Bibliographic information Overall rating	Study* Category (points deducted)	Practice* Category (points deducted)	Outcome measures* Category (pts deducted)	Results/findings* Category (points deducted)
– Author(s): Giavarina, D; Pasquale, L; Mezzena, G; Soffiati, G.  – Year: 2010  – Publication: Rivista Italiana Della Medicina Di Laboratorio (Italian)  –Affiliations: San Bortolo Hospital Vicenza  – Funding: Internal	– Design: (0) Cross-Sectional Random assignment – Facility/setting: (0) ED is a 21-bed unit with 33,000 patients/year — 40% having blood drawn, average between 3 and 4 tubes — thus, approximately 52,800 tubes/year – Time period: (0) 78 consecutive days. – Population/sample: (0) 363 consecutive ED patients requiring blood chemistry draws randomly assigned to four different IV catheter brands. All used 18 gauge catheters. 100 consecutive straight needle venipuncture draws from the intensive care department. All used 21 gauge needle. – Comparator: (0) 1) Straight needle vs. IV start – Study bias: (1) None observed — only one sample per patient drawn. However, needle venipunctures came from intensive care and IV starts came from ED. Need size is controlled, but not the same in each practice (this is usual).	– Description: (0) Practices evaluated: 1) Straight Needle vs. IV Start – Duration: (0) 78 consecutive days. – Training: (0) Minimal – Staff/ other resources: (0) Minimal – Cost: (0) Not provided	– Description: (0) Hemolysis — quantitatively measured by automatic lab instrument. – Recording method: (0) Not described	– Type of findings: (0) Rates of hemolysis – Findings/effect size: (1) 1) Straight needle vs. IV start Compares ICU straight needle venipuncture to ED IV start: Light hemolysis: 3/100=3% vs. 64/321=19.9% Severe hemolysis: 0/100=0% vs. 17/321=5.3% Other findings: Rates for IV types: not a practice of interest — see chart abstracted and attached. – Statistical significance/test(s): (0) None presented for comparison of interest. – Results/conclusion biases: (1) Clear difference in rates for straight needle venipuncture vs any of the IV start types used. However, comparison is with ICU. Other potential confounders not addressed are: staff collecting bloods and site. Also, while implied, not clearly stated that vacuum tubes were used over syringes (stated that in general practice vacuum tubes had replace the use of syringe except in particular circumstances).
Quality rating: 7 (fair)  Effect rating: Substantial  Relevance: Direct	Study (3 max): 2 As noted, potential confounding by comparing different populations	Practice (2 max): 2	Outcome (2 max): 2 As noted, lack of information process	Results/findings (3 max): 1 Comparison between ED and ICU. Also, missing information on potential confounders

^*Numbers in () by category headings reflect the number of points deducted from the maximum points for that column domain.