Health and Social Care Institute, Teesside University, Middlesbrough, UK.
J Clin Nurs. 2019 Dec;28(23-24):4166-4176. doi: 10.1111/jocn.14997. Epub 2019 Aug 5.
Venepuncture involves the introduction of a needle into a vein to collect a representative blood sample for laboratory testing. In the pre-analytical phase, haemolysis (the rupturing of erythrocytes and release of their contents into the extracellular compartment) has safety, quality and cost implications. Training in correct venepuncture practice has the potential to reduce in vitro haemolysis rates, but the evidence for this notion has yet to be synthesised.
Systematic review (PRISMA Checklist).
Published studies on the effectiveness of venepuncture training on haemolysis rates were searched in relevant databases. The McMaster critical appraisal tool was used to assess methodological quality. The GRADE tool was used to evaluate the body of evidence in relation to the research questions. Implementation fidelity was also scrutinised in each study.
Eight out of 437 retrieved studies met the inclusion criteria. None were randomised controlled trials (RCT). Between-study heterogeneity in design, intervention characteristics and the biochemical threshold for haemolysis precluded a meta-analysis. Post-training reductions in haemolysis rates of between 0.4%-19.8% were reported in four of the studies, which developed their intervention according to a clear evidence base and included mentoring in the intervention. Rises in haemolysis rates of between 1.3%-1.9% were reported in two studies, while the intervention effect was inconsistent within two other studies.
There are no RCTS on the effectiveness of venepuncture training for reducing haemolysis rates, and findings from the existing uncontrolled studies are unclear. For a more robust evidence base, we recommend more RCTs with standardisation of haemolysis thresholds and training-related factors.
While venepuncture training is an important factor influencing quality of blood sample in clinical practice, more robust evidence is needed to make specific recommendations about training content for reduction of haemolysis rates. Standardisation of haemolysis thresholds would also enable future meta-analyses.
静脉穿刺术是将一根针插入静脉，以采集具有代表性的血液样本进行实验室检测。在分析前阶段，溶血（红细胞破裂并将其内容物释放到细胞外间隙）会对安全性、质量和成本产生影响。正确的静脉穿刺术培训有可能降低体外溶血率，但这一观点的证据尚未被综合。
系统评价（PRISMA 清单）。
在相关数据库中搜索关于静脉穿刺术培训对溶血率影响的已发表研究。使用麦克马斯特批判性评估工具评估方法学质量。使用 GRADE 工具评估与研究问题相关的证据体。在每一项研究中，还对实施保真度进行了审查。
在 437 篇检索到的研究中，有 8 篇符合纳入标准。没有随机对照试验（RCT）。由于设计、干预措施特征和溶血的生化阈值在研究之间存在异质性，因此无法进行荟萃分析。四项研究报告了培训后溶血率降低了 0.4%-19.8%，这四项研究根据明确的证据基础制定了干预措施，并在干预措施中包含指导。两项研究报告了溶血率升高 1.3%-1.9%，而两项其他研究的干预效果不一致。
目前没有 RCT 研究静脉穿刺术培训对降低溶血率的效果，现有非对照研究的结果也不清楚。为了获得更可靠的证据基础，我们建议进行更多的 RCT，标准化溶血阈值和与培训相关的因素。
虽然静脉穿刺术培训是影响临床实践中血液样本质量的一个重要因素，但需要更多的证据来提出具体的培训内容建议，以降低溶血率。标准化溶血阈值也将使未来的荟萃分析成为可能。
