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. Author manuscript; available in PMC: 2015 Jul 29.
Published in final edited form as: Clin Biochem. 2012 Sep;45(0):1012–1032. doi: 10.1016/j.clinbiochem.2012.08.002
Bibliographic information
Overall rating		 Study*
Category (points deducted)		 Practice*
Category (points deducted)		 Outcome measures*
Category (pts deducted)		 Results/findings*
Category (points deducted)
– Author(s): Lisa Dugan, BC, Lida Leech; Karen Gabel Speroni; Joy Corriher
 – Year: 2005
 – Publication: Journal of Emergency Nursing
 – Affiliations: Loudoun Hospital Center, Leesburg, VA
 – Funding: Internal		 – Design: (0)
Cross-Sectional
Observational
– Facility/setting: (0)
ED — 21-bed unit with 33,000 patients/year — 40% having blood drawn, average between 3 – 4 tubes — thus, approximately 52,800 tubes/year
– Time period: (0)
36 day period from 6/3 to 7/9, 2004
– Population/sample: (1)
100 randomly selected ED patients 18 years or older with orders for IV blood draw (excluding blood cultures). N= 382 drawn by RN, LPN or technician (others excluded).
– Comparator: (0)
1) Syringe vs. vacuum tube
2) Antecubital vs. other
3) ≥21 vs >21 gauge catheter
– Study bias: (2)
Counted multiple tubes from one patient (~4) as independent samples; potential bias by order.
Also, study observed regular (unregulated) practices and recorded rates of hemolysis for various main effects, but did not provide data allowing control for potential confounding factors		 – Description: (0)
Practices Evaluated:
For IV starts:
1) Syringe vs. vacuum tube
2) Placement (AC, forearm, hand)
3) Needle size
All practices recorded on a report form.
– Duration: (0)
36 days — 100 patients — 382 blood draws.
– Training: (0)
Minimal
– Staff/other resources: (0)
Minimal
– Cost: (0)
Not provided		 – Description: (0)
Hemolysis determined by subjective comparison to color charts
– Recording method: (0)
Laboratory technician completed a report form providing information on level of hemolysis and whether the sample was rejected.		 – Type of findings: (0)
Rates of hemolysis
– Findings/effect size: (0)
1) Syringe vs. vacuum tube
14/104 (13.5%) vs. 35/278 (12.6%)
2) Antecubital vs. distal site
26/296 (8.8%) vs. 23/86 (26.7)
Forearm: 11/52 (21.2%)
Hand: 12/34 (35.3%)
3) ≤21 vs. >21 gauge catheter
40/367 (10.9%) vs. 9/15 (60.0%)
18 gauge: 15/183 (8.2%)
20 gauge: 25/184 (13.6%)
22 gauge: 9/15 (60.0%)
Other findings — tube size
1.8 mL tube: 0/3 (0.0%)
3 mL tube: 15/162 (13.6%)
3.5 mL tube: 7/70 (10.0%)
4.5 mL tube: 11/57 (19.3%)
5 mL tube: 11/71 (15.5%)
6 mL tube: 5/19 (26.3%)
– Statistical significance/test(s): (0)
Logistic regression too ambitious for sample size — not useful.
– Results/conclusion biases: (1)
No information to control for confounding factors. Potentially useful results for main effects are compromised by potential for bias.
Quality rating: 7 (fair)
 Effect rating: Minimal/ none, substantial, substantial
 Relevance: Direct 		Study (3 max): 1
As noted, used multiple tubes per patient as independent samples. Also, lