Kennedy C, Angermuller S, King R, Noviello S, Walker J, Warden J, Vang S
Emergency Department, Medical Center, Columbus, Georgia, USA.
J Emerg Nurs. 1996 Dec;22(6):566-9. doi: 10.1016/s0099-1767(96)80213-3.
The primary purpose of this study was to compare the rate of hemolysis in blood samples obtained by an i.v. catheter versus the rate in samples obtained by venipuncture (Vacutainer tubes and needles; Becton Dickinson Vacutainer Systems, Franklin Lakes, N.J.). Subsequently, variance in i.v. catheter diameter was reviewed to determine its influence on hemolysis rate of i.v. catheter aspirate.
A randomized, prospective study was used to evaluate hemolysis differences between the two blood sampling methods. A descriptive, retrospective review of study data was used to evaluate the importance of the variable i.v. catheter diameter.
The study group consisted of patients who came to the emergency department and required both an i.v. infusion and blood sampling for determination of electrolyte levels and complete blood cell count. Pediatric patients (younger than 16 years) were excluded. The ED patients who qualified for the study were randomly assigned to either group A or B. The blood samples for patients in the A group were obtained through the i.v. catheter at the time of insertion. The i.v. catheters ranged in size from 24 gauge to 14 gauge. Patients in the B group also had insertion of an i.v. line, but their blood samples were obtained by Vacutainer venipuncture at a separate site. The Vacutainer needle was standardized at 21 gauge. All blood samples were collected by one of seven experienced ED nurses. The nurse who collected the blood sample for an study patient was responsible for result follow-up.
A total of 165 patients participated in the study; 87 patients were assigned to the A (i.v.) group, and 78 patients participated in the B (venipuncture) group. In group A a total of 12 of 87 (13.7%) blood samples hemolyzed. Hemolysis occurred in 3 of 78 (3.8%) of group B samples. These findings were statistically significant (p < 0.05). When we examined the variable i.v. catheter diameter, we noted a lower incidence of hemolysis with larger catheter diameters: 24 gauge (100%), 22 gauge (25%), 20 gauge (15%), 18 gauge (10%), 16 gauge (0%), 14 gauge (0%). This findings was statistically significant (p < 0.05).
Hemolysis of blood samples obtained by an i.v. catheter was significantly higher than when blood was obtained through Vacutainer venipuncture. There is an inverse correlation between i.v. catheter diameter and the rate of hemolysis.
本研究的主要目的是比较经静脉留置导管采集的血样溶血率与经静脉穿刺（使用真空采血管和采血针；BD真空采血管系统，新泽西州富兰克林湖市的百特公司）采集的血样溶血率。随后，回顾静脉留置导管直径的差异，以确定其对静脉留置导管采集血样溶血率的影响。
采用随机前瞻性研究评估两种采血方法之间的溶血差异。对研究数据进行描述性回顾性分析，以评估静脉留置导管直径这一变量的重要性。
研究组由前来急诊科且需要静脉输液和采血以测定电解质水平及全血细胞计数的患者组成。儿科患者（16岁以下）被排除。符合研究条件的急诊科患者被随机分为A组或B组。A组患者的血样在静脉留置导管插入时采集。静脉留置导管的尺寸范围为24号至14号。B组患者也插入了静脉输液管，但其血样在另一个部位通过真空采血管静脉穿刺采集。真空采血管采血针标准化为21号。所有血样均由7名经验丰富的急诊科护士之一采集。为研究患者采集血样的护士负责结果随访。
共有165名患者参与研究；87名患者被分配到A（静脉留置导管）组，78名患者参与B（静脉穿刺）组。A组87份血样中有12份（13.7%）发生溶血。B组78份血样中有3份（3.8%）发生溶血。这些结果具有统计学意义（p<0.05）。当我们检查静脉留置导管直径这一变量时，我们注意到导管直径越大，溶血发生率越低：24号（100%）、22号（25%）、20号（15%）、18号（10%）、16号（0%）、14号（0%）。这一结果具有统计学意义（p<0.05）。
经静脉留置导管采集的血样溶血率显著高于通过真空采血管静脉穿刺采集的血样。静脉留置导管直径与溶血率呈负相关。
