The effect of blood drawing techniques and equipment on the hemolysis of ED laboratory blood samples.

Author(s): Grant MS

Publication: J Emerg Nurs, 2003, Vol. 29, Page 116-21

PubMed ID: 12660692 PubMed Review Paper? No

Purpose of Paper

Conclusion of Paper

Studies

1. Study Purpose

   The purpose of this study was to determine the effects of venipuncture technique (IV catheter versus straight needle), blood-draw method (vacutainer versus syringe), and blood-transfer method (needle to a tube versus needleless connector to a vacutainer and a tube) on the degree of hemolysis in serum specimens. The degree of hemolysis was determined by manual observation of serum color and graded on a 0-4 scale.

   Summary of Findings:

   144/454 (32%) of specimens had some degree of hemolysis (level 1-4). 13% of specimens had high or gross hemolysis (graded at a 3-4 level) and were inappropriate for scheduled tests. 20% of specimens collected via new IV catheters (1st collection) were hemolyzed at high or gross levels while 10% of specimens collected via existing IV catheters and 1% of the specimens collected via straight needle had similar levels of hemolysis. The difference in hemolysis rates between new IV catheters and straight needles was significant (P<0.001). No significant differences were found in hemolysis rates between specimens collected using the different IV catheter gauges. Hemolysis rates among specimens collected using straight needles were too low to assess the effects of needle gauge. The authors state that syringe size had no effect on hemolysis rates. New IV catheter draws using a vacutainer had a significantly higher level of hemolysis than those collected using a syringe (P=0.02). High or gross levels of hemolysis were not observed when specimens were drawn using a straight needle and either a vacutainer or syringe. The authors state that blood transfer method from a syringe (by needle directly to tube versus needleless connector to vacutainer and tube) had no effect on hemolysis rates.

   Biospecimens

   • Bodily Fluid - Serum
   • Bodily Fluid - Blood

   Preservative Types

   • None (Fresh)

   Diagnoses:

   • Not specified

   Platform:

   Analyte	Technology Platform
   Cell count/volume	Macroscopic observation

   Pre-analytical Factors:

   Classification	Pre-analytical Factor	Value(s)
   Biospecimen Acquisition	Method of fluid acquisition	Central venous catheter IV catheter Needle Needleless connector Syringe draw Venipuncture Vacuum tube
   Biospecimen Acquisition	Needle gauge	21 gauge 22 gauge 23 gauge
   Biospecimen Acquisition	Cannulation	14 gauge catheter 16 gauge catheter 18 gauge catheter 20 gauge catheter
   Biospecimen Aliquots and Components	Aliquot sequential collection	1st collection Not first collection
   Biospecimen Acquisition	Type of collection container/solution	5 mL syringe 10 mL syringe 20 mL or higher syringe

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