Joint EFLM-COLABIOCLI Recommendation for venous blood sampling

Abstract

This document provides a joint recommendation for venous blood sampling of the European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE) and Latin American Working Group for Preanalytical Phase (WG-PRE-LATAM) of the Latin America Confederation of Clinical Biochemistry (COLABIOCLI). It offers guidance on the requirements for ensuring that blood collection is a safe and patient-centered procedure and provides practical guidance on how to successfully overcome potential barriers and obstacles to its widespread implementation. The target audience for this recommendation are healthcare staff members directly involved in blood collection. This recommendation applies to the use of a closed blood collection system and does not provide guidance for the blood collection with an open needle and syringe and catheter collections. Moreover, this document neither addresses patient consent, test ordering, sample handling and transport nor collection from children and unconscious patients. The recommended procedure is based on the best available evidence. Each step was graded using a system that scores the quality of the evidence and the strength of the recommendation. The process of grading was done at several face-to-face meetings involving the same mixture of stakeholders stated previously. The main parts of this recommendation are: 1) Pre-sampling procedures, 2) Sampling procedure, 3) Post-sampling procedures and 4) Implementation. A first draft of the recommendation was circulated to EFLM members for public consultation. WG-PRE-LATAM was also invited to comment the document. A revised version has been sent for voting on to all EFLM and COLABIOCLI members and has been officially endorsed by 33/40 EFLM and 21/21 COLABIOCLI members. We encourage professionals throughout Europe and Latin America to adopt and implement this recommendation to improve the quality of blood collection practices and increase patient and workers safety.

A comparison of stability of chemical analytes in plasma from the BD Vacutainer® Barricor™ tube with mechanical separator versus tubes containing gel separator

“…Blood sampling was performed by experienced laboratory staff, and blood was collected by venipuncture in the antecubital vein. The procedure for blood sampling followed the EFLM recommendation on venous blood sampling …”

Pre‐ and postanalytical errors in haematology

“…Venous stasis of just one to three minutes during venepuncture has also been shown to have an adverse effect on CBC results, leading to an increase in Hb, Hct and RBC . The use of vein‐mapping or visualisation technology with the use of infra‐red light overcomes the need for a tourniquet to locate a vein …”

“…Physical activity has been identified as an important preanalytical variable, 15 and the European Federation of Laboratory Medicine (EFLM) advises that patients abstain from excessive or unaccustomed exercise for 24 hours prior to routine phlebotomy. 16 An increase in the white blood count (WBC), neutrophil count, platelet count, red cell fragmentation and platelet activation has been reported post-marathon running. 17 Sustained exercise produces an increase in plasma volume (PV), 18 which may lead to a decrease in haemoglobin (Hb), red blood cells (RBC) and haematocrit (Hct) in athletes in training programmes.…”

“…21 The EFLM recommendation is that patients should rest for fifteen minutes in a seated position prior to phlebotomy as a standardised approach to phlebotomy procedures. 16 The impact of posture is as a result of changes in PV from the supine to the upright position and the consequence of this on Hb, cell counts and Hct.…”

Impact of low volume citrate tubes on results of first‐line hemostasis testing

“…Blood sample collection is essentially an unavoidable activity to obtain suitable biological material to be used for laboratory testing . Laboratory hemostasis is no exception to this general rule and indeed comprises special considerations .…”