Effectiveness of practices to reduce blood sample hemolysis in EDs: a laboratory medicine best practices systematic review and meta-analysis.

Author(s): Heyer NJ, Derzon JH, Winges L, Shaw C, Mass D, Snyder SR, Epner P, Nichols JH, Gayken JA, Ernst D, Liebow EB

Publication: Clin Biochem, 2012, Vol. 45, Page 1012-32

PubMed ID: 22968086 PubMed Review Paper? Yes

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   The purpose of this study was to determine the effects of straight needle venipuncture versus IV catheter collection, location of IV catheter, use of a syringe draw versus vacuum tubes, and needle gauge on the rates of hemolysis among blood specimens from previously published and unpublished studies. Studies included were given a study quality rating based on the CDC-sponsored Laboratory Medicine Best Practices Initiative's "A-6 Cycle" systematic review methods.

   Summary of Findings:

   Meta-analysis found the reduction in hemolysis rates among straight needle draws to be approximately 84% (RR=0.16) with a strength rating of "high", when compared to IV catheter blood collection (11 studies). Meta-analysis determined the reduction in hemolysis rates among antecubital IV catheters to be approximately 55% (RR=0.45), also with a strength rating of "high" compared to IV catheters in distal sites (4 studies). Meta-analysis determined the reduction in hemolysis rates among syringe draws versus vacuum tube draws to be 3% (RR=0.97) and not significant (3 conflicting studies). While 2 "fair" studies reported there were substantial reductions in hemolysis rates when needle gauges of 21 or less (larger) were used, the single study rated "good" found the effect to be minimal or absent. Meta-analysis determined the reduction in hemolysis rates when needle gauges of 21 or less (larger) were used, as opposed to smaller needles, to be 63% (RR=0.37), although the strength of the evidence was deemed "insufficient" due to heterogeneous results. Meta-analysis of the effects of collecting blood in a partial vacuum tube versus a full vacuum tube on hemolysis rates revealed an 89% reduction in hemolysis rates when a low vacuum tube was used (RR=0.11) based on 1 published and 1 unpublished study. However, the strength of the evidence in this case was rated as "suggestive" rather than "high".

   Biospecimens

   • Bodily Fluid - Blood

   Preservative Types

   • None (Fresh)

   Diagnoses:

   • Not specified

   Platform:

   Analyte	Technology Platform
   Cell count/volume	Spectrophotometry
   Cell count/volume	Macroscopic observation

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Biospecimen Acquisition	Method of fluid acquisition	IV catheter Syringe draw Vacuum tube Needle
   Biospecimen Acquisition	Needle gauge	21 gauge or less (larger) >21 gauge (smaller)
   Biospecimen Acquisition	Type of collection container/solution	Full vacuum tube Partial/low vacuum tube
   Biospecimen Acquisition	Anatomical location of blood draw	Anticubital vein Distal vein

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