毛细血管采血增加儿科住院患者分析前误差风险：观察性临床研究。

Capillary blood sampling increases the risk of preanalytical errors in pediatric hospital care: Observational clinical study.

机构信息

Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.

Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.

出版信息

J Spec Pediatr Nurs. 2021 Oct;26(4):e12337. doi: 10.1111/jspn.12337. Epub 2021 May 7.

DOI:10.1111/jspn.12337

PMID:33960595

Abstract

PURPOSE

The blood sampling procedure is complex and prone to failure, as reflected by preanalytical errors in pediatric hospital care. The primary aim was to evaluate if the risk of preanalytical errors was higher with capillary blood sampling than with venous blood sampling, and secondary, explore specific factors associated with preanalytical errors, both overall and stratified by capillary and venous blood sampling.

DESIGN AND METHODS

This observational pediatric hospital study collected outcomes from medical records and blood sampling surveys from year 2014 to 2016. The risk of preanalytical errors was analyzed with adjusted-odds ratio (adj-OR) by multivariable logistic regression with 95% confidence intervals (CIs).

RESULTS

Overall, 128 (13%) preanalytical errors were identified among 951 blood samples. The proportion and adj-OR of errors was significantly higher in capillary compared with venous blood samples, 72 (20%) of 354 versus 56 (9.4%) of 597, p = .001, adj-OR 2.88 (CI 1.79-4.64). Blood collection with multiple sample tubes was significantly associated with increased risk of preanalytical errors (n = 97 of 601, 16%), while log weight (kg) significantly decreased the risk of preanalytical errors adj-OR 0.66 (CI 0.50-0.86), indicating a protective effect of increasing weight. However, stratified analyses indicated a protective effect of increasing log weight for venous blood sampling adj-OR 0.52 (CI 0.38-0.72), but not capillary blood sampling, adj-OR 1.08 (CI 0.76-1.55).

CONCLUSION

This study indicates that capillary blood sampling collection increases the risk of preanalytical errors. Further, a child's increasing body weight reduced the risk of preanalytical errors, while multiple sample tube collections significantly increased the risk of preanalytical errors.

PRACTICE IMPLICATIONS

This new information may help nurses improve their knowledge concerning blood sampling collection in pediatrics. Altogether, this study also indicates that implementing more venous blood sampling and improve the cases of capillary sampling could reduce the number of preanalytical errors in pediatric hospitals.

摘要

目的

采血过程复杂且容易失败，这反映出儿科医院护理中存在分析前误差。本研究的主要目的是评估毛细血管采血与静脉采血相比，前者发生分析前误差的风险是否更高，其次是探索总体及按毛细血管和静脉采血分层后与分析前误差相关的具体因素。

设计和方法

本项观察性儿科医院研究收集了 2014 年至 2016 年期间的病历和采血调查结果。采用多变量逻辑回归分析，用 95%置信区间（CI）计算调整后的优势比（adj-OR）来分析分析前误差的风险。

结果

在 951 份血样中，共发现 128 例（13%）分析前误差。与静脉血样相比，毛细血管血样的误差比例和 adj-OR 显著更高，354 份毛细血管血样中有 72 例（20%），597 份静脉血样中有 56 例（9.4%），p=0.001，adj-OR 为 2.88（95%CI 1.79-4.64）。使用多个采血管采集血液与分析前误差风险增加显著相关（n=601，97 例，16%），而对数体重（kg）则显著降低分析前误差的风险 adj-OR 为 0.66（95%CI 0.50-0.86），表明体重增加具有保护作用。然而，分层分析表明，静脉血样的对数体重增加具有保护作用，adj-OR 为 0.52（95%CI 0.38-0.72），但毛细血管血样无此作用，adj-OR 为 1.08（95%CI 0.76-1.55）。