VERIFICATION OF VERIFICATION OF BLOOD BLOOD

COLLECTION COLLECTION SYSTEMSYSTEM

GIAN LUCA SALVAGNO , MD, PhDGIAN LUCA SALVAGNO , MD, PhD

University of Verona,University of Verona,

ItalyItaly

HUBHUB

Spoke

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STARTSTART

LaboratoLaboratory’s ry’s errorserrors

Lundberg’s loop.Lundberg’s loop.

Laboratory Laboratory testingtesting

Laboratory Laboratory testingtesting

Errors and patient’s Errors and patient’s outcomeoutcomeErrors and patient’s Errors and patient’s outcomeoutcome

Pre-Pre-analytianalyti

cal cal errorserrors

Pre-Pre-analytianalyti

cal cal errorserrors

Preanalytical:Preanalytical: 56%56%Analytical:Analytical: 21%21%Postanalytical:Postanalytical: 18%18%Multiple:Multiple: 5%5%

Preanalytical:Preanalytical: 56%56%Analytical:Analytical: 21%21%Postanalytical:Postanalytical: 18%18%Multiple:Multiple: 5%5%

……………….and in .and in laboratory?laboratory?

Pre-analytical phase: Where?Pre-analytical phase: Where?Patient identificationPatient identification

CriticalCriticals points pointCriticalCriticals points point

Blood specimen collectionBlood specimen collection

Specimen identificationSpecimen identification

Specimen transportSpecimen transport

Time of specimen arrivalTime of specimen arrival

Check-inCheck-in

Centrifugation decapingCentrifugation decaping

Aliquoting and labeling of the Aliquoting and labeling of the secondary specimensecondary specimen

OutsideOutside

LLaabboorraattoorryy

WithinWithin

Phlebotomist?Phlebotomist?

Blood collection deviceBlood collection device

Blood Blood drawing drawing

techniquetechnique

VENOUS STASISVENOUS STASIS

Venous Venous Stasis:Tourniquet Stasis:Tourniquet timetime

1)Tourniquet time: Clinical 1)Tourniquet time: Clinical ChemistryChemistry

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2) Tourniquet time: 2) Tourniquet time: Coagulation testingCoagulation testing

3) Tourniquet time: 3) Tourniquet time: Hematological testingHematological testing

BLOOD CONTAINERBLOOD CONTAINER

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AnticoagulanAnticoagulants ts

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VENOUS ACCESSVENOUS ACCESS

Hemolysis:Hemolysis:

Clinical Clinical Chemistry Chemistry

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Hemolysis:Hemolysis:

Coaguation Coaguation testingtesting

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VisuallyVisuallyundetectableundetectablehemolysishemolysis

VisuallyVisuallyundetectableundetectablehemolysishemolysis

Percentage RBC lysate on the total RBC mass.Percentage RBC lysate on the total RBC mass.0 0.1 0.2 0.4 0.8 1.6 3.3 6.8 14.70 0.1 0.2 0.4 0.8 1.6 3.3 6.8 14.7

HemolyHemolysis:clinisis:clini

cal cal chemistchemist

ry ry testingtesting

NEEDLE SIZENEEDLE SIZE

Recommendations for Collection of Recommendations for Collection of a Quality Specimen for Coagulation a Quality Specimen for Coagulation

TestingTesting

Recommendations for Collection of Recommendations for Collection of a Quality Specimen for Coagulation a Quality Specimen for Coagulation

TestingTesting

Influence of under-filling of 3.2% buffered sodium citrate blood Influence of under-filling of 3.2% buffered sodium citrate blood tubes on results of activated partial thromboplastin time tubes on results of activated partial thromboplastin time (APTT),(APTT),prothrombin time (PT), fibrinogen, activated protein C resistance prothrombin time (PT), fibrinogen, activated protein C resistance

(APCR), and coagulation factor VIII. The dotted lines designate (APCR), and coagulation factor VIII. The dotted lines designate the desirable biasthe desirable bias

for each parameter.for each parameter.

Influence of under-filling of 3.2% buffered sodium citrate blood Influence of under-filling of 3.2% buffered sodium citrate blood tubes on tubes on results of activated partial thromboplastin time (APTT),results of activated partial thromboplastin time (APTT),prothrombin time (PT), fibrinogen, activated protein C resistance prothrombin time (PT), fibrinogen, activated protein C resistance

(APCR), and coagulation factor VIII. The dotted lines designate (APCR), and coagulation factor VIII. The dotted lines designate the desirable biasthe desirable bias

for each parameter.for each parameter.

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The The JCAHOJCAHO has recently given priority within the has recently given priority within the 2007 2007 National Patient Safety GoalsNational Patient Safety Goals to the to the

improvement of the accuracy of patient improvement of the accuracy of patient identification and it applies to all JCAHO-accredited identification and it applies to all JCAHO-accredited healthcare organizations and those seeking JCAHO healthcare organizations and those seeking JCAHO

accreditation. Failure to comply can result in a accreditation. Failure to comply can result in a special Type I recommendation and jeopardize a special Type I recommendation and jeopardize a

facility’s accreditation status.facility’s accreditation status.

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The The International Organization International Organization for Standardizationfor Standardization 15189:2003 15189:2003

clause 5.4 “clause 5.4 “Pre-examination Pre-examination procedures'procedures'” includes ” includes

requirements for traceability of requirements for traceability of primary samples to an identified primary samples to an identified

individual.individual.

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What’s next?What’s next?

““Which is the best choice?”Which is the best choice?”

Or……Or……

……and I am ready to start!and I am ready to start!

The EndThe End

Take a home message