A prospective study of causes of haemolysis during venepuncture: tourniquet time should be kept to a minimum

Saleem, Saira; Mani, Venkatesh; Chadwick, Matthew; Creanor, Siobhan; Ayling, Ruth M

doi:10.1258/acb.2009.008228

Cited by 49 publications

(28 citation statements)

References 5 publications

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“…Other factors increasing haemolysis in samples, such as tourniquet time, number of attempts at venepuncture and methods of sampling have previously been shown to be related to increased haemolysis rates. 6 In our study, the use of cannula is demonstrated as something that needs to be considered further as a major cause of heamolysis in samples collected in the Emergency Department.…”

Section: Discussionmentioning

confidence: 77%

Variation in phlebotomy techniques in emergency medicine and the incidence of haemolysed samples

Berg

Ahee²,

Berg³

2011

Ann Clin Biochem

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Background: Phlebotomy is a potential cause of preanalytical errors. We have observed phlebotomy in routine practice in a busy Emergency Department, to see how current practice compares with optimal blood sampling. Methods: Phlebotomy episodes were audited and compared with standard procedures. A computer-based search of the number of haemolysed samples from Emergency Medicine and hospital inpatients was reviewed. Results: Four different ways of taking blood were observed: cannulation and a syringe (38%), cannula with evacuated tube and adaptor (42%), syringe and needle into vein (14%) and evacuated tube system used conventionally (6%). Where a syringe was used, two methods of transfer into the sample tube were observed; needle kept on with cap piercing (77%) and needle and evacuated cap both removed (23%). On 20 out of 50 phlebotomy episodes (40%), the potassium-EDTA tube was filled prior to the biochemistry serum gel tube. A search of the laboratory computer records for ward-based phlebotomy found 30 of 1034 samples were haemolysed (2.9%). In the 50 phlebotomy episodes in the Majors area of the Emergency Department, 24% produced a haemolysed sample (P , 0.0001). For samples taken from all areas of Emergency Medicine over a seven-day period, 52 of 485 were haemolysed (10.7%; P , 0.0001). Conclusions: This study has shown that phlebotomy techniques in the Emergency Department deviate from standard practice significantly. This may well be a reason for the much higher frequency of haemolysed samples and with the wrong order of collection the possibility of potassium-EDTA-contaminated samples.

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Section: Discussionmentioning

confidence: 77%

Variation in phlebotomy techniques in emergency medicine and the incidence of haemolysed samples

Berg

Ahee²,

Berg³

2011

Ann Clin Biochem

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“…A study analysing prevalence of haemolysis in blood samples taken from adolescents (mean age of 17.3 years) (Vissers et al, 2008) found that 0.8% of samples were strongly (grade 2) haemolysed and concluded that more research into strategies for reducing haemolysis when taking samples is needed. A study by Saleem et al (2009) showed that the duration with which the tourniquet is applied during blood sampling was the most significant factor in causing haemolysis, with times of over one minute resulting in an almost 20 times greater probability. Similar observations were published by Blazys (1999) and Becan-McBride (1999).…”

Section: Venepuncture Procedures Analysismentioning

confidence: 99%

“…These values were estimated based on the findings from Saleem et al (2009), Blazys (1999 and Becan-McBride (1999). The probability of laboratory rejection due to the other causes, such as the insufficient sample quantity, contamination and incorrect labelling, was estimated based on the data from Jones et al (1997) to be 0.0014.…”

Section: Task Modelsmentioning

confidence: 99%

Effect of venepuncture process design on efficiency and failure rates: A simulation model study for secondary care

