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de Koning L, Orton D, Seiden Long I, Boyd J, Kellogg M, Abdullah A, Naugler C, Tsui A, Strange B, Glaser D. Distribution of videos demonstrating best practices in preventing hemolysis is associated with reduced hemolysis among nurse-collected specimens in hospitals. Clin Biochem 2023; 119:110632. [PMID: 37579938 DOI: 10.1016/j.clinbiochem.2023.110632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 07/25/2023] [Accepted: 08/11/2023] [Indexed: 08/16/2023]
Abstract
BACKGROUND Minimizing hemolysis during phlebotomy ensures accurate chemistry results and reduces test cancellations and specimen recollections. We developed videos demonstrating best practices to reduce hemolysis and tested whether distribution to clinical nurse educators (CNEs) for provision to nursing staff affected the degree of specimen hemolysis in hospital inpatient units and outpatient clinics. METHODS Videos of common blood collections demonstrating best practices to reduce hemolysis were filmed and then distributed via email link to all hospital-based CNEs in Calgary, Alberta, Canada. (https://vimeo.com/user18866730/review/159869683/a0cec9827f). Roche Cobas hemolysis index (H-index) results from specimens collected +/- 12 months from the date of video distribution were extracted from Roche Cobas IT middleware (cITM) and linked to collection location. An interrupted time series (ITS) analysis with collection location as the unit of anlaysis was used to quantify impact of video distribution on the trajectory of weekly mean log-H-index weighted by inverse variance. RESULTS In +/- 3 months of data flanking video distribution (n = 137 241 collections), where overall impact was strongest, H-index trajectory (change in units per week) decreased immediately following video distribution (-5.7% / week, p < 0.01). This was accompanied by a 22% drop in overall H-index from the week before to the week after video distribution (y-intercept change, or gap). There was also a small but significant overall decrease in the proportion of hemolyzed specimens (-0.3%, p < 0.01). These changes were not observed at all collection locations, and in fact increases occured at some locations. CONCLUSIONS We developed a novel and convenient educational aid that, when distributed, was associated with beneficial changes in specimen hemolysis at hospital inpatient units and outpatient clinics. Including it in ongoing nursing education will fill a knowledge gap that may help to reduce specimen hemolysis.
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Affiliation(s)
- Lawrence de Koning
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Health Sciences Centre, Foothills Campus, University of Calgary, 3030 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Alberta Precision Laboratories - South Sector, Diagnostic and Scientific Research Centre, #9 3535 Research Way NW, Calgary, AB T2L 2K8, Canada.
| | - Dennis Orton
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Health Sciences Centre, Foothills Campus, University of Calgary, 3030 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Alberta Precision Laboratories - South Sector, Diagnostic and Scientific Research Centre, #9 3535 Research Way NW, Calgary, AB T2L 2K8, Canada
| | - Isolde Seiden Long
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Health Sciences Centre, Foothills Campus, University of Calgary, 3030 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; Alberta Precision Laboratories - South Sector, Diagnostic and Scientific Research Centre, #9 3535 Research Way NW, Calgary, AB T2L 2K8, Canada
| | - Jessica Boyd
- Department of Pathology, University of Utah, 15N Medical Drive East, Salt Lake City, UT 84112, USA
| | - Mark Kellogg
- Boston Children's Hospital, Department of Laboratory Medicine, 300 Longwood Ave, Boston, MA 02115, USA
| | - Amid Abdullah
- DynaLIFE Medical Laboratories, Diagnostic and Scientific Research Centre, #9 3535 Research Way NW, Calgary, AB T2L 2K8, Canada
| | - Christopher Naugler
- Department of Pathology and Laboratory Medicine, Cumming School of Medicine, Health Sciences Centre, Foothills Campus, University of Calgary, 3030 Hospital Drive NW, Calgary, AB T2N 4N1, Canada; DynaLIFE Medical Laboratories, Diagnostic and Scientific Research Centre, #9 3535 Research Way NW, Calgary, AB T2L 2K8, Canada
| | - Albert Tsui
