[Issues of blood collection using evacuated tubes and needle holders].

Upon collecting venous blood using evacuated tubes without sterilization, some operation procedures for tourniquets are increasing the risk for bacterial infection by back flow from tube to vein. This fact was widely indicated in 2003 and safety for blood collection was getting more and more recognition in Japan, although reported in Canada and U.S. about 30 years ago. Thereafter, the MHLW (Ministry of Health, Labor and Welfare) ordered blood collection tube manufacturers to revise directions for use in their package inserts--A tourniquet should be released before inserting a tube into a holder. It was followed by obligation of sterilization of all evacuated blood collection tubes. Concurrently, JCCLS (Japanese Committee for Clinical Laboratory Standards) examined safety of patients and healthcare workers, assurance of correct test results, practicality and so on and issued the Guideline for Standard Procedure of Blood Collection 1st Edition. It recommends changing a holder every patient and then throwing it away into a disposal container keeping the needle with the holder in order to prevent cross infection. In 2005, MHLW ordered manufacturers to revise package insert again, in consideration of responses of healthcare field such as launching the sale of single use holders or issuing the guideline. If sterilized tubes, single use holders, and needles with pressure-resistant rubber sleeve are used all together, tourniquets can be applied during blood collection.