George is working with Dr. Jeanine Walenga, coagulation editor, on the “Methods” chapter for the fifth edition of Hematology, Clinical Principles and Applications. (The Rodak Hematology textbook published by Elsevier). While most hemostasis specimens are collected in evacuated tube systems, we use syringes for difficult draws or special applications. When transferring syringe blood to an evacuated tube, the general rule, outlined in CLSI H3-A6, is to detach the needle, affix a safety transfer device, pierce the tube closure, and allow the negative pressure of the tube to draw the proper volume of blood from the syringe, ensuring it runs gently down the side of the tube.However, many of us advocate for removing the needle and the closure and gently expelling the blood through the syringe hub into the tube. The risk of the former approach is hemolysis if the blood moves too vigorously, the latter exposes the phlebotomist to blood-borne pathogens and may result in an inaccurate volume. This CLSI document does not specifically prohibit this approach, and George has found no references that prevent the latter form of transfer. What is your experience, which method do you prefer, and have you seen any supporting documentation?
Jun 10 2014
Comments (1)Specimen Management
There is much to be considered here. As chairholder of the C
There is much to be considered here. As chairholder of the CLSI committee that revised the venipuncture standard currently in effect (H3-A6), this practice is discouraged in Section 8.9.3 of H3-A6, which states:
“Rubber stoppers should not be removed from venous blood collection tubes to transfer blood to multiple tubes.”
My CLSI committee is currently revising the standard once again, and I suspect that language will be retained.
I must respectfully disagree that there is a significant risk of hemolysis when tubes are filled by piercing the stopper and angling the tube. Indeed, that’s how tube manufacturers design and recommend their tubes to be filled. Therefore, filling tubes by removing the stopper goes against the tube manufacturer’s recommended use.
Certainly, patients with fragile red cells will hemolyze regardless of the technique, I suspect, but risking the bloodborne exposure and potential for under/overfill by filling with stoppers removed seems to me to be creating more potential problems than it solves.