Neonatal intensive care unit quality initiative: Identifying preanalytical variables contributing to specimen hemolysis and measuring the impact of evidence-based practice interventions

Nicole V. Tolan, Erin J. Kaleta, Jennifer L. Fang, Christopher E. Colby, William A. Carey, Brad S. Karon, Nikola A. Baumann

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Objectives: Blood specimen hemolysis is a major cause of sample recollection in the neonatal intensive care unit. We aimed to reduce the hemolysis rate from 6.3% at baseline to less than 4% within the 9 months' duration of the study. Methods: Intravenous infusion of lipid emulsion during sample collection, sample collection site, and blood sample transportation methods were investigated as possible contributors to hemolysis. Subsequently, two practice improvements were implemented: pausing lipid emulsion infusion prior to collection and slowing withdrawal rates through arterial catheters. Results: Samples were more likely to be hemolyzed if they were collected during lipid infusion and subsequently transported by pneumatic tube or collected through an arterial catheter. Retrospective analysis demonstrated a decreased number of tests cancelled due to specimen hemolysis (3.5%) after our interventions. Conclusions: We identified three variables contributing to hemolysis and instituted two clinical practice interventions to significantly reduce test cancellations due to hemolysis.

Original languageEnglish (US)
Pages (from-to)113-118
Number of pages6
JournalAmerican Journal of Clinical Pathology
Volume146
Issue number1
DOIs
StatePublished - Jul 1 2016

Keywords

  • Arterial catheter draws
  • Clinical chemistry
  • Clinical practice intervention
  • Lipid emulsion infusion
  • Neonatal ICU
  • Quality improvement
  • Sample transport
  • Specimen hemolysis

ASJC Scopus subject areas

  • Medicine(all)

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