Ong Marcus E H, Chan Yiong Huak, Lim Chin Siah
Department of Emergency Medicine, Singapore General Hospital, Singapore.
Ann Acad Med Singap. 2008 Sep;37(9):745-8.
Haemolysis of blood samples is a common problem encountered in the Emergency department (ED). It leads to inaccurate blood results and has cost implications as blood samples very often have to be retaken. The purpose of our study was to determine which factors in blood sampling were associated with higher rates of haemolysis.
An observational convenience sample of all patients presenting to the ED requiring blood urea and electrolyte (UE) analysis were eligible for our study. Questionnaires were distributed to the doctors and nurses conducting blood sampling to determine the method used and outcome data were collected after the samples were processed.
Out of 227 UE samples analysed, 45 (19.8%) were haemolysed. Various factors, including method (IV cannulation or venepuncture), system (syringe or vacutainer), operator, rate of blood flow, difficulty of cannulation/venepuncture and source of blood (arterial or venous), were analysed, but their effects on haemolysis were not statistically significant (P >0.05). However, the use of the vacutainer system was associated with the highest rates of haemolysis [adjusted odds ratio (OR), 6.0; 95% confidence interval (CI), 2.3 to 15.1].
We found blood sampling with the vacutainer system to have increased rates of haemolysis. This could potentially change attitudes towards equipment used for blood sampling in the ED.
血液样本溶血是急诊科常见的问题。它会导致血液检测结果不准确，并且由于经常需要重新采集血样，会产生成本问题。我们研究的目的是确定采血过程中的哪些因素与较高的溶血率相关。
所有到急诊科就诊且需要进行血尿素和电解质（UE）分析的患者构成的观察性便利样本符合我们的研究条件。向进行采血的医生和护士发放问卷，以确定所使用的方法，并在样本处理后收集结果数据。
在分析的227份UE样本中，45份（19.8%）发生了溶血。对包括方法（静脉留置针穿刺或静脉穿刺）、采血器具（注射器或真空采血管）、操作人员、血流速度、穿刺难度以及血液来源（动脉血或静脉血）等各种因素进行了分析，但它们对溶血的影响无统计学意义（P>0.05）。然而，使用真空采血管系统与最高的溶血率相关[校正比值比（OR）为6.0；95%置信区间（CI）为2.3至15.1]。
我们发现使用真空采血管系统采血时溶血率增加。这可能会潜在地改变对急诊科用于采血的设备的看法。
