Speaker: Stephen Church (BD) ; on behalf of the EFLM Working Group on the Preanalytical Phase (WG-PRE)Moderator: Zorica Sumarac (SRB)
Recorded on 18th September 2018 at 18:00 CET
Vascular Access (VA) is a routine procedure, conducted worldwide, with an estimated 60-90% of hospital inpatients expected to require an intra-venous catheter (Helm et al., 2015), particularly in emergency situations or departments. A number of vascular access devices (VADs) or IV catheters could potentially be used to collect blood samples, including peripherally-inserted venous catheters, centrally-inserted venous catheters and arterial catheters. Practices and procedures for blood collection from conventional blood collection needles are well defined (Simundic et al., 2018). Until recently, many guidelines have not commented on or proposed a best practice for collection from a VAD. The CLSI document GP41-A6 (2007) stated that without complete, thorough and documented training, “Phlebotomists should not draw blood from VADs.” However the 2017 edition, GP41-A7, is the first to make recommendations for blood collection using VADs. Trauma from VAD insertion, together with a tortuous blood path with increased shear forces, can contribute to increased cell lysis. Further incomplete flushing of the collection site resulting in contamination and/or dilution of the specimen has the significant potential to create test errors and inaccurate results. While haemolysis is the most widely reported error (Lippi et al., 2011), impacts on coagulation parameters have also been reported (Strauss et al., 2012). Furthermore, the collection may lead to dislodgement of the catheter and require a replacement. In special circumstances, for example when obtaining samples from paediatric patients, adults with difficult venous access, presence of bleeding disorders or when serial tests are requested, blood collection from a short peripheral catheter may be clinically beneficial. In these patients, guidance on the best practice is required to ensure patient safety and care.
This webinar will overview the risks associated with blood collections from VADs, the type of VAD from which samples may be collected and also provide recommendations on best practices to obtain the highest quality sample and ensure patient care.