Comparison of blood collection with injector and venipuncture adapter in terms of hemolysis and test results in patients applying to the emergency department
DOI:
https://doi.org/10.5281/zenodo.14774718Keywords:
Injector, venipuncture adapter, hemolysisAbstract
Aim: Injector blood collection has been identified as the main cause of in vitro hemolysis. Blood collection with a venipuncture adapter has been associated with potential benefits in reducing hemolysis rates during blood collection. In our study, we aimed to compare the number of hemolyzed samples and the parameters most affected by hemolysis between the two methods.
Materials and Methods: Two tubes of blood were collected from the volunteer participants who applied to the emergency department, one with a syringe and one with an intravenous adapter. Serum samples of 100 patients were divided into two groups as injector and intravenous adapter blood samples and analyzed by spectrophotometric method under the same conditions. Hemolysis rates and results of hemolysis-affected tests were compared for both groups.
Results: The total hemolysis rate and the number of tests affected by hemolysis were significantly higher in samples collected with the syringe than in those collected with the venipuncture adapter (p<0.001 for both). Total protein (p=0.018), urea (p=0.031), lactate dehydrogenase (p=0.001), aspartate aminotransferase (p<0.001), alanine aminotransferase (p=0.001) and potassium (p=0.004) levels were significantly higher in the injector group, while sodium (p=0.006) level was significantly higher in the vascular access adapter group.
Conclusions: The use of appropriate venipuncture adapters instead of syringes in emergency departments may have significant implications for laboratory test safety and quality. It is important for healthcare professionals to consider the potential impact on hemolysis rates, patient comfort and reliability of analytical results when choosing the most appropriate blood collection method.
References
Blagojević I, Bojanin D, Ristovski-Kornic D, Marković J, Aleksić P, Subošić B, et al. The role of laboratory biomarkers in diagnostics and management of covid-19 patients. Arhiv Za Farmaciju. 2022;72(2):231-246.
Ponti G, Maccaferri M, Ruini C, Tomasi A, Özben T. Biomarkers associated with covid-19 disease progression. Critical Reviews in Clinical Laboratory Sciences. 2020;57(6):389-399.
Eliza D, Dobreanu M. Risk management in clinical laboratory: from theory to practice. Acta Medica Marisiensis. 2015;61(4):372-377.
Gresele P, Falcinelli E, Bury L. Laboratory diagnosis of clinically relevant platelet function disorders. International Journal of Laboratory Hematology. 2018:40(S1):34-45.
Hinds L, Brown C, Clark S. Point of care estimation of haemoglobin in neonates. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2007;92(5):F378-F380.
Fearon M. The laboratory diagnosis of hiv infections. Canadian Journal of Infectious Diseases and Medical Microbiology. 2005;16(1):26-30.
Mercatali L, Serra P, Miserocchi G, Spadazzi C, Liverani C, De Vita A, et al. Dried blood and serum spots as a useful tool for sample storage to evaluate cancer biomarkers. Journal of Visualized Experiments. 2018;(136).
Yousefichaijan P, Dorreh F, Ziaei E, Pakniyat A. Distribution of abnormal laboratory tests in patients with dehydration due to gastroenteritis: a medical audit study. Journal of Comprehensive Pediatrics. 2016;7(4).
Whitehead N, Williams L, Meleth S, Kennedy SM, Ubaka-Blackmoore N, Geaghan SM,et al. Interventions to prevent iatrogenic anemia: a laboratory medicine best practices systematic review. Critical Care. 2019;23(1).
Ginn E, Lee B. Reducing neonatal phlebotomy blood losses through the accurate calculation of minimum test volume requirements. Annals of Clinical Biochemistry International Journal of Laboratory Medicine. 2021;58(6):593-598.
Pasqualetti S, Aloisio E, Birindelli S, Dolci A, Panteghini M. Impact of total automation consolidating first-line laboratory tests on diagnostic blood loss. Clinical Chemistry and Laboratory Medicine (Cclm). 2019;57(11):1721-1729.
Lippi G, Avanzini P, Musa R, Sandei F, Aloe R, Cervellin G. Evaluation of sample hemolysis in blood collected by s-monovetter using vacuum or aspiration mode. Biochemia Medica. 2013;64-69.
Azman W, Omar J, Koon T, Ismail T. Hemolyzed specimens: major challenge for identifying and rejecting specimens in clinical laboratories. Oman Medical Journal. 2019;34(2):94-98.
Du Z, Liu J, Zhang H, Bao B, Zhao R, Jin Y. Determination of hemolysis index thresholds for biochemical tests on siemens advia 2400 chemistry analyzer. Journal of Clinical Laboratory Analysis. 2019;33(4).
Jia Y, Tian M, Wang T, Wu S, Zhu B, Cao Z. The estimation of postmortem serum urea via the ultrafiltration of hemolyzed blood. Journal of Forensic Sciences. 2020;65(5):1761-1766.
Kosecki P, Brooke P, Abbott L, Canonico E. The effect of sample hemolysis on blood ethanol analysis using headspace gas chromatography. Journal of Forensic Sciences. 2021;66(3):1136-1142.
