Preanalytical errors

Courses tagged with "Preanalytical errors"

Pre-analytical mysteries

Speaker: Pieter Vermeersch (BE)
Moderator: Janne Cadamuro (AT)

Recorded on 27th November 2018 at 18:00 CET

Abstract: The pre-analytical phase is the major source of errors in the total  testing process. The fact that many of the processes take place outside of the direct control of the laboratory and the involvement of different parties such as patients, clinicians, phlebotomists and logistics personnel make keeping the preanalytical phase under control a major challenge. The EFLM Working Group for the Preanalytical Phase has in recent years issued a number of recommendations and guidelines with the to improve standardization and harmonization of the preanalytical phase in Europe. While recommendations and guidelines are important to improve the overall quality, the devil is often in the detail. Laboratory professionals must continue to keep a careful eye (or two if they can spare them) on the preanalytical phase. The aim of this webinar is to make participants aware of the wide range of possible causes of preanalytical errors, both outside the laboratory and inside the laboratory  and illustrate these a number of mysteries from routine practice which ultimately allowed the identification of a pre-analytical problem.

Category: Recorded

Catheter Blood Collection Practices: Can A High Quality Sample for Laboratory Diagnostics Be Obtained?

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.

Category: Recorded

The order of draw

Speaker: Michael Cornes (UK)
Moderator: João Tiago Guimarães (PT)

Recorded on 15th May 2018


National and international (WHO, CLSI) guidelines recommended that order of draw of blood during phlebotomy should be blood culture/sterile tubes, then plain tubes/gel tubes, then tubes containing additives. This prevents contamination of sample tubes with additives from previous tubes for example sodium citrate or more commonly potassium EDTA (K3EDTA).

These recommendations are based on a case report by and a follow up study by Calam and Cooper in 1982 which reported that incorrect order of draw caused hyperkalaemia and hypocalcaemia. By measuring EDTA, it has been demonstrated that reverse order of draw of blood samples using closed loop venesection systems does not cause EDTA contamination. It is difficult to reconcile the directly conflicting results of these studies but it may be that reversed order of draw using poor technique and/or difficult venepuncture may result in sample tube cross-contamination.

It has been shown that contamination is still relatively common and may be difficult to identify. As this is not due to reversed order of draw of blood samples in a closed loop system other mechanisms must be in operation. Here I will present the evidence for and against the need to follow an order of draw.

Teacher: Mike Cornes
Category: Recorded

How to perform tube validation?

Recorded on: 3rd April 2018 at 18:00 CET

Speaker: Tiago Guimaraes
Moderator: Giuseppe Lippi


Every laboratory has to be aware of the need to validate the tubes it is using.

The importance of the pre-analytical activities is well known but sometimes not valued.

For tube validation each place has to set its own objectives according to its particular needs.

The EFLM Working Group on pre-analytics tries to help in setting some consensus on these aspects.

A EFLM Recommendation on this is being prepared.

Category: Recorded

Harmonization of preanalytical phase in Europe

Speaker: Ana-Maria Simundic (HR)
Moderator: João Tiago Guimarães (PT)

Recorded on 21st November 2017 at 18:00 CET

European National Societies, members of EFLM, have agreed in Porto, during the 3rd EFLM-BD European Preanalytical Phase Conference that harmonization of preanalytical practices and policies is necessary and possible in each and every country in Europe as well as internationally, at the European level. The Working group for Preanalytical phase (WG-PRE) of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM), has taken the leading role in this process. The aim of this e-seminar is to present past, ongoing and future WG-PRE activities and various projects which aim is to improve the quality of preanalytical phase in Europe as well as to promote wide harmonization of preanalytical practices, patient safety improvement and reduction of unnecessary waste and healthcare expenses.

Category: Recorded

Management of the quality in the pre-analytical phase

The preanalytical phase is the main contributor to diagnostic errors. Modifying staff behaviour to conform to venous specimen collection practice guidelines and other recommended practices has proved to be a difficult task.

Teacher: Daniel Rajdl
Category: Recorded

Promoting clinical and laboratory interaction by harmonization

A recording of a plenary presentation by professor Mauro Panteghini, recorded at 4th Joint EFLM-UEMS Congress: Warsaw, Poland, 21–24 September, 2016

Harmonization in laboratory testing is more than merely analytical harmonization. Although the focus was mainly on the standardization and harmonization of measurement procedures and their results, the scope of harmonization goes beyond method and analytical results. It includes all aspects of the total examination process from the “pre-pre-analytical” phase through analysis to the “post-post-analytical” phase. Rapidly available and precise results can indeed be of very limited value if they cannot be compared with each other, are produced on a wrong material or within an inappropriate diagnostic workflow. In particular, as evidence collected in last decades demonstrates that pre-pre- and post-post-analytical steps are more vulnerable to errors, harmonization initiatives should be performed to improve procedures and processes at the laboratory–clinical interface. Managing upstream demand, down-stream interpretation of laboratory results, and subsequent appropriate action through close relationships between laboratorians and clinicians remains a crucial issue of the laboratory testing process. Therefore, initiatives to improve test demand management from one hand and to harmonize procedures to improve physicians’ acknowledgment of laboratory data and their interpretation from the other hand are needed in order to assure quality and safety in the total examination process. A harmonized context will increase the value of laboratory results facilitating their interpretation and thus improving the patient’s outcome.

Category: Congresses