Pregledni rad

https://doi.org/10.11613/BM.2013.026

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

Gabriel Lima-Oliveira orcid.org/0000-0002-5937-9137 ; gement case report. Biochemia Medica 2013;23(2):218-23. http://dx.doi.org/10.11613/BM.2013.026 1Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy 2Post-Graduate Program of Pharmaceutical
Giuseppe Lippi ; Clinical Chemistry and Hematology Laboratory, Department of Pathology and Laboratory Medicine, Academic Hospital of Parma, Parma, Italy
Gian Luca Salvagno ; Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
Martina Montagnana ; Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy
Geraldo Picheth ; Post-Graduate Program of Pharmaceutical Sciences, Department of Medical Pathology Federal University of Parana, Curitiba, Parana, Brazil
Gian Cesare Guidi ; 1Laboratory of Clinical Biochemistry, Department of Life and Reproduction Sciences, University of Verona, Verona, Italy 2Post-Graduate Program of Pharmaceutical Sciences, Department of Medical Pathology Federal University of Parana, Curitiba, Parana, Braz

Sažetak

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 medi-cine. 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) K3EDTA, iii) a needleless blood gas dedicated-syringe with 80 I.U. lithium heparin, directly connected to the vacuum tube holder system. The laboratory testing re-sults 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 K3EDTA 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.

Ključne riječi

clinical laboratory techniques; preanalytical phase; laboratory variability; blood specimen collection; EDTA contamination carryover

Hrčak ID:

103798

URI

https://hrcak.srce.hr/103798

Datum izdavanja:

15.6.2013.

Posjeta: 2.759 *