Bibliographic information Overall rating	Study* Category (points deducted)	Practice* Category (points deducted)	Outcome measures* Category (pts deducted)	Results/findings* Category (points deducted)
– Author(s): Marian Sue Grant  – Year: 2003  – Publication: Journal of Emergency Nursing  – Affiliations: Johns Hopkins Hospital, Baltimore, MD  – Funding: Internal	– Design: (0) Cross-sectional Observational – Facility/setting: (0) Adult ED of a major teaching hospital – Time period: (0) 19 days from May 21 to June 8, 2001 – Population/sample: (0) Convenience sample of 454 blood draws with sufficient information — draws conducted by ED nurse or ED technician — no information on experience level. – Comparator: (0) 1) Straight needle vs. IV start: 2) For IV starts: Syringe vs. vacuum tube: Regular (unregulated) practices and hemolysis rates for both main effects and some within practice parameters. However, did not control for location or tourniquet use or training. – Study bias: (1) Did not discuss number of tubes per draw — reported only one result per draw. Lack of control for other practice parameters Potential bias: hemolysis determined by visual inspection (subjective) without blinding of lab technicians to draw technique.	– Description: (0) Practices evaluated: – Straight needle vs. IV start – Vacuum tube vs syringe Other practices: – Needle size (none>20 gauge) – Transfer techniques – Personnel (nurse vs technician) All practices recorded on a form. – Duration: (0) 19 days from May 21 to June 8, 2001 — 598 blood draw forms collected — 454 complete enough for analysis. Participation voluntary and participation estimated to be only 31%. Only one result per draw recorded — no mention of how multiple tube draws were analyzed. – Training: (0) None – Staff/other resources: (0) Minimal – Cost: (0) Not reported	– Description: (0) Hemolysis determined subjectively by lab technicians who were not blinded as to collection method – Recording method: (1) Laboratory technician completed a report previously completed by the person conducting the draw– therefore not blinded	– Type of findings: (0) Rates of hemolysis – Findings/effect size: (0) Main effects and sub-practices (see attached table). Meaningful results are shown here: 1) Straight needle vs. IV start Any hemolysis 4/117=3% vs. 126/255=49% Requiring re-draw 1/117=<1% vs. 50/255=20% (p<0.001) 2) For IV starts: syringe vs. vacuum tube: Any hemolysis” 17/60=28% vs. 151/195=77% Requiring re-draw 5/60=9% vs. 44/195=23% (p=0.02) Other findings: – Statistical significance/test(s): (0) Chi-square significance tests using SAS. – Results/conclusion biases: (1) Sufficient population. It is likely that more than one sample was drawn per patient. Thus, either result was reported on multiple samples per patient or on only one sample per patient, without discussion about how this was handled in protocol or analysis. Good discussion of confounders. Potential confounding associated with subjective hemolysis measures without blinding for lab techs.
Quality rating: 7 (fair)  Effect rating: Substantial  Relevance: Direct	Study (3 max): 2 As noted, no control for potential confounders. No information on # of tubes drawn..	Practice (2 max): 2	Outcome (2 max): 1 Subjective determination — no blinding of lab technicians.	Results/findings (3 max): 2 Not clear how hemolysis was calculated across multiple tubes.

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