I have also seen this phenomenon and did a short study in order to identify
potential reasons.
The variables noted were :
blood taker JHOs / nurses / phlebotomists
system evacuated tube / syringe / both!
access Venflon / not venflon
The conclusions were almost non-existent, but it appeared that the
proficiency was as expected : phlebs > nurses > doctors (not statistically
tested), and I could not see a relationship with venflon use, but some of
that may be due to the lack of correct adapters at the time resulting in the
use of syringe+needle acces to venflon being applied.
I suspect that the data were not accurately collected, since the trial was
self-reported. Time and workload precluded a re-run.
My biggest concern however is the number of people (mostly doctors/students)
who use a syringe to get the blood and then inject the blood into the
evacuated system (Vacutainer) through the same needle. This seems to be the
'normal' practice taught (if that is the right word) by whoever introduces
phlebotomy into the curriculum of the medical student. I find the practice
abhorrent, not only because of the potential for mechanical haemolysis, but
also from a H&S risk to the operator.
The answer has to be education by proper trainers rather than on the hoof by
a colleague. We have instituted a training & supervision opportunity within
the phlebotomy area (with certificates issued) under the care of the senior
phlebotomist. This has been received quite favourably, the best response
being from GP nurses.
with best wishes
Richard
Richard Mainwaring-Burton
-----Original Message-----
From: Peter Stromberg [mailto:[log in to unmask]]
Sent: 25 November 2004 09:05
To: [log in to unmask]
Subject: Re: Haemolysed A/E samples
We see this as well. I am surprised its as low as 8%. The JHO's do the A/E
bloods and phlebotomists the routine ward bloods. JHO's ability to take
bloods has diminished markedly here and no-one formally teaches them. Look
at how lots of nurses take bloods...it will frighten you. Same resons apply.
>>> Ian Barlow <[log in to unmask]> 11/25/04 08:51am >>>
Dear colleagues,
A relatively high proportion (8.5%) of our A/E samples are haemolysed. In
contrast only 2.5% of routine ward samples are haemolysed.
Is this due to the collapsed nature of the patients, poor venesection
techniques or are there other explanations?
I seem to remember this being discussed previously - were there any
conclusions/explanations?
Best wishes,
Ian Barlow
Scunthorpe
UK
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