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

Abstract

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.

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.…”

Pre-analytical issues in the haemostasis laboratory: guidance for the clinical laboratories

“…The venipuncture should be ideally collected directly from a peripheral vein (antecubital vein). If a tourniquet needs to be used, it should immediately be released when the first tube starts to fill [48]. The diameter of the needle should preferably be comprised between 19 and 22 gauge [34, 49].…”

Patient identification and tube labelling – a call for harmonisation

“…In addition, continuous education of the staff for venous blood sampling is highly advisable, since appropriate education of the personnel generates a better adherence to guideline recommendations for patient identification, tourniquet release, and test tube labelling [23,24]. 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].…”