Abstract
The predominant technique used to draw blood for laboratory testing is a conventional straight needle attached to an evacuated tube system. However, alternative tools might be advantageous in exceptional circumstances. The use of butterfly devices has been traditionally discouraged for reasons of costs and due to the high risk of obtaining unsuitable samples, but there is no convincing evidence to support the latter indication. The purpose of this study was to compare results of hematological and clinical chemistry testing, after drawing blood into evacuated tubes, employing either a traditional 21-gauge straight needle or a 21-gauge butterfly device with 300-mm-grade polyvinyl chloride tubing. Blood samples and complete sets of data were successfully obtained for 30 consecutive outpatients. Of the 43 hematological and clinical chemistry parameters measured, means for paired samples collected by the two alternative drawing techniques did not differ significantly, except for serum sodium, white blood cells and platelets counts. Bland-Altman plots and limits-of-agreement analysis showed mean bias of between −7.2% and 1.7% and relative coefficients of variation ranging from 0.2% to 21.2%. The 95% agreement interval in the set of differences was acceptable and was mostly within the current analytical quality specifications for desirable bias. The rate of hemolysis in plasma was not statistically different between the two collection techniques. Taken together, the results of the present investigation suggest that, when a proper technique is used and within certain limitations, the butterfly device may be a reliable alternative to the conventional straight needle to draw blood for laboratory testing.
References
1 Young DS. Conveying the importance of the preanalytical phase. Clin Chem Lab Med 2003; 41: 884–7. 10.1515/CCLM.2003.133Search in Google Scholar
2 Bonini PA, Plebani M, Ceriotti F, Francesca Rubboli F. Errors in laboratory medicine. Clin Chem 2002; 48: 691–8. 10.1093/clinchem/48.5.691Search in Google Scholar
3 Godolphin W, Bodtker K, Uyeno D, Goh LO. Automated blood-sample handling in the clinical laboratory. Clin Chem 1990; 36: 1551–5. 10.1093/clinchem/36.9.1551Search in Google Scholar
4 Frey AM. Drawing blood samples from vascular access devices: evidence-based practice. J Infus Nurs 2003; 26: 285–93. 10.1097/00129804-200309000-00004Search in Google Scholar
5 NCCLS. Reference and selected procedures for the quantitative determination of hemoglobin in blood: approved standard, 3rd ed. NCCLS document H15-A3. Wayne, PA: NCCLS, 2000. Search in Google Scholar
6 Ricos C, Alvarez V, Cava F, Garcia-Lario JV, Hernandez A, Jimenez CV, et al. Current databases on biologic variation: pros, cons and progress. Scand J Clin Lab Invest 1999; 59: 491–500. 10.1080/00365519950185229Search in Google Scholar
7 Stankovic AK, Smith S. Elevated serum potassium values: the role of preanalytic variables. Am J Clin Pathol 2004; 121(Suppl): S105–12. 10.1309/UEPQUM11WH9P8JNYSearch in Google Scholar
8 Raisky F, Gauthier C, Marchal A, Blum D. Haemolyzed samples: responsibility of short catheters. Ann Biol Clin (Paris) 1994; 52: 523–7. Search in Google Scholar
9 Hill AB, Nahrwold ML, Noonan D, Northrop P. A comparison of methods of blood withdrawal and sample preparation for potassium measurements. Anesthesiology 1980; 53: 60–3. 10.1097/00000542-198007000-00012Search in Google Scholar
10 Lippi G, Guidi GC. Effect of specimen collection on routine coagulation assays and d-dimer measurement. Clin Chem 2004; 50: 2150–2. 10.1373/clinchem.2004.036244Search in Google Scholar
11 Kennedy C, Angermuller S, King R, Noviello S, Walker J, Warden J, et al. A comparison of hemolysis rates using intravenous catheters versus venepuncture tubes for obtaining blood samples. J Emerg Nurs 1996; 22: 566–9. 10.1016/S0099-1767(96)80213-3Search in Google Scholar
12 Sharp MK, Mohammad SF. Scaling of hemolysis in needles and catheters. Ann Biomed Eng 1998; 26: 788–97. 10.1114/1.65Search in Google Scholar PubMed
