Vacutainer ve Enjektör ile Kan Alma Tekniğinin Hemoliz Oranına Etkisinin İncelenmesi

Year 2022, Volume: 7 Issue: 2, 307 - 312, 31.05.2022

Burcu Ceylan , Saliha Aksun , Ayşe Akbıyık , Derya Uzelli Yılmaz , Esra Akın Korhan

Abstract

Amaç: Bu araştırma enjektör ve vacutainer kullanılarak alınan venöz kanlarda hemoliz oranını belirlemek ve kan alma tekniğinin hemoliz gelişimi üzerindeki etkisini değerlendirmek amacıyla yapılmıştır.

Gereç ve Yöntem: Kesitsel ve analitik tipte olan bu araştırma, bir üniversite hastanesinin Kardiyoloji ve Anjiyo kliniklerine yatışı yapılan ve araştırmaya dahil edilme kriterlerine uyan 128 hasta ile yürütülmüştür. Rutin biyokimyasal tetkikleri istenilen bir grup hastadan enjektörle, diğer gruptaki hastalardan vacutainer ile kan alınmıştır.

Bulgular: Serum hemoliz düzeyi cinsiyetler arasında anlamlı olarak farklı değildir. Enjektör ve vacutainer ile alınan kan örneklerindeki serum hemoliz düzeyleri ile yaş ve Beden Kütle İndeksi arasında anlamlı korelasyon saptanmamıştır. Serum hemoliz düzeyi enjektör ile alınan kanlarda ortalama 0.11 g/dl iken vacutainer ile alınan kanlarda ortalama 0.06 g/dl olup bu fark istatistiksel olarak anlamlı bulunmamıştır.

Sonuç: Bu araştırmada enjektör ve vacutainer ile alınan kan örneklerindeki hemoliz oranları istatistiksel olarak anlamlı farklılık göstermemiştir. Ancak enjektörle alınan kanlarda ortalama hemoliz oranı vacutainer ile alınan kanlardan neredeyse iki kat fazladır, bu fark klinik açıdan anlamlı olabilmektedir.

Keywords

Kan alma, teknik, hemoliz, hemşirelik uygulaması

Examining the Effect of Venipuncture Technique with Vacutainer and Injector on the Rate of Hemolysis

Abstract

Objective: This study was conducted to determine hemolysis rates for venous blood samples drawn by injector and vacutainer holder and to assess the effect of the venipuncture technique on the process of hemolysis.

Material and Method: This cross-sectional and analytical study was conducted with 128 patients who were admitted to the Cardiology and Angio clinics of a university hospital and met the inclusion criteria. One group of patients who were to have routine biochemical tests underwent venipuncture with an injector, and another group with a vacutainer.

Results: The serum hemolysis level is not significantly different by gender. No significant correlation was found between blood serum hemolysis levels and age or Body Mass Index with blood drawn with an injector or with a vacutainer. While the serum hemolysis level was on average 0.11 g/dl in blood drawn with an injector, the level in blood drawn with a vacutainer was 0.06 g/dl; the difference was not statistically significant.

Conclusion: This study revealed that there was no statistically significant difference between hemolysis rates in blood drawn with an injector or with a vacutainer. However, the hemolysis rates in blood drawn with an injector were almost twice the rates noted in blood drawn with a vacutainer, and this difference may be clinically significant.

