Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
Department of Nursing and Midwifery Education, Hamad Medical Corporation, Doha, Qatar.
Nurs Crit Care. 2024 Nov;29(6):1672-1679. doi: 10.1111/nicc.12941. Epub 2023 Jun 20.
Blood draws for laboratory investigations are essential for patient management in neonatal intensive care units (NICU). When blood samples clot before analysis, they are rejected, which delays treatment decisions and necessitates repeated sampling.
To decrease the incidence of rejected blood samples taken for laboratory investigation as a result of clotted sample.
This retrospective observational study used routine data on blood draws from preterm infants collected between January 2017 and June 2019 in a 112-cot NICU in Qatar. Quality improvement interventions to reduce the rate of clotted blood samples included: awareness raising and safe sampling workshops with NICU staff, involvement of the neonatal vascular access team, development of a complete blood count (CBC) sample collection pathway, review of sample collection equipment, introducing the Tenderfoot® heel lance, establishment of benchmarks and provision of dedicated blood extraction equipment.
First attempt blood draw occurred in 10 706 cases, representing a 96.2% success rate. In 427 (3.8%) cases, the samples were clotted requiring repeat collection. The overall rate of clotted specimens decreased from 4.8% in 2017 and 2018 to 2.4% in 2019, with odds ratios of 1.42 (95% confidence interval [CI] 1.13-1.78, p = .002), 1.46 (95% CI 1.17-1.81, p < .001) and 0.49 (95% CI 0.39-0.63, p < .001), respectively. The majority (87%-95%) of blood samples were by venepuncture using an intravenous (IV) catheter or the NeoSafe™ blood sampling device. Heel prick sampling was the second (2%-9%) most common method. Clotted samples were most frequently associated with needle use, 228 of 427 (53%), and IV cannula, 162 of 427 (38%), with odds ratios of 4.14 (95% CI 3.34-5.13, p < .001) and 3.11 (95% CI 2.51-3.86, p < .001), respectively.
Our interventions over 3 years were associated with reduced rates of sample rejection due to clotting, and this led to improved patient experience through fewer repeated samplings.
The insights gained from this project can help to improve patient care. Interventions that reduce the rate of blood sample rejection by clinical laboratories can lead to economic savings, timelier diagnostic and treatment decisions, and contribute to an improved quality care experience for all critical care patients, irrespective of age, by reducing the need for repeated phlebotomy and the risk of related complications.
在新生儿重症监护病房（NICU）中，为了进行患者管理，必须进行血液检测。如果血液样本在分析前凝结，就会被拒收，这将延迟治疗决策，并需要再次进行采样。
降低因样本凝结而拒收用于实验室检测的血液样本的发生率。
这是一项回顾性观察性研究，使用了卡塔尔一家 112 张床位 NICU 中 2017 年 1 月至 2019 年 6 月期间早产儿的血液采集常规数据。减少凝结血样本率的质量改进干预措施包括：提高 NICU 工作人员对安全采血的认识和举办相关研讨会、新生儿血管通路团队的参与、制定完整的血细胞计数（CBC）样本采集路径、对样本采集设备进行审查、引入 Tenderfoot®足跟采血器、建立基准和提供专用采血设备。
首次尝试采血 10706 例，成功率为 96.2%。427 例（3.8%）的样本凝结，需要重复采集。总的来说，2017 年和 2018 年的凝结样本率为 4.8%，2019 年为 2.4%，优势比分别为 1.42（95%置信区间 [CI] 1.13-1.78，p=0.002）、1.46（95% CI 1.17-1.81，p<0.001）和 0.49（95% CI 0.39-0.63，p<0.001）。静脉穿刺采血是最常用的方法，其中 87%-95%是通过静脉内（IV）导管或 NeoSafe™采血设备进行的。足跟穿刺采血是第二常见的方法（2%-9%）。凝结样本最常与针头（228/427，53%）和 IV 套管（162/427，38%）有关，优势比分别为 4.14（95% CI 3.34-5.13，p<0.001）和 3.11（95% CI 2.51-3.86，p<0.001）。
我们在 3 年多的时间里采取的干预措施与样本凝结导致的拒收率降低有关，这通过减少重复采样，改善了患者的体验。
从这个项目中获得的见解可以帮助改善患者的护理。通过降低临床实验室拒收血液样本的比例，有助于减少因反复采血而产生的经济节约、更及时的诊断和治疗决策，并通过减少重复采血的需要和相关并发症的风险，为所有重症监护患者提供更好的护理体验，无论其年龄大小。