13 Grant MS. The effect of blood drawing techniques and equipment on the hemolysis of ED laboratory blood samples. J Emerg Nurs 2003; 29: 116–21. 10.1067/men.2003.66Search in Google Scholar
14 Burnett RW, Covington AK, Fogh-Andersen N, Kulpman WR, Maas AH, Muller-Plathe O, et al. Recommendations on whole blood sampling, transport, and storage for simultaneous determination of pH, blood gases, and electrolytes. International Federation of Clinical Chemistry Scientific Division. J Int Fed Clin Chem 1994; 6: 115–20. Search in Google Scholar
15 Mohler M, Sato Y, Bobick K, Wise LC. The reliability of blood sampling from peripheral intravenous infusion lines. Complete blood cell counts, electrolyte panels, and survey panels. J Intraven Nurs 1998; 21: 209–14. Search in Google Scholar
16 Holmes KR. Comparison of push-pull versus discard method from central venous catheters for blood testing. J Intraven Nurs 1998; 21: 282–5. Search in Google Scholar
17 Seemann S, Reinhardt A. Blood sample collection from a peripheral catheter system compared with phlebotomy. J Intraven Nurs 2000; 23: 290–7. Search in Google Scholar
18 Himberger JR, Himberger LC. Accuracy of drawing blood through infusing intravenous lines. Heart Lung 2001; 30: 66–73. 10.1067/mhl.2001.110535Search in Google Scholar
19 Zlotowski SJ, Kupas DF, Wood GC. Comparison of laboratory values obtained by means of routine venepuncture versus peripheral intravenous catheter after a normal saline solution bolus. Ann Emerg Med 2001; 38: 497–504. 10.1067/mem.2001.118015Search in Google Scholar
20 Fincher RK, Strong JS, Jackson JL. Accuracy of measurements of hemoglobin and potassium in blood samples from peripheral catheters. Am J Crit Care 1998; 7: 439–43. 10.4037/ajcc1998.7.6.439Search in Google Scholar
21 Henry CJ, Russell LE, Tyler JW, Buss MS, Seguin B, Cambridge AJ, et al. Comparison of hematologic and biochemical values for blood samples obtained via jugular venepuncture and via vascular access ports in cats. J Am Vet Med Assoc 2002; 220: 482–5. 10.2460/javma.2002.220.482Search in Google Scholar
22 Sonntag G. Hemolysis as an interference factor in clinical chemistry. J Clin Chem Clin Biochem 1986; 24: 127–39. Search in Google Scholar
23 Sliwa CM Jr. A comparative study of hematocrits drawn from a standard venepuncture and those drawn from a saline lock device. J Emerg Nurs 1997; 23: 228–31. 10.1016/S0099-1767(97)90012-XSearch in Google Scholar
24 Spijker HT, Graaff R, Boonstra PW, Busscher HJ, van Oeveren W. On the influence of flow conditions and wettability on blood material interactions. Biomaterials 2003; 24: 4717–27. 10.1016/S0142-9612(03)00380-6Search in Google Scholar
25 Da Luz Moreira P, Wada ML, Novello WP. Importance of uniform heparin coating on biopolymers. Artif Organs 2000; 24: 209–11. 10.1046/j.1525-1594.2000.06530.xSearch in Google Scholar
26 Grigioni M, Daniele C, Morbiducci U, D'Avenio G, Di Benedetto G, Barbaro V. The power-law mathematical model for blood damage prediction: analytical developments and physical inconsistencies. Artif Organs 2004; 28: 467–75. 10.1111/j.1525-1594.2004.00015.xSearch in Google Scholar
27 Hong J, Nilsson Ekdahl K, Reynolds H, Larsson R, Nilsson B. A new in vitro model to study interaction between whole blood and biomaterials. Studies of platelet and coagulation activation and the effect of aspirin. Biomaterials 1999; 20: 603–11. 10.1016/S0142-9612(98)00210-5Search in Google Scholar
28 Borgdorff P, van den Berg RH, Vis MA, van den Bos GC, Tangelder GJ. Pump-induced platelet aggregation in albumin-coated extracorporeal systems. J Thorac Cardiovasc Surg 1999; 118: 946–52. 10.1016/S0022-5223(99)70066-8Search in Google Scholar
29 Narayanan S. The preanalytic phase – an important component of laboratory medicine. Am J Clin Pathol 2000; 113: 429–52. 10.1309/C0NM-Q7R0-LL2E-B3UYSearch in Google Scholar PubMed
30 Majid A, Heaney DC, Padmanabhan N, Spooner R. The order of draw of blood specimens into additive containing tubes not affect potassium and calcium measurements. J Clin Pathol 1996; 49: 1019–20. 10.1136/jcp.49.12.1019Search in Google Scholar PubMed PubMed Central
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