Keywords

Hemolysis, nursing practice, phlebotomy, technique, venipuncture

References

• Cadacio C, Nachamkin I. A novel needle-free blood draw device for sample collection from short peripheral catheters. J Infus Nurs. 2017;40(3):156-162.
• Makhumula‐ Nkhoma N, Weston KL, McSherry R., et al. The impact of venepuncture training on the reduction of pre‐ analytical blood sample haemolysis rates: A systematic review. J Clin Nurs. 2019;28(23-24):4166-4176.
• Heireman L, Van Geel P, Musger L., et al. Causes, consequences and management of sample hemolysis in the clinical laboratory. Clin Biochem. 2017;50: 1317- 1322.
• Marques-Garcia F. Methods for hemolysis interference study in laboratory medicine–a critical review. EJIFCC. 2020;31(1):85-97.
• Plebani M. Quality Indicators to Detect Pre-Analytical Errors in Laboratory Testing. Clin Biochem Rev. 2012;33(3):85-88.
• Aksit MZ, Yalcın H, Bilgi PT., et al. [Evaluation of causes of preanalytical rejections in our emergency laboratory]. The Journal of Tepecik Education and Research Hospital. 2016;26(1):41-45.
• Chawla R, Goswami B, Singh B., et al. Evaluating laboratory performance with quality indicators. Laboratory Medicine. 2010;41(5):297-300.
• Lippi G, Avanzini P, Cervellin G. Prevention of hemolysis in blood samples collected from intravenous catheters. Clin Biochem. 2013;46(7-8):561-4.
• Plebani M, Sciacovelli L, Aita, A., et al. Quality indicators to detect pre-analytical errors in laboratory testing. Clin Chim Acta. 2014;15:44- 48.
• Dorotić A, Antončić D, Radišić Biljak V., et al. Hemolysis from a nurses’ standpoint– survey from four Croatian hospitals. Biochem Med (Zagreb). 2015;25(3):393-400.
• Guvenc Y. [Sample rejection in outpatient, ınpatient and emergency bloods: traning and new approaches]. Journal of Turkish Clinical Biochemistry. 2017;15(3):119-128.
• Yigitbası T, Sentürk BA, Baskın Y., et al. [The Effect of Hemolysis on Routine Emergency Biochemistry Tests]. Journal of Turkish Clinical Biochemistry. 2010;8(3):105-110.
• Wollowitz A, Bijur PE, Esses, D., et al. Use of butterfly needles to draw blood is independently associated with marked reduction in hemolysis compared to intravenous catheter. Acad Emerg Med. 2013;20(11):1151-1155.
• Coventry LL, Jacob AM, Davies HT., et al. Drawing blood from peripheral intravenous cannula compared with venepuncture: A systematic review and meta‐ analysis. J Adv Nurs. 20192019;75(11):2313- 2339.
• Lippi G, Salvagno GL, Montagnana M., et al. Influence of the needle bore size on platelet count and routine coagulation testing. Blood Coagul Fibrinolysis. 2006;17(7:557-561.
• Lippi G, Salvagno GL, Montagnana M., et al. Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing. Clin Chem Lab Med. 2006;44(8):1009-1014.
• Portney LG, Watkins MP. Power analysis and determination of sample size. In: Foundations of clinical research Applications to practice. Norwalk, Connecticut; Appleton & Lange, 1993:652-661.
• Simundic AM, Bölenius K, Cadamuro J., et al. Joint EFLMCOLABIOCLI Recommendation for venous blood sampling: v 1.1, June 2018. Clin Chem Lab Med. 2018;56(12):2015-2038.
• World Health Organization guidelines on drawing blood: best practices in phlebotomy.https://apps.who.int/iris/bitstream/handle/10665/44294/9789241599221_eg.pdf;jsessionid=F3DF669FBF5C59873C092FF4257209CE?sequence=1 Published 2010. Accessed June 1, 2020.
• Giavarina D, Lippi G. Blood venous sample collection: Recommendations overview and a checklist to improve quality. Clin Biochem. 2017;50(10-11):568-573.
• Cadamuro J, von Meyer A, Wiedemann H., et al. Hemolysis rates in blood samples: differences between blood collected by clinicians and nurses and the effect of phlebotomy training. Clin Chem Lab Med. 2016;54(12):1987- 1992.
• Lowe G, Stike R, Pollack, M., et al. Nursing blood specimen collection techniques and hemolysis rates in an emergency department: analysis of venipuncture versus intravenous catheter collection techniques. J Emerg Nurs. 2008;34(1):26-32.
• Barnaby DP, Wollowitz A, White D., et al. Generalizability and effectiveness of butterfly phlebotomy in reducing hemolysis. Acad Emerg Med. 2016;23(2):204-207.
• Mrazek C, Simundic AM, Wiedemann H., et al. The relationship between vacuum and hemolysis during catheter blood collection: a retrospective analysis of six large cohorts. Clin Chem Lab Med. 2017;55(8):1129-1134.