- Alberta Precision Laboratories - South Sector, Diagnostic and Scientific Research Centre, #9 3535 Research Way NW, Calgary, AB T2L 2K8, Canada; Department of Laboratory Medicine and Pathology, College of Health Sciences, Faculty of Medicine & Dentistry, University of Alberta, 116 Street and 85 Ave, Edmonton, Alberta, T6G 2R3, Canada
| | - Brenda Strange
- Alberta Precision Laboratories - South Sector, Diagnostic and Scientific Research Centre, #9 3535 Research Way NW, Calgary, AB T2L 2K8, Canada
| | - Dory Glaser
- Alberta Health Services, Calgary, Alberta, Canada
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Calleja R, Mielke N, Lee R, Johnson S, Bahl A. Hemolyzed Laboratory Specimens in the Emergency Department: An Underappreciated, but Frequent Problem. J Emerg Nurs 2023; 49:744-754. [PMID: 37389514 DOI: 10.1016/j.jen.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/29/2023] [Accepted: 06/01/2023] [Indexed: 07/01/2023]
Abstract
INTRODUCTION Hemolysis of blood samples from emergency department (ED) patients leads to delays in treatment and disposition. The aim of this study is to determine the frequency of hemolysis and variables predictive of hemolysis. METHODS This observational cohort study was conducted among three institutions: academic tertiary care center and two suburban community EDs, with an annual census of over 270,000 ED visits. Data were obtained from the electronic health record. Adults requiring laboratory analysis with at least one peripheral intravenous catheter (PIVC) inserted within the ED were eligible. Primary outcome was hemolysis of lab samples and secondary outcomes included variables related to PIVC failure. RESULTS Between January 8, 2021 and May 9, 2022, 141,609 patient encounters met inclusion criteria. The average age was 55.5 and 57.5% of patients were female. Hemolysis occurred in 24,359 (17.2%) samples. In a multivariate analysis, when compared to 20-gauge catheters, smaller 22-gauge catheters had an increased odds of hemolysis (OR 1.78, 95% confidence interval (CI) 1.65-1.91; P < .001), while larger 18-gauge catheters had a lower odds of hemolysis (OR 0.94; 95% CI 0.90-0.98; P = .0046). Additionally, when compared to antecubital placement, hand/wrist placement demonstrated increased odds of hemolysis (OR 2.06; 95% CI 1.97-2.15; P < .001). Finally, hemolysis was associated with a higher rate of PIVC failure (OR 1.06; 95%CI 1.00-1.13; P = 0.043). DISCUSSION This large observational analysis demonstrates that lab hemolysis of is a frequent occurrence among ED patients. Given the added risk of hemolysis with certain placement variables, clinicians should consider catheter gauge/placement location to avoid hemolysis that may result in patient care delays and prolonged hospital stays.
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Ersoy S, Ilanbey B. A Single-Center Prospective Study of the Effects of Different Methods of Phlebotomy in the Emergency Department on Blood Sample Hemolysis Rates. J Emerg Nurs 2023; 49:134-139. [PMID: 36137822 DOI: 10.1016/j.jen.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2022] [Revised: 08/05/2022] [Accepted: 08/14/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Hemolysis is more commonly seen in the emergency department and causes delays in diagnosis, hospitalization, discharge, and treatment of patients. The aim of this study was to determine the most appropriate phlebotomy method and device to reduce blood sample hemolysis in the emergency department. METHODS This prospective, comparative descriptive study involved patients who presented to the emergency department with any medical condition and required blood sampling. Patients were divided into 6 groups according to the method of phlebotomy and the device used for phlebotomy. Data were analyzed with logistic regression. RESULTS A total of 715 patients participated in the study. The blood sample hemolysis rate in the emergency department was 25.7%. When the hemolysis rates were compared with a steel straight needle or intravenous catheter, it was found that the use of steel straight needle significantly reduced hemolysis. Blood drawing through a 20 G intravenous catheter with Luer-Lock access device reduces the risk of hemolysis. Male sex and difficult blood collection also have been shown to increase the risk of hemolysis. DISCUSSION Blood should be drawn with a steel straight needle instead of an intravenous catheter. However, when that is not possible, we recommend the use of a 20 G intravenous catheter with Luer-Lock access device if a blood sample is to be drawn from intravenous line.
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