Reduction of burden of hemolyzed specimens in a large urban emergency department: A real-world, five years’ experience

Abstract

In vitro hemolysis may jeopardize patient care because tests results generated using unsuitable specimens may lead to inappropriate patient management. The prevalence of hemolyzed specimens is high in the emergency department (ED). We previously showed that collecting blood by means of a closed system entailing manual aspiration of blood instead of using conventional evacuated systems was effective to cut-down by nearly half the rate of hemolysis. Aim of this real world study was to verify whether longterm replacement of standard evacuated blood collection systems may be really effective to reduce the burden of spurious hemolysis. Starting from May 2014 in the ED of our Hospital vacuum tubes were replaced with S-Monovette serum tubes. We compared data about hemolyzed specimens entered in the two years before the implementation of the new device (i.e., 2012 and 2013) and the two years after introducing SMonovette in manual aspiration mode (i.e. 2015 and 2016). The year 2014 was not considered due to mixed data. The rate of hemolyzed specimens decreased from 4.36% to 3.07% with the use of S-Monovette in manual aspiration mode (Chi squared, 183.8; P<0.001). The likelihood of obtaining hemolyzed specimens was hence reduced by approximately 30% (relative risk, 0.707), with an expected economic saving of approximately 510€/year. The results of this real-world study demonstrate that the use of an alternative closed device encompassing manual aspiration for drawing blood from intravenous catheters may reduce hemolyzed samples by approximately 30%, so representing a valuable perspective for safeguarding patient safety and improving ED efficiency.

Keywords

• hemolysis
• hemolyzed specimens
• preanalytical variability
• blood collection tube
• blood drawing