Venipuncture Equipment, Technique, and Hemolysis of Blood Samples Obtained in the Emergency Department

2.50
Hdl Handle:
http://hdl.handle.net/10755/162839
Type:
Presentation
Title:
Venipuncture Equipment, Technique, and Hemolysis of Blood Samples Obtained in the Emergency Department
Abstract:
Venipuncture Equipment, Technique, and Hemolysis of Blood Samples Obtained in the Emergency Department
Conference Sponsor:Emergency Nurses Association
Conference Year:2004
Author:Seguin, Debra, RN, MN, CCRN, CEN
P.I. Institution Name:William Beaumont Hospital
Title:Clinical Nurse Specialist
Contact Address:3601 West Thirteen Mile Road, Royal Oak, MI, 48073, USA
Contact Telephone:(248) 551-1990
Co-Authors:Timothy Murphy, RN BSN; Chris McEachin, RN, BSN CEN
Purpose: Research has shown that venipuncture equipment and techniques can cause hemolysis of blood
samples. Hemolysis is the damage of red blood cells, which can cause false elevations in some lab results,
particularly electrolytes. This can and does lead to repeat blood draws for the patient with a potential delay
of definitive care and a subsequent increase in length of stay. The purpose of this study was to identify
venipuncture equipment and techniques that were associated with hemolysis of blood samples obtained
in the emergency department.
Design/Setting/Sample: This study used a prospective, cross-sectional design that reviewed lab samples
drawn on all patients (= 18 years old) that presented to the emergency department who had blood work
ordered. A blood samples were reviewed for hemolysis, technique, and supplies used. These blood samples
were drawn as part of patients' routine care from October 1 to October 21, 2003. This study received IRB
exempt status.
Methodology: ED nursing and technician staff completed data forms (after the blood was drawn) for
every blood sample drawn in the emergency department and compared with the laboratory data on
hemolysis of the blood samples. This staff was instructed not to change their phlebotomy technique for
the study. More than one sample from the same patient could have been included (< 20), however, the
exact number is unknown. During the analysis process, patient identifiers were kept securely in a locked
office and destroyed once the completed phlebotomy tools were matched with the hemolysis analysis.
Laboratory technicians examined each sample for hemolysis and dichotomized the results into present or
not present. Data collected included technique type (drip, needle/syringe, angiocatheter/vacutainer) and
the equipment size (needle, angiocatheter, and/or syringe) used. Data was analyzed using SPSS.
Results: During the 21-day study, 1,206 forms were completed with corresponding laboratory analyses.
Phlebotomies were done using vacutainers (82.6%), syringes (16.4%), and the drip method (1.0%). In 6.1%
of the samples, laboratory results indicated hemolysis. Hemolysis was present in blood samples drawn with
syringes (13), vacutainers (57), and the drip method (3) (p = 0.02). Removing the drip method (small sample)
resulted in no statistical difference (p = 0.645) between syringe and vacutainer techniques. There was
a significant difference in hemolysis between smaller (23g and 25g) and larger (< 23g) butterfly needles (p
< 0.001). Angiocatheters showed a significant difference (p < 0.001) between smaller (22g and 24g) versus
larger gauges (< 22g). Hemolyzed blood samples done by straight needle draw were excluded.
Conclusions: A very low rate of hemolysis was found in this study compared to other published reports.
No difference in hemolysis was found when using either a needle and syringe or an angiocatheter and a
vacutainer. The drip method appears to have a higher rate of hemolysis associated with it; however, the
small sample cannot provide a definitive statement. Smaller needle sizes were associated with greater
occurrence of hemolysis for both butterfly and angiocatheter. Further research should address all aspects
of phlebotomy technique, equipment, and laboratory analysis of hemolysis. [Poster Presentation]
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.titleVenipuncture Equipment, Technique, and Hemolysis of Blood Samples Obtained in the Emergency Departmenten_GB
dc.identifier.urihttp://hdl.handle.net/10755/162839-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Venipuncture Equipment, Technique, and Hemolysis of Blood Samples Obtained in the Emergency Department</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">2004</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Seguin, Debra, RN, MN, CCRN, CEN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">William Beaumont Hospital</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Clinical Nurse Specialist</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">3601 West Thirteen Mile Road, Royal Oak, MI, 48073, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">(248) 551-1990</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">dseguin@beaumont.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Timothy Murphy, RN BSN; Chris McEachin, RN, BSN CEN<br/></td></tr><tr><td colspan="2" class="item-abstract">Purpose: Research has shown that venipuncture equipment and techniques can cause hemolysis of blood<br/>samples. Hemolysis is the damage of red blood cells, which can cause false elevations in some lab results,<br/>particularly electrolytes. This can and does lead to repeat blood draws for the patient with a potential delay<br/>of definitive care and a subsequent increase in length of stay. The purpose of this study was to identify<br/>venipuncture equipment and techniques that were associated with hemolysis of blood samples obtained<br/>in the emergency department.<br/>Design/Setting/Sample: This study used a prospective, cross-sectional design that reviewed lab samples<br/>drawn on all patients (= 18 years old) that presented to the emergency department who had blood work<br/>ordered. A blood samples were reviewed for hemolysis, technique, and supplies used. These blood samples<br/>were drawn as part of patients' routine care from October 1 to October 21, 2003. This study received IRB<br/>exempt status.<br/>Methodology: ED nursing and technician staff completed data forms (after the blood was drawn) for<br/>every blood sample drawn in the emergency department and compared with the laboratory data on<br/>hemolysis of the blood samples. This staff was instructed not to change their phlebotomy technique for<br/>the study. More than one sample from the same patient could have been included (&lt; 20), however, the<br/>exact number is unknown. During the analysis process, patient identifiers were kept securely in a locked<br/>office and destroyed once the completed phlebotomy tools were matched with the hemolysis analysis.<br/>Laboratory technicians examined each sample for hemolysis and dichotomized the results into present or<br/>not present. Data collected included technique type (drip, needle/syringe, angiocatheter/vacutainer) and<br/>the equipment size (needle, angiocatheter, and/or syringe) used. Data was analyzed using SPSS.<br/>Results: During the 21-day study, 1,206 forms were completed with corresponding laboratory analyses.<br/>Phlebotomies were done using vacutainers (82.6%), syringes (16.4%), and the drip method (1.0%). In 6.1%<br/>of the samples, laboratory results indicated hemolysis. Hemolysis was present in blood samples drawn with<br/>syringes (13), vacutainers (57), and the drip method (3) (p = 0.02). Removing the drip method (small sample)<br/>resulted in no statistical difference (p = 0.645) between syringe and vacutainer techniques. There was<br/>a significant difference in hemolysis between smaller (23g and 25g) and larger (&lt; 23g) butterfly needles (p<br/>&lt; 0.001). Angiocatheters showed a significant difference (p &lt; 0.001) between smaller (22g and 24g) versus<br/>larger gauges (&lt; 22g). Hemolyzed blood samples done by straight needle draw were excluded.<br/>Conclusions: A very low rate of hemolysis was found in this study compared to other published reports.<br/>No difference in hemolysis was found when using either a needle and syringe or an angiocatheter and a<br/>vacutainer. The drip method appears to have a higher rate of hemolysis associated with it; however, the<br/>small sample cannot provide a definitive statement. Smaller needle sizes were associated with greater<br/>occurrence of hemolysis for both butterfly and angiocatheter. Further research should address all aspects<br/>of phlebotomy technique, equipment, and laboratory analysis of hemolysis. [Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:35:02Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:35:02Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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