Reed

Remenyte‐Prescott

Rees

2017

International Journal of Nursing Studies

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Reed, Sean and Remenyte-Prescott, Rasa and Rees, Ben (2017) Effect of venepuncture process design on efficiency and failure rates: a simulation model study for secondary care. International Journal of Nursing Studies,[68][69][70][71][72][73][74][75][76][77][78][79][80][81][82] Access from the University of Nottingham repository: http://eprints.nottingham.ac.uk/41154/1/Effect%20of%20Venepuncture%20process %20design%20on%20efficiency%20and%20failure.pdf Copyright and reuse:The Nottingham ePrints service makes this work by researchers of the University of Nottingham available open access under the following conditions. This article is made available under the Creative Commons Attribution Non-commercial No Derivatives licence and may be reused according to the conditions of the licence. For more details see: http://creativecommons.org/licenses/by-nc-nd/2.5/ A note on versions:The version presented here may differ from the published version or from the version of record. If you wish to cite this item you are advised to consult the publisher's version. Please see the repository url above for details on accessing the published version and note that access may require a subscription.For more information, please contact eprints@nottingham.ac.uk Effect of venepuncture process design on efficiency and failure rates: a simulation model study for secondary care AbstractBackground: Healthcare aims to deliver good patient outcomes. For many clinical procedures there are multiple alternative task sequences that can be performed. These deviations can influence procedure reliability, efficiency of usage of hospital resources and risk to staff and patient safety. Venepuncture is one of the most common invasive procedures in healthcare. Literature of clinical practice shows evidence of wide variability in the procedure order and the duration of each step, which can depend on attributes, such as patient health, sampling method and staff skills.Objective: To use a computer simulation model based on Petri nets to evaluate the impact on outcomes of commonly practiced deviations from the guideline venepuncture procedure and variations in key dependent variables. The outcomes considered include the probability of successfully obtaining a blood sample and the procedure completion time.Design: A computer simulation model was constructed using the Petri net technique which mimics the different variations of the venepuncture procedure. Qualitative and quantitative data for the model was collected from the literature and through interviews and questionnaire responses from doctors and phlebotomists. Statistics on the reliability and duration for different variations were then calculated from the model output.Setting: A digital laboratory to model venepuncture in secondary care.Results: The model showed that the common practice of applying the tourniquet prior to vein identification and releasing it after sample tubes are filled may result in a ten-fold increase in sample haemolysis, compared to the recommended guideline procedure. Equipment la...

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Section: 진단검사에 대한 정도관리를 하고 있는 미국의 임상병리사회에unclassified

“…그러나 실제 문헌에서 제시된 채혈관련 검체의 용혈 발생률은 6.5% (Saleem, Mani, Chadwick, Creanor, & Ayling, 2009), 12.8% (Dugan, Leech, Speroni, & Corriher, 2005). 19.8% (Ong, Chan, & Lim, 2008), 심지어 32% (Grant, 2003) (Dugan et al, 2005;Grant, 2003;Kennedy et al, 1996), 토니켓 적용시간 (Saleem et al, 2009). 채혈자의 숙련도 (Lowe et al, 2008), 채혈 시 사용되는 주사바늘의 크기 (Dugan et al;Kennedy et al, 1996), 혈액이 수집되는 채혈관의 크기 (Cox et al, 2004;Dugan et al), 채혈시도 횟수, 진단명 및 채혈부위 (Dugan et al), 검체 이송방법 (Fang, Fang, Chung, & Chien, 2008 채혈로 인한 용혈관련 문헌을 살펴보면, 외국의 경우는 용혈발생 에 대한 실태조사 (Fernandes, Walker, Price, Marsden, & Haley, 1997;Grant, 2003), 용혈발생 영향요인 (Dugan et al, 2005), 채혈방법에 따른 용혈 비교 (Cox et al, 2004;Grant;Kennedy et al, 1996;Lowe et al, …”

Section: 진단검사에 대한 정도관리를 하고 있는 미국의 임상병리사회에unclassified

A Comparison of the Rates of Hemolysis and Repeated Blood Sampling using Syringe needles versus Vacuum tube needles in the Emergency Department

et al. 2012

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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 fortyfive 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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A prospective study of causes of haemolysis during venepuncture: tourniquet time should be kept to a minimum

Cited by 49 publications

References 5 publications

Variation in phlebotomy techniques in emergency medicine and the incidence of haemolysed samples

Variation in phlebotomy techniques in emergency medicine and the incidence of haemolysed samples

Effect of venepuncture process design on efficiency and failure rates: A simulation model study for secondary care

A Comparison of the Rates of Hemolysis and Repeated Blood Sampling using Syringe needles versus Vacuum tube needles in the Emergency Department

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