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      Avoidance to wipe alcohol before venipuncture is not a source of spurious hemolysis

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          Abstract

          Background

          It is still uncertain whether or not avoidance to let disinfectant alcohol dry at the site of venipuncture is a source of spurious hemolysis when drawing venous blood.

          Methods:

          In a consecutive series of 52 outpatients referred for routine laboratory testing, venous blood was drawn by direct venipuncture with (odd group) or without (pair group) wiping 70% isopropyl alcohol at the site of venipuncture. A 3.5 mL evacuated tube with clot activator and gel separator was drawn from a vein of the upper limb, serum was immediately separated with standard centrifugation and tested for potassium, lactate dehydrogenase (LD), aspartate aminotransferase (AST) and hemolysis index (HI) on Roche Cobas.

          Results:

          No specimen was discarded for unsatisfactory venipuncture. No differences for age and gender were observed between groups. As regards the four parameters investigated, no significant differences could be observed between patients in whom blood was drawn with or without letting the alcohol dry. It is also noteworthy that no sample in both groups exceeded the conventional sample rejection threshold of cell-free hemoglobin.

          Conclusions:

          The results of our prospective, randomized study attest that failure to wipe alcohol at the site of venipuncture should not be considered as a potential source of spurious hemolysis when drawing blood.

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          Most cited references15

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          Hemolyzed specimens: a major challenge for emergency departments and clinical laboratories.

          The term hemolysis designates the pathological process of breakdown of red blood cells in blood, which is typically accompanied by varying degrees of red tinge in serum or plasma once the whole blood specimen has been centrifuged. Hemolyzed specimens are a rather frequent occurrence in laboratory practice, and the rate of hemolysis is remarkably higher in specimens obtained in the Emergency Department (ED) as compared with other wards or outpatient phlebotomy services. Although hemolyzed specimens may reflect the presence of hemolytic anemia, in most cases they are due to preanalytical sources related to incorrect procedures or failure to follow procedures for collection, handling and storage of the samples; some of these are typical of the ED. Since hemolyzed specimens are often an important cause of relationship, economic, organizational and clinical problems between the ED and the clinical laboratory, it is essential to develop effective processes for systematically identifying unsuitable specimens (e.g. by using the hemolysis index), differentiating in vitro from in vivo hemolysis, troubleshooting the potential causes, and maintaining good relations between the clinical laboratory and the ED.
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            Quality standards for sample collection in coagulation testing.

            Preanalytical activities, especially those directly connected with blood sample collection and handling, are the most vulnerable steps throughout the testing process. The receipt of unsuitable samples is commonplace in laboratory practice and represents a serious problem, given the reliability of test results can be adversely compromised following analysis of these specimens. The basic criteria for an appropriate and safe venipuncture are nearly identical to those used for collecting blood for clinical chemistry and immunochemistry testing, and entail proper patient identification, use of the correct technique, as well as appropriate devices and needles. There are, however, some peculiar aspects, which are deemed to be particularly critical when collecting quality specimens for clot-based tests, and these require clearer recognition. These include prevention of prolonged venous stasis, collection of nonhemolyzed specimens, order of draw, and appropriate filling and mixing of the primary collection tubes. All of these important preanalytical issues are discussed in this article, and evidence-based suggestions as well as recommendations on how to obtain a high-quality sample for coagulation testing are also illustrated. We have also performed an investigation aimed to identify variation of test results due to underfilling of primary blood tubes, and have identified a clinically significant bias in test results when tubes are drawn at less than 89% of total fill for activated partial thromboplastin time, less than 78% for fibrinogen, and less than 67% for coagulation factor VIII, whereas prothrombin time and activated protein C resistance remain relatively reliable even in tubes drawn at 67% of the nominal volume.
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              Phlebotomy issues and quality improvement in results of laboratory testing.

              Laboratory testing is an integral part of the decision-making process, and results of laboratory testing often strongly influence medical diagnoses and therapies. There is a long history of quality requirements in laboratory medicine, which have mainly concerned the analytic phase of this process. Owing to the substantial advances in technology, laboratory automation and analytic quality, there is increasing evidence that further quality improvements should be targeted to extra-analytic phases of laboratory testing. Objective difficulties to monitor most of the preanalytic variables which lie outside the direct control or supervision of the laboratory personnel, such as phlebotomy, call for effective educational and preventive policies. Owing to high personnel turnover rates, lack of understanding about good laboratory practices, and inadequate training, there are several opportunities for making errors during phlebotomy, which mainly concern patient misidentification and collection of unsuitable specimens for testing due to unsuited venous accesses, venous stasis, inappropriate collection devices and containers. Improved standardization of phlebotomy techniques, along with operative guidelines dissemination, continuous education, certification, and training of health care professionals involved in blood drawing responsibilities would enhance the chance of obtaining specimens of consistent quality, with favorable revenues for the health care system and the patient's outcome.
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                Author and article information

                Journal
                Biochem Med (Zagreb)
                Biochem Med (Zagreb)
                Biochemia Medica
                Biochemia Medica
                Croatian Society of Medical Biochemistry and Laboratory Medicine
                1330-0962
                1846-7482
                15 June 2013
                June 2013
                : 23
                : 2
                : 201-205
                Affiliations
                [1 ]Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
                [2 ]Post-Graduate Program of Pharmaceutical Sciences, Department of Medical Pathology Federal University of Parana, Curitiba, Parana, Brazil
                [3 ]Laboratory of Clinical Chemistry and Hematology, Academic Hospital of Parma, Parma, Italy
                Author notes
                Article
                biochem_med-23-2-201-8
                10.11613/BM.2013.023
                3900069
                23894865
                b10401c7-e71b-4910-ba3d-9d75b821011c
                ©Copyright by Croatian Society of Medical Biochemistry and Laboratory Medicine

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 09 March 2013
                : 16 April 2013
                Categories
                Original Papers

                preanalytical variability,hemolysis,alcohol,practice guideline

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