Corbo Jill, Fu Lequan, Silver Matthew, Atallah Hany, Bijur Polly
Department of Emergency Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Acad Emerg Med. 2007 Jan;14(1):23-7. doi: 10.1197/j.aem.2006.06.053. Epub 2006 Nov 10.
To assess the utility of a peripheral saline lock device (SLD) as an alternative to a second venipuncture for obtaining selected blood samples.
This prospective study used a comparative design and was conducted in an urban emergency department (ED). Adult patients with an existing SLD in place who required serial phlebotomy were eligible for inclusion in the study. Each subject had blood samples obtained by venipuncture (control) with a Vacutainer adapter according to standard protocols. Within 5 minutes of obtaining the control samples, a sample was obtained from the patients' SLDs; a tourniquet was applied proximal to the intravenous line, a 5-mL waste portion was obtained, and a Vacutainer adapter was placed to draw specimens for testing. Each of the paired samples was analyzed for hematocrit, electrolytes, and cardiac enzymes. The Bland-Altman method was used to analyze the concordance between each pair of measurements. Paired t-tests for each of the eight laboratory tests were used to assess whether the values were statistically different from each other. The 95% limits of agreement around the mean differences were calculated. Differences between SLD aspirates and venipuncture aspirates also were compared with the federal regulatory standards that ensure reliable and accurate laboratory testing.
Eighty-one patients were eligible for the study; in 73 (90.1%; 95% confidence interval [CI] = 81.5% to 95.6%) of the patients, the SLD could be aspirated for testing. The paired t-tests indicated that there were no statistically significant differences between the mean values of the two methods of testing. Of the 584 paired values analyzed, 35 (6.0%; 95% CI = 4.3% to 8.2%) exceeded the Bland-Altman limits of agreement, and 43 (7.4%; 95% CI = 5.4% to 9.8%) fell outside the acceptable range determined by the federal regulation of clinical laboratories. Of those values that exceeded the acceptable Bland-Altman limits of agreement, none would have resulted in clinical intervention.
Aspirating blood via an SLD is an acceptable method of obtaining serial laboratory values in a group of stable, consenting adult ED patients.
评估外周生理盐水锁装置（SLD）作为获取特定血样的二次静脉穿刺替代方法的效用。
这项前瞻性研究采用对比设计，在一家城市急诊科（ED）进行。有现成SLD且需要连续静脉采血的成年患者符合纳入本研究的条件。每位受试者按照标准规程通过使用真空采血管适配器进行静脉穿刺（对照）获取血样。在获取对照样本的5分钟内，从患者的SLD中获取样本；在静脉输液管近端扎上止血带，先抽取5毫升弃去，然后接上真空采血管适配器采集用于检测的标本。对每对样本进行血细胞比容、电解质和心肌酶分析。采用Bland - Altman方法分析每对测量值之间的一致性。对八项实验室检测中的每一项进行配对t检验，以评估这些值彼此之间是否存在统计学差异。计算平均差异周围的95%一致性界限。还将SLD吸出物与静脉穿刺吸出物之间的差异与确保实验室检测可靠准确的联邦监管标准进行比较。
81名患者符合研究条件；其中73名（90.1%；95%置信区间[CI]=81.5%至95.6%）患者的SLD可用于抽吸检测。配对t检验表明，两种检测方法的平均值之间无统计学显著差异。在分析的584对数值中，35对（6.0%；95% CI = 4.3%至8.2%）超过了Bland - Altman一致性界限，43对（7.4%；95% CI = 5.4%至9.8%）超出了临床实验室联邦法规确定的可接受范围。在超出可接受的Bland - Altman一致性界限的值中，没有一个会导致临床干预。
对于一组稳定且同意参与的成年ED患者，通过SLD抽吸血液是获取连续实验室值的可接受方法。
