Bibliographic information Overall rating	Study* Category (points deducted)	Practice* Category (points deducted)	Outcome measures* Category (pts deducted)	Results/findings* Category (points deducted)
– Author(s): Munnix; ICA; Schellart, M; Gorissen, C; Kleinveld, HA.  – Year: 2010  – Publication: Ned Tijdschr Klin Chem Labgeneesk  –Affiliations: Atrium Medical Center, Heerlen, Netherlands  – Funding: Internal	– Design: (0) Cross-Sectional Observational – Facility/setting: (0) Emergency and outpatient depts. Last half of 2008 lab processed 8710 samples from ED and 9754 from internal med. – Time period: (0) 3 months in 2009 – Population/sample: (1) 4 blood draws each from 100 ED patients (all IV draws). 50 straight needle draws from outpatients were not used in analysis because not from ED. No description provided of who drew the samples or how subjects were selected. – Comparator: (0) 1) Antecubital vs. other 2) ≤21 vs >21 gauge catheter Observed regular (unregulated) practices — did not provide data allowing control for potential confounding factors. – Study bias: (0) None observed. Although multiple tubes collected — primary results reported for first tube only	– Description: (0) Practices of interest include: – Placement (AC, forearm, hand) – Needle size (only 18 & 20 gauge) so not useable for this analyses. Notes: All IV starts, but not clear if vacuum tubes or syringe is used. Person who conducted draw recorded practices on a report form. Had straight needle vs. IV draw comparison, but not within ER — so not reportable for this evaluation. – Duration: (0) 36 days — 100 patients – Training: (0) Minimal. – Staff/other resources: (0) Minimal – Cost: (0) Not provided.	– Description: (0) Hemolysis determined by automated colorimetric reader — hemolysis defined as an index of 300 or more. – Recording method: (0) Standardized data collection form completed by person drawing sample.	– Type of findings: (0) Rates of hemolysis 1) Antecubital vs. other 5/54 (9.3%) vs. 11/45 (24.4%) Forearm: 6/37 (16.2) Hand: 5/8 (62.5) 2)≥21 vs >21 gauge catheter No data on >21 g. catheters 18 gauge: 5/34(14.7) 20 gauge: 11/65 (16.9) Note: Missing data on one subject. – Statistical significance/ test(s): (0) Not done. – Results/conclusion biases: (0) Limited sample size and did not provide information to control for confounding factors.
Quality rating: 8 (good)  Effect rating: SubstantialRelevance: Direct	Study (3 max): 2 No description of how subjects were selected or who drew sample (training/position)	Practice (2 max): 2	Outcome (2 max): 2	Results/findings (3 max): 2 Small sample size, no way to control for potential confounders — can only calculate main effects

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