Reply

Abstract

Thank you for your interest and comments regarding our recent article, “Nursing Blood Specimen Collection Techniques and Hemolysis Rates in an Emergency Department: Analysis of Venipuncture Versus Intravenous Catheter Collection Techniques.” This article deals with a complex issue that most health care systems are addressing, and we believe our results will assist in the development of a rational approach. The development and use of benchmarks in health care have, in general, improved outcomes through standardization of procedures. A discussion on the utility of benchmarks is beyond the scope of our study. Our study enrolled only that subset of ED patients who required an intravenous catheter and had blood tests ordered. These patients tend to be sicker than most, and a delay in obtaining laboratory results because of hemolysis might have a serious impact on their ED care and length of stay. There is an additional venipuncture in some patients to prevent significant delays in potentially critical laboratory results. Exactly what percent is acceptable is uncertain, so we used the currently existing benchmark as a starting point. We do not support inflicting unnecessary pain on patients. However, when the choices and rationale are presented to the patient, they have chosen the 2-stick method. Trained phlebotomists have achieved hemolysis rates as low as 1.6% in a previous study.1.Burns ER Yoshi Kawa N Hemolysis in serum samples drawn by emergency department personnel versus laboratory phlebotomist.Laboratory Medicine. 2002; 33: 378-380Crossref Scopus (74) Google Scholar Emergency departments in these institutions have used dedicated phlebotomists to minimize hemolysis and specimen recollection and have removed phlebotomy from the responsibilities of the nursing staff. In this setting, there would be an automatic second stick while the registered nurse (RN) is starting the intravenous line. Our study confirms this procedure but achieves similar results with our ED staff. At our institution, no additional RN time is needed to perform the phlebotomy because these duties usually are performed by emergency nursing assistants trained in venipuncture collection techniques. We also would like to point out that delays have been avoided with decreased hemolysis rates as a result of this study. We have realized a decreased workload for core laboratory staff, who no longer have to call the emergency department for re-collection and spend time re-analyzing the specimen; for ED secretarial staff, who no longer have to get the re-collection message to the primary RN; and for nursing staff, who no longer have to re-collect the specimens. In this era of ED overcrowding, any delay in obtaining laboratory results would prolong patient length of stay. ED staff can affect laboratory turnaround time if correct blood specimen collection techniques are applied and hemolysis is reduced. In our last ED-Lab Committee meeting, the laboratory supervisor mentioned that their staff sees the emergency department as so independent now that they get confused when ED personnel call for someone to perform a difficult stick and haven’t made an attempt yet to get a specimen. This research project has not only affected patient care but has positively affected the relationship between the emergency department and the Core Lab. Future studies are needed to determine if intravenous catheter size or location are associated with lower hemolysis rates.