2.50
Hdl Handle:
http://hdl.handle.net/10755/162407
Type:
Presentation
Title:
Hemolysis of Coagulation Specimens: A Comparison of IV Draw Methods
Abstract:
Hemolysis of Coagulation Specimens: A Comparison of IV Draw Methods
Conference Sponsor:Emergency Nurses Association
Conference Year:2010
Author:Sherman, Beth, RN, BSN, CEN
P.I. Institution Name:Cooper University Hospital
Title:Staff RN-ED
Contact Address:One Cooper Plaza, Camden, NJ, 08103, USA
Contact Telephone:856-968-8678
Co-Authors:Lorene Pugh, RN, BSN, CEN; Dominic Parone, RN, BSN,CEN; Karen Looby-Rodriguez, LPN; Annette Bell, MS, MT(ASCP)SH; Mary Stauss, RN, MSN, APN, CEN; Carole-Rae Reed, RN, PhD, APN-BC
[ENA Annual Conference - Research Presentation]
Purpose: Hemolysis of blood samples creates significant delays in the treatment and disposition of patients in the emergency department (ED). The purpose of this study was to compare the hemolysis rates of coagulation blood samples obtained during insertion of an intravenous catheter with (group 1) or without (group 2) extension tubing connected to the IV catheter hub. The secondary aim of this study was to determine if nurses could predict sample hemolysis.

Design: A prospective, two group randomized comparative design was used to determine which method of blood collection for coagulation specimens provided the lowest hemolysis rate.

Setting: This study was conducted in an urban Level I emergency department averaging 58,000 visits per year.

Subjects: The sample consisted of 121 adult ED patients randomly assigned to one of the two groups.

Methods: Data collectors were trained in the two methods and followed a strict protocol. The Clinical Laboratory utilized a standardized color coded scale to determine hemolysis.

Results: Pearson chi-square analysis was used to test for differences between all nominal variables. The level of significance for all tests was p <0.05. There was no significant difference in hemolysis rates between the groups (hemolysis rate for group 1=; hemolysis rate for group 2 =) using chi-square analysis, 2x2 contingency table (Pearson chi-square, 2-sided, p= 0.84). A secondary aim of this study was to determine if the investigators could predict whether or not a coagulation sample was hemolyzed based on visual observation during the specimen withdrawal process. Results were significant but not in the expected way. Nurses were significantly more likely to predict a sample was hemolyzed when it was not, and to think it was not hemolyzed, when in fact it was (Pearson chi-square 18.18, p<0.00, 2-sided).

Implications: Individual clinicians often have strong biases about whether obtaining blood directly from the IV catheter hub or from an extension tubing results in a lower hemolysis rate. There are several clinical implications of the findings of this study. First, even with careful blood withdrawal techniques there is a high rate of hemolysis in coagulation specimens drawn in ED patients. This leads to repeated blood draws and increases time to treatment and disposition. One suggested approach if hemolysis rates are high is to consider obtaining blood whenever possible through a venipuncture technique, rather than through an IV catheter. This method has been shown in prior experimental studies to reduce hemolysis rates to less than 5%.5,6 However, ED staff rarely use this route for obtaining specimens.1,3

A second implication is that withdrawing blood from a peripheral IV catheter at the hub or through an extension tubing does not appear to effect hemolysis rates. Finally, emergency nurses can not accurately predict by visualization whether or not a coagulation sample is hemolyzed at the time of blood withdrawal. ED nurses should use the method that is the easiest to perform, best avoids health care worker exposure to blood, limits potential for increasing risk for nosocomial IV infections, and/or has the lowest cost for equipment. Additional research is needed to determine factors or techniques that can reduce hemolysis rates in coagulation samples obtained in ED patients.
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleHemolysis of Coagulation Specimens: A Comparison of IV Draw Methodsen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162407-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Hemolysis of Coagulation Specimens: A Comparison of IV Draw Methods</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2010</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Sherman, Beth, RN, BSN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Cooper University Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Staff RN-ED</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">One Cooper Plaza, Camden, NJ, 08103, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">856-968-8678</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">sherman-beth@cooperhealth.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Lorene Pugh, RN, BSN, CEN; Dominic Parone, RN, BSN,CEN; Karen Looby-Rodriguez, LPN; Annette Bell, MS, MT(ASCP)SH; Mary Stauss, RN, MSN, APN, CEN; Carole-Rae Reed, RN, PhD, APN-BC</td></tr><tr><td colspan="2" class="item-abstract">[ENA Annual Conference - Research Presentation] <br/>Purpose: Hemolysis of blood samples creates significant delays in the treatment and disposition of patients in the emergency department (ED). The purpose of this study was to compare the hemolysis rates of coagulation blood samples obtained during insertion of an intravenous catheter with (group 1) or without (group 2) extension tubing connected to the IV catheter hub. The secondary aim of this study was to determine if nurses could predict sample hemolysis.<br/><br/>Design: A prospective, two group randomized comparative design was used to determine which method of blood collection for coagulation specimens provided the lowest hemolysis rate. <br/><br/>Setting: This study was conducted in an urban Level I emergency department averaging 58,000 visits per year. <br/><br/>Subjects: The sample consisted of 121 adult ED patients randomly assigned to one of the two groups. <br/><br/>Methods: Data collectors were trained in the two methods and followed a strict protocol. The Clinical Laboratory utilized a standardized color coded scale to determine hemolysis. <br/><br/>Results: Pearson chi-square analysis was used to test for differences between all nominal variables. The level of significance for all tests was p &lt;0.05. There was no significant difference in hemolysis rates between the groups (hemolysis rate for group 1=; hemolysis rate for group 2 =) using chi-square analysis, 2x2 contingency table (Pearson chi-square, 2-sided, p= 0.84). A secondary aim of this study was to determine if the investigators could predict whether or not a coagulation sample was hemolyzed based on visual observation during the specimen withdrawal process. Results were significant but not in the expected way. Nurses were significantly more likely to predict a sample was hemolyzed when it was not, and to think it was not hemolyzed, when in fact it was (Pearson chi-square 18.18, p&lt;0.00, 2-sided).<br/><br/>Implications: Individual clinicians often have strong biases about whether obtaining blood directly from the IV catheter hub or from an extension tubing results in a lower hemolysis rate. There are several clinical implications of the findings of this study. First, even with careful blood withdrawal techniques there is a high rate of hemolysis in coagulation specimens drawn in ED patients. This leads to repeated blood draws and increases time to treatment and disposition. One suggested approach if hemolysis rates are high is to consider obtaining blood whenever possible through a venipuncture technique, rather than through an IV catheter. This method has been shown in prior experimental studies to reduce hemolysis rates to less than 5%.5,6 However, ED staff rarely use this route for obtaining specimens.1,3 <br/><br/>A second implication is that withdrawing blood from a peripheral IV catheter at the hub or through an extension tubing does not appear to effect hemolysis rates. Finally, emergency nurses can not accurately predict by visualization whether or not a coagulation sample is hemolyzed at the time of blood withdrawal. ED nurses should use the method that is the easiest to perform, best avoids health care worker exposure to blood, limits potential for increasing risk for nosocomial IV infections, and/or has the lowest cost for equipment. Additional research is needed to determine factors or techniques that can reduce hemolysis rates in coagulation samples obtained in ED patients.<br/></td></tr></table>en_GB
dc.date.available2011-10-27T10:27:42Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:27:42Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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