Nursing blood specimen collection techniques and hemolysis rates in an emergency department: analysis of venipuncture versus intravenous catheter collection techniques.

INTRODUCTION

Re-collection of hemolyzed blood specimens delays patient care in overcrowded emergency departments. Our emergency department was unable to meet a benchmark of a 2% hemolysis rate for the collection of blood samples. Our hypothesis was that hemolysis rates of blood specimens differ dependent on the blood collection technique by venipuncture or intravenous catheter draw.

METHODS

A prospective, cross-over study of blood collection techniques in a 64,000 annual visit, community teaching hospital emergency department was conducted. Eleven experienced registered nurses with more than 2 years' ED experience completed a standardized phlebotomy retraining session. Registered nurses were randomly assigned to collect samples via intravenous catheters or venipuncture. After nurses collected 70 samples, they then collected samples via the other method. A standardized data collection form was completed. Blood samples were processed and assessed for hemolysis using standard procedures by laboratory technicians who were blinded to the collection method.

RESULTS

A total of 853 valid samples were collected; 355 samples (41.6%) were drawn via venipuncture and 498 samples (58.4%) were drawn through an intravenous catheter. Of these, 28 intravenous catheter samples (5.6%) were found to be hemolyzed, whereas only 1 venipuncture sample (0.3%) was hemolyzed. This finding was significant (x2 < 0.001).

DISCUSSION

Experienced ED nurses can reduce the number of hemolyzed specimens by collecting via venipuncture instead of through intravenous catheters. This practice should be considered as standard of care in the ED setting.

LIMITATIONS

Total samples by nurse were affected by EMS patients arriving with existing intravenous lines, and nurse schedules affected total samples per nurse.