Koga M, Okumiya T, Ishibashi M. Sample transport and/or storage can cause falsely low hba1c levels in blood cells measured by enzymatic assay. Diabetology International. 2019;11(2):155-157.
Islamzada E, Matthews K, Lamoureux E, Duffy S, Scott M, Ma H. Blood unit segments accurately represent the biophysical properties of red blood cells in blood bags but not hemolysis. Transfusion. 2021;62(2):448-456.
Penoyer D, Bennett M, Geddie P, Nugent A, Volkerson T. Evaluation of processes, outcomes, and use of midline peripheral catheters for the purpose of blood collection. British Journal of Nursing. 2021;30(2):S24-S32.
Ruth N, Wand C, Doyle K, Noguez J. Evaluation of a new venous catheter blood draw device and its impact on specimen hemolysis rates. Practical Laboratory Medicine. 2018;10:38-43.
Psaila J, Parsons T, Hahn S, Fichera L. Prospective study evaluating whether standard peripheral intravenous catheters can be used for blood collection throughout hospital stay. Journal of Infusion Nursing. 2023;46(1):43-47.
Prete C, Lanci A, Cocchia N, Freccero F, Maio CD, Castagnetti C, et al. Venous blood gas parameters, electrolytes, glucose and lactate concentration in sick neonatal foals: direct venipuncture versus push‐pull technique. Equine Veterinary Journal. 2020;53(3):488-494.
Eijkelenkamp K, Geel E, Kerstens M, Faassen MV, Kema IP, Links TP, et al. Blood sampling for metanephrines comparing venipuncture vs. indwelling intravenous cannula in healthy subjects. Clinical Chemistry and Laboratory Medicine (Cclm). 2020;58(10):1681-1686.
Heyer N, Derzon J, Winges L, Shaw C, Mass D, Snyder SR, et al. Effectiveness of practices to reduce blood sample hemolysis in eds: a laboratory medicine best practices systematic review and meta-analysis. Clinical Biochemistry. 2012;45(13-14):1012-1032.
Baird G. Preanalytical considerations in blood gas analysis. Biochemia Medica. 2013;19-27.
Welch E, Crooks M, Hart S. Agreement between blood draw techniques for assessing platelet activation by flow cytometry. Platelets. 2018:30(4);530-534.
Lippi G, Salvagno G, Brocco G, Guidi G. Preanalytical variability in laboratory testing: influence of the blood drawing technique. Clinical Chemistry and Laboratory Medicine (Cclm). 2005;43(3).
Grzych G, Roland E, Beauvais D, Maboudou P, Lippi G. Leukocytosis interference in clinical chemistry: shall we still interpret test results without hematological data? Journal of Medical Biochemistry. 2019;39(1):66-71.
Coene K, Roos A, Scharnhorst V. Iatrogenic anemia/twenty-five million liters of blood into the sewer: comment. Journal of Thrombosis and Haemostasis. 2015;13(6):160-1161.
Ashavaid T, Dandekar S, Khodaiji S, Ansari M, Singh A. Influence of method of specimen collection on various preanalytical sample quality indicators in edta blood collected for cell counting. Indian Journal of Clinical Biochemistry. 2009;24(4):356-360.
Dorotić A, Antončić D, Biljak V, Nedić D, Beletić A. Hemolysis from a nurses’ standpoint – survey from four croatian hospitals. Biochemia Medica. 2015;393-400.
Lippi G, Salvagno G, Blanckaert N, Giavarina D, Green S, Kitchen S, et al. Multicenter evaluation of the hemolysis index in automated clinical chemistry systems. Clinical Chemistry and Laboratory Medicine (Cclm). 2009;47(8).
Alcantara J, Alharbi B, Almotairi Y, Alam M, Muddathir,A, Alshaghdali K. Analysis of preanalytical errors in a clinical chemistry laboratory: a 2-year study. Medicine. 2022;101(27):e29853.
Ünlü B, Küme T, Emek M, Örmen M, Doğan Y, Şişman AR, et al. Effect of blood cell subtypes lysis on routine biochemical tests. Journal of Medical Biochemistry. 2018;37(1):67-77.
Liu X, Liu X, Mao M, Yijun L, Wang J, Dai S. The automated processing algorithm to correct the test result of serum neuron‐specific enolase affected by specimen hemolysis. Journal of Clinical Laboratory Analysis. 2021;35(9).
Peng Z, Xiang W, Zhou J, Cao J, Li Z, Gao H, et al. Hemolytic specimens in complete blood cell count: red cell parameters could be revised by plasma free hemoglobin. Journal of Clinical Laboratory Analysis. 2020;34(6).
Tian G, Wu Y, Jin X, Zeng Z, Gu X, Li T, et al. The incidence rate and influence factors of hemolysis, lipemia, icterus in fasting serum biochemistry specimens. Plos One. 2022;17(1):e0262748.
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Journal of Social and Analytical Health
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
JSOAH is licensed under a 