how to avoid pre analytical errors{ keyword }

This one is useful for the identification of subjects requiring laboratory evaluation for VWD and for assessing the clinical severity of the disorder in patients with type 1 VWD [7, 2729]. Data combined from [14] and unpublished data by Radiometer Medical A/S. Potassium. Explain how the COVID-19 pandemic has renewed the urgency for automation. Ideally, samples for coagulation assays should be performed in the laboratory that performs the assays. Cattaneo M, Cerletti C, Harrison P, Hayward CP, Kenny D, Nugent D, Nurden P, Rao AK, Schmaier AH, Watson SP, Lussana F, Pugliano MT, Michelson AD. Eur J Anaesthesiol. The pH of the anticoagulated plasma should be comprised between 7.3 and 7.45 [35, 36]. The IT method is effective in preventing hemolysis-induced pre-analytical errors. Sometimes samples are inappropriately mixed or left unmixed for a long time, thereby avoiding full contact of the blood with the anticoagulant, which determines partial clotting. Rodeghiero F, Tosetto A, Abshire T, Arnold DM, Coller B, James P, Neunert C, Lillicrap D, ISj VWF. PRE-ANALYTICAL ERRORS IN THE CLINICAL LABORATORY The findings of our search have been grouped into different subtopics. Google Scholar. That means handling stress, getting good women's health care, and nurturing yourself. Unfortunately, we seem to be arguing that some errors are more important (i.e. Blood sampling should be performed without generating foam or bubbles in the sample and with as little shear stress as possible [4]. The investigation of platelets is highly vulnerable to a broad series of pre-analytical variables [8]. The temperature during transport is of special relevance. Biochem Med (Zagreb). . This may strongly influence some of the coagulation assays and may lead to platelet activation, activation of factor VII, which in turn can give shorter clotting times and hence lower PT-INR and PT-sec results. Plasmas that are lipemic and icteric may also affect analytic results by interfering with optical absorbance or impeding light transmittance [49]. Clin Chem 1995; 41: 201. Sample collection and platelet function testing: influence of vacuum or aspiration principle on PFA-100 test results. Blood venous sample collection: Recommendations overview and a checklist to improve quality. 1.1 Lacroix R, Judicone C, Poncelet P, Robert S, Arnaud L, Sampol J, Dignat-George F. Impact of pre-analytical parameters on the measurement of circulating microparticles: towards standardization of protocol. Reduced concentrations of protein S can be caused by functional impairment of this protein by differences in modulation of its activity by other plasma proteins that change during the oral contraceptives use or by changes induced in the protein S molecule that impair its anticoagulant activity [24]. Common Pre Analytical Mistakes And Ways To Solve Them Standardization efforts are essential to control and prevent errors and to ensure the quality of exploration in haemostasis. Extreme temperatures should be avoided in order to maintain sample integrity [5]. The five main reasons of preanalytical errors when measuring electrolytes on a blood gas analyzer are: NCCLS [2] recommends the exclusive use of preheparinized sample tubes or syringes for electrolyte measurements on a blood gas analyzer. Bohm M, Taschner S, Kretzschmar E, Gerlach R, Favaloro EJ, Scharrer I. Narayanan S. The preanalytical phase - an important component of laboratory medicine. Your privacy choices/Manage cookies we use in the preference centre. As more laboratories use electronic readers for orders and patient identification, one of the major sources of error will decrease. 3. Most of the respondents have also invested in automation to track and report errors while virtually eliminating others, such as illegible handwriting and clerical mistakes. Correspondence to Clipboard, Search History, and several other advanced features are temporarily unavailable. Pre-Analytical, Analytical, & Post-Analytical Phases of Lab No incidences of undue blood exposure was seen in either group. Wiley-Blackwell. A comparison of the quality of blood specimens drawn in the field by EMS versus specimens obtained in the emergency department, J Emerg Nurs. The samples have to be thawed at least 5min in a water bath at 37C and not at room temperature, on a bench or in a microwave oven. Pre Contamination can occur through contact from micro drops from caps with a compress, or from contact with the interior of the tube with the syringe and from the anticoagulant of the first tube to the second tube [4]. The evaporation increases due to condensation on the cooling element [7]. By establishing a standardized system to recognize pre Critically ill patients in an ICU are often equipped with an arterial catheter. Part of Thromb Res. plasma/serum, will at some point increase the concentration of electrolytes in the sample. 