Incorrect order of draw could be mitigate the patient safety: a phlebotomy management case report

被引:25
作者
Lima-Oliveira, Gabriel [1 ,2 ,3 ,4 ]
Lippi, Giuseppe [5 ]
Salvagno, Gian Luca [1 ]
Montagnana, Martina [1 ]
Picheth, Geraldo [2 ]
Guidi, Gian Cesare [1 ,2 ]
机构
[1] Univ Verona, Dept Life & Reprod Sci, Lab Clin Biochem, I-37100 Verona, Italy
[2] Univ Fed Parana, Dept Med Pathol, Postgrad Program Pharmaceut Sci, BR-80060000 Curitiba, Parana, Brazil
[3] MERCOSUL Sect Comm Clin Anal & Vitro Diagnost, Rio De Janeiro, Brazil
[4] Brazilian Soc Clin Anal Sao Paulo State, Sao Paulo, Brazil
[5] Acad Hosp Parma, Dept Pathol & Lab Med, Clin Chem & Hematol Lab, Parma, Italy
关键词
clinical laboratory techniques; preanalytical phase; laboratory variability; blood specimen collection; EDTA contamination carryover; VACUUM TUBES VALIDATION; BIOLOGICAL VARIATION; BLOOD-GAS; ROUTINE; BIOCHEMISTRY; VARIABILITY; QUALITY; SAMPLES; STASIS; PHASE;
D O I
10.11613/BM.2013.026
中图分类号
R446 [实验室诊断]; R-33 [实验医学、医学实验];
学科分类号
1001 ;
摘要
Procedures involving phlebotomy are critical for obtaining diagnostic blood specimens and represent a well known and recognized problem, probably among the most important issues in laboratory medicine. The aim of this report is to show spurious hyperkalemia and hypocalcemia due to inadequate phlebotomy procedure. The diagnostic blood specimens were collected from a male outpatient 45 years old, with no clinical complaints. The tubes drawing order were as follows: i) clot activator and gel separator (serum vacuum tube), ii) K(3)EDTA, iii) a needleless blood gas dedicated-syringe with 80 I.U. lithium heparin, directly connected to the vacuum tube holder system. The laboratory testing results from serum vacuum tube and dedicated syringe were 4.8 and 8.5 mmol/L for potassium, 2.36 and 1.48 mmol/L for total calcium, respectively. Moreover 0.15 mmol/L of free calcium was observed in dedicated syringe. A new blood collection was performed without K(3)EDTA tube. Different results were found for potassium (4.7 and 4.5 mmol/L) and total calcium (2.37 and 2.38 mmol/L) from serum vacuum tube and dedicated syringe, respectively. Also free calcium showed different concentration (1.21 mmol/L) in this new sample when compared with the first blood specimen. Based on this case we do not encourage the laboratory managers training the phlebotomists to insert the dedicated syringes in needle-holder system at the end of all vacuum tubes. To avoid double vein puncture the dedicated syringe for free calcium determination should be inserted immediately after serum tubes before EDTA vacuum tubes.
引用
收藏
页码:218 / 223
页数:6
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