The top 10 considerations for factors contributing to blood sample integrity and quality
1. Meeting the patient
First impressions count. This brief opportunity should be used to take control of the blood collection procedure, by exuding calm. Attention should be paid to a clean and hygienic appearance to underline a professional attitude and assure the patient and encourage confidence about the upcoming procedure.
2. Identification of the patient
The patient must be correctly identified, either verbally, in written form or electronically via barcode scan. A case of mixed identity can lead to serious problems, especially in the case of a misdiagnosis and inappropriate treatment.
3. Thorough evaluation of veins
When a thorough vein assessment is carried out before the procedure, a decision can be made on the best possible vein, meaning for example good refill rate, avoidance of bifurcations and understanding which needle size and product type is most appropriate for the vein conditions.
4. Good hygiene practice
Hands should be washed or sanitized between patients and gloves should be worn during the procedure helps to ensure that there is no cross-contamination.
5. Tourniquet application
A sufficient amount of pressure is 40mmHg [1], to make veins more prominent without blocking any blood flow. Tourniquets should not be applied for longer than 1 minute [2].
6. Order of draw
Observing the CLSI GP412 recommended order of draw helps ensure sample integrity by preventing carryover of additives that may interfere with subsequent samples. Taking tubes in the wrong order could furthermore invalidate results altogether due to this risk of additive contamination.
7. Invert samples
When a sample tube is filled, the tube is fully inverted 5-10 times or 4-5 times if a sodium citrate tube. One inversion is turning upside down, then upright again.
8. Allow serum samples to clot
In a standard tube this will be at least 30 minutes, but there are some rapid clot tube versions on the market, containing fibrin to speed up the process.
9. Store tubes upright
This helps keep samples intact, preventing gel or blood drops becoming attached to the rubber stopper and promotes clotting.
10. Transport as soon as possible
To ensure samples are analyzed whilst in the best possible condition, transport to the laboratory as soon as possible, ensuring that the samples are not exposed to extremes of temperature.
[1] WHO guidelines on drawing blood: best practices in phlebotomy, 2010, ISBN 978 92 4 159922 1
[2] CLSI GP41, Collection of Diagnostic Venous Blood Specimens, 7th Edition, April 2017
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