device (intravenous [IV] catheter or butterfly needle), needle size, anatomic site, fullness of collection tube, tourniquet time, and difficulty of venipuncture. Specimens were sent to the laboratory by a vacuum-powered tube system. A standard automated process that measures free hemoglobin was used to identify hemolysis. A multivariable logistic regression and a tabular analysis stratified by device were performed. Ninety-five percent confidence intervals (CIs) were calculated around the odds ratios (ORs) and around the difference between hemolysis rates.Results: Data were collected on 5,118 blood specimens. There were 4,513 specimens with complete data on all characteristics of the blood draw included in the analyses. The overall hemolysis rate was 12.5% (95% CI = 11.6% to 13.5%), 14.6% in blood drawn from IV catheters and 2.7% from butterfly needles (difference = 11.9%; 95% CI = 10.2% to 13.4%). Device was the strongest independent predictor of hemolysis (OR = 7.7; 95% CI = 4.9 to 12.0). In specimens drawn by IV catheter, hemolysis was significantly higher when blood was drawn from locations other than the antecubital fossa, with smallgauge catheters, collection tubes ≤ half full, tourniquet time ≥ 1 minute, and difficult venipuncture. In contrast, none of these factors was associated with hemolysis when blood was drawn by butterfly needle. Conclusions:The device used to collect blood was the strongest independent predictor of hemolysis in blood samples drawn in the ED in this study. This finding suggests that the most effective strategy to reduce the rate of hemolysis in the ED is to use butterfly needles for phlebotomy rather than IV catheters.

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“…In our opinion, this kind of training program should instead be strongly recommended and performed worldwide. Moreover, previous investigations had shown that educational program and technological interventions for phlebotomists are relevant and promote decrease of sample errors consequently resulting in quality improvement (16–19). Maybe Bölenius et al .…”

Section: Discussionmentioning

confidence: 99%

The effective reduction of tourniquet application time after minor modification of the CLSI H03-A6 blood collection procedure

et al. 2013

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Introduction:The phlebotomists’ procedures are a still source of laboratory variability. The aim of this study was to verify the efficacy of minor modification in procedure for collection of diagnostic blood specimens by venipuncture from CLSI H03-A6 document is able to reduce the tourniquet application time.Materials and methods:Thirty phlebotomists were invited to participate. Each phlebotomist was trained individually to perform the new venipuncture procedure that shortens the time of tourniquet release and removal. The phlebotomy training program was delivered over 8h. After training, all phlebotomists were monitored for 20 working days, to guarantee the adoption of the correct new procedures for collection of diagnostic blood specimens. After this time frame the phlebotomists were evaluated to verify whether the new procedure for blood collection derived from CLSI H03-A6 document was effective to improve the quality process by decrease in tourniquet application time. We compared the tourniquet application time and qualitative difference of phlebotomy procedures between laboratories before and after phlebotomy training.Results:The overall mean ± SD tourniquet application time before and after this intervention were 118 ± 1 s and 30 ± 1 s respectively. Minor modifications in procedure for blood collection were able to reduce significantly the tourniquet application time (−88 s, P < 0.001).Conclusions:The minor modifications in procedure for collection of diagnostic blood specimens by venipuncture from CLSI H03-A6 document were able to reduce the tourniquet application time. Now the proposed new procedure for collection of diagnostic blood specimens by venipuncture could be considered usefulness and should be put into practice by all quality laboratory managers and/or phlebotomy coordinators to avoid preanalytical errors regard venous stasis and guarantee patient safety.

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Use of separate venipunctures for IV access and laboratory studies decreases hemolysis rates

Cited by 16 publications

References 10 publications

Review article: Idle ‘just‐in‐case’ peripheral intravenous cannulas in the emergency department: Is something wrong?

Review article: Idle ‘just‐in‐case’ peripheral intravenous cannulas in the emergency department: Is something wrong?

Use of Butterfly Needles to Draw Blood Is Independently Associated With Marked Reduction in Hemolysis Compared to Intravenous Catheter

The effective reduction of tourniquet application time after minor modification of the CLSI H03-A6 blood collection procedure

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