691-98. Clin Chem Lab Med. Semin Thromb Hemost. Following collection, blood should be adequately and promptly mixed by three to six complete end-over-end inversions of the tubes in order to ensure complete distribution of anticoagulant [8, 36, 47, 49, 57]. 2013;132:e1527. Effect of pneumatic tube transport on rotational thromboelastometry. Article van Vliet HA, Bertina RM, Dahm AE, Rosendaal FR, Rosing J, Sandset PM, Helmerhorst FM. The interference observed in lipemic samples is most evident with readings using wavelengths lower than 500 nm and can be prevented with readings at 650 nm or above, and/or using higher dilutions of the test sample, or can be abated in high hypertriglyceridemic specimens (i.e., > 1,000 mg/dL) using high speed micro-centrifugation, lipid extraction with organic solvents such as fluorine-chlorinated hydrocarbon, or lipid-clearing agents such as LipoClear (StatSpin Inc., Norwood, MA) and n-hexane.9. 28 No. restless child), because stress increases acute phase proteins of which von Willebrand factor (VWF), factor VIII and fibrinogen [40] are most important (in particular in the workup for haemophilia or VWD). dependence on clinician interpretation regarding patient recall, inability to distinguish among bleeding events occurring at different anatomical sites, etc.) 2013;110:142. Describe the reasons for pre-analytical errors and their impact. The combination of the standardized bleeding questionnaire and an interpretation grid has been referred to as a Bleeding Assessment Tool (BAT) [7]. The article starts by giving a general description of the five main reasons of preanalytical errors when measuring electrolytes and the biochemical background of their influence on measurements.. Understanding the different values in electrolyte measurements. MeSH One of the components is free hemoglobin, which will give the plasma or serum a visible red color when the concentration is above 0.02 g/dL [26].. A study [19] shows that the rate of calcium increase is about 5.3 % for a pH decrease of 0.1. Residual platelets in plasma have been known to affect phospholipid-dependent coagulation tests through the exposure from platelet membranes of anionic phospholipids that quench LA activity. The ED had an excessive number of hemolyzed specimens when compared to the rest of the medical center. Thromb Res. In: Burritt MF, Cormier AD, Maas AHJ, Moran RF, O'Connell KM, eds. WebMD Managing Post-analytical Errors - Elite Learning When aliquoting the plasma, care must be taken so that the buffy coat (the layer of cells between the red cells and plasma) is not disturbed or that this cellular component is not introduced back into the plasma. errors Lock, R. The whole-blood sampling handbook. Haemolysis may lead to statistically significant increases in PT and D-dimer. Venipuncture may be necessary, on occasion, to obtain blood from an existing vascular access device such as an intravenous (IV) line or a central line [5]. How to Avoid 2013; 2244. Several aliquots (suggested volume of 5001200L) should be prepared as a backup. The redraw rate was higher for the ED group (11.5%) than the EMS group (9.5%).10 The primary reason for redraw in the EMS group was insufficient quantity (52.6%; ED=8.7%). Br J Haematol. The authors declare that they have no competing interests. 8. Federici AB, Bucciarelli P, Castaman G, Mazzucconi MG, Morfini M, Rocino A, Schiavoni M, Peyvandi F, Rodeghiero F, Mannucci PM. 3.3 Sampling these tubes allows a delay in analysis until 4h before centrifugation [52]. Another common way to obtain blood samples from critically ill patients 2013;11:11903. 918-231. Crit Care Med 2003; 31,6: 1654-58. Below you will find detailed lists of preanalytical issues affecting each of the four electrolyte parameters. To ensure reliability and reduce the time load, the questionnaire should be performed by a physician or other health professional experienced in assessing a (mild) bleeding disorder (MBD), particularly in patients who have abnormal clotting screening test results requiring invasive procedures or elective surgery [7, 34]. Women using combined oral contraceptives with the highest risk of venous thrombosis (e.g. A quantitative analysis of bleeding symptoms in type 1 von willebrand disease: results from a multicenter European study (MCMDM-1 VWD). 1 Flowchart of the pre-analytical phase from bedside to bench in biomedical metabolomics and lipidomics projects. Thrombosis J 14, 49 (2016). DOI: 10.7754/Clin.Lab.2016.151224. Nelson S, Pritt A, Marlar RA. WebThe pre-analytical phase begins: When the test is ordered by the physcian. A discard tube (or a citrate tube if the sampling is difficult) must be drawn when citrated plasma is obtained using butterfly systems or other IV catheter devices because the air volume contained in the tubing partially fills the vacuum tube, leading to insufficient filling of the tube with citrate. 2011 Jul;44(10-11):944-5. doi: 10.1016/j.clinbiochem.2011.05.003. Blood samples for coagulation analyses should be drawn into siliconized glass tubes, or plastic (polypropylene) tubes [35, 49]. Tosetto A, Castaman G, Rodeghiero F. Bleeders, bleeding rates, and bleeding score. Pre-, Post- & Analytical Errors - Westgard Pre-analytical issues in the haemostasis laboratory: guidance for the clinical laboratories, https://doi.org/10.1186/s12959-016-0123-z, http://site.geht.org/site/Pratiques-Professionnelles/Documents-GEHT/Variables-Preanalytiques/Recommandations-Variables-preanalytiques_69_722.html, http://www.euro.who.int/__data/assets/pdf_file/0005/268790/WHO-guidelines-on-drawing-blood-best-practices-in-phlebotomy-Eng.pdf?ua=1, http://www.pathology.vcu.edu/media/pathology/clinical/coag/LabHemostasis.pdf, http://www.mayomedicallaboratories.com/articles/communique/2008/10update1.html, http://www.practical-haemostasis.com/index.html, http://creativecommons.org/licenses/by/4.0/, http://creativecommons.org/publicdomain/zero/1.0/. Samples should be transported non-refrigerated at ambient temperature (1525C) in as short a time as possible [8, 49, 57]. Routinely haemostasis testing has very little therapeutic impact and lacks prognostic utility. Bethesda, MD 20894, Web Policies Bonini P, Plebani M, Ceriotti F et al. 27 No. Vascul Pharmacol. government site. 2006;64:3157. For additional information on this or related content, please email, Sexual Assault Nurse Examiner (SANE) Core Course, What Not to Say at Work: Career-Limiting Habits and Behaviors, Now Available: The 2021 Holiday Guide for Healthcare Professionals. Preventing pre-analytical errors to reduce costs and ensure positive patient outcomes. However, this sampling technique may also cause problems on e.g. Article McCaughey EJ, Vecellio E, Lake R, Li L, Burnett L, Chesher D, Braye S, Mackay M, Gay S, Badrick T, Westbrook J, Georgiou A. Crit Rev Clin Lab Sci. 2013;39:8349. Google Scholar. WebSome of the pre-analytical errors include hemolyzed sample, insufficient sample, incorrect label, incorrect requisition, clotted sample and tube broken in centrifuges. J Thromb Haemost. Zurcher M, Sulzer I, Barizzi G, Lammle B, Alberio L. Stability of coagulation assays performed in plasma from citrated whole blood transported at ambient temperature. 2014;36:28995. 2005;3:261926. Sommer SR, Warekois RS. Avoiding Pre-analytical Errors in the Laboratory. Bermes EW, Young DS. In order to eliminate platelet debris and microparticles from plasma, which may contribute to the variability in thrombin generation results, a second centrifugation step at 10,000g is recommended [2]. The effect of different hormonal contraceptives on plasma levels of free protein S and free TFPI. 2008;6:34651. Lima-Oliveira G, Salvagno GL, Lippi G, Danese E, Gelati M, Montagnana M, Picheth G, Guidi GC. Samples can be stored as whole blood or stored following centrifugation [81]. However, owing to costs and the risk of obtaining unsuitable samples, the use of butterfly needles and IV catheters has generally been discouraged, because haemolysis, activation of the contact system, initiated by activation of factor XII, can occur when blood comes into contact with the surface of a biomaterial [2]. These recommendations are in line with those issued in the United States and in the United Kingdom by the National Institute for Health and Clinical Excellence (NICE). Pre-analytic errors occur in a number of different circumstances: At the time of patient assessment and decision to 2016;54:11415. Vol. This review aimed at summarizing recommendations with regard to the pre-analytical phase and provides some guidance to reduce the effects of biological factors that can have a significant impact on patient care. What are Preanalytic Errors Mayo Medical Laboratories. Int J Lab Hematol. This means that a sample with a true cCa2+ of 1.15 mmol/L will report a value that is 0.07 mmol/L too low - that corresponds to 50 % of the reference range (1.15-1.29 mmol/L) [3]. Unfortunately, 46-68 percent of all laboratory errors occur during the pre-analytics phase of testing due to the complexity and manual processes involved. Rao LV, Okorodudu AO, Petersen JR, Elghetany MT. These procedures are intended to prevent these problems and to protect against complications and patient mismanagement that could otherwise arise when specimens are not collected properly in order to achieve accurate and reliable coagulation measurements. A standardized sequence of blood sampling must be respected in order to avoid carry-over between tubes [3]. WebUseful tips to avoid preanalytical errors in blood gas testing: electrolytes 2.2 Peripheral venous catheter. Samples for PT/INR have longer stability (24h) at room temperature.

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