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Emergency department (ED) patients routinely undergo placement of a saline lock device (SLD) with the aspiration of blood for laboratory testing. Drawing blood through a SLD may result in hemolysis of sample, repeated venipuncture and increased ED length of stay (LOS). The objective of this study was to examine if separate venipunctures for intravenous (IV) access and laboratory studies decrease the rate of hemolysis and ED LOS. The study was conducted at an urban university level 1 trauma center with an ED volume of 55,000. We compared the rate of hemolysis and ED LOS before and after mandating the use of separate venipunctures for IV access and laboratory studies over 1 month. Venipuncture was performed utilizing either a 21 ga needle or an IV catheter (BD Insight Autoguard) with a needless vacutainer. The incidence of hemolysis was calculated and a Student's t test was used to compare groups. The potassium sample redraw and processing time was observed. Blood was aspirated from 315 patients using the SLD. A baseline hemolysis rate of 23.0% (16.7-29.1) was obtained, corrected to 6.7% after factoring a 29.2% redraw rate for critical potassium levels. In the following month, 2,564 samples were obtained using the butterfly needle with a hemolysis rate of 6.6% (5.5-7.5), corrected to 2.0% after applying the 29.2% redraw rate. Avoiding hemolysis, we saved 4.7% of our patients' 56 min of ED stay, and avoided 185 retests over the month. In conclusion, venipuncture from a butterfly needle decreases the rate of hemolysis and may decrease the overall ED LOS.
Department of Emergency Medicine, Beth Israel Deaconess Medical Center, One Deaconess Road, WCC-2, Boston, MA, 02215, USA, firstname.lastname@example.org.
This article was published in the following journal.
Name: Internal and emergency medicine
In vitro hemolysis is probably the most common pre-analytic problem in laboratory medicine. However, it introduces variation into results in unknown ways. Therefore, the purpose of this study was to a...
Blood collection through intravenous (IV) catheters is a common practice at emergency departments (EDs). This technique is associated with higher in vitro hemolysis rates and may even be amplified by ...
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This study aims to investigate the outcome of hemolysis frequency when a hemolysis point of care test is introduced in a emergency department.
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The application of discoveries generated by laboratory research and preclinical studies to the development of clinical trials and studies in humans. A second area of translational research concerns enhancing the adoption of best practices
The application of discoveries generated by laboratory research and preclinical studies to the development of clinical trials and studies in humans. A second area of translational research concerns enhancing the adoption of best practices.
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Methods of detecting genetic etiology in human traits. The basic premise of twin studies is that monozygotic twins, being formed by the division of a single fertilized ovum, carry identical genes, while dizygotic twins, being formed by the fertilization of two ova by two different spermatozoa, are genetically no more similar than two siblings born after separate pregnancies. (Last, J.M., A Dictionary of Epidemiology, 2d ed)