急诊科减少血样溶血实践的效果：实验室医学最佳实践系统评价和荟萃分析。
Effectiveness of practices to reduce blood sample hemolysis in EDs: a laboratory medicine best practices systematic review and meta-analysis.
机构信息
Battelle Centers for Public Health Research and Evaluation, USA.
出版信息
Clin Biochem. 2012 Sep;45(13-14):1012-32. doi: 10.1016/j.clinbiochem.2012.08.002.
Abstract
OBJECTIVE
To complete a systematic review of emergency department (ED) practices for reducing hemolysis in blood samples sent to the clinical laboratory for testing.
RESULTS
A total of 16 studies met the review inclusion criteria (12 published and 4 unpublished). All 11 studies comparing new straight needle venipuncture with IV starts found a reduction in hemolysis rates, [average risk ratio of 0.16 (95% CI=0.11-0.24)]. Four studies on the effect of venipuncture location showed reduced hemolysis rates for the antecubital site [average risk ratio of 0.45 (95% CI=0.35-0.57].
CONCLUSIONS
Use of new straight needle venipuncture instead of IV starts is effective at reducing hemolysis rates in EDs, and is recommended as an evidence-based best practice. The overall strength of evidence rating is high and the effect size is substantial. Unpublished studies made an important contribution to the body of evidence. When IV starts must be used, observed rates of hemolysis may be substantially reduced by placing the IV at the antecubital site.
摘要
目的
系统评价急诊科（ED）减少血液样本溶血的操作实践，这些样本将被送往临床实验室进行检测。
结果
共有 16 项研究符合综述纳入标准（12 项已发表，4 项未发表）。所有 11 项比较新直针静脉穿刺与静脉切开术的研究均发现溶血率降低，[平均风险比为 0.16（95%CI=0.11-0.24）]。4 项关于静脉穿刺部位的研究表明，肘前窝部位的溶血率降低，[平均风险比为 0.45（95%CI=0.35-0.57）]。
结论
与静脉切开术相比，使用新直针静脉穿刺术可有效降低急诊科的溶血率，建议将其作为循证最佳实践。证据的总体强度评级高，效果显著。未发表的研究为证据体系做出了重要贡献。如果必须进行静脉切开术，将静脉置于肘前窝可显著降低观察到的溶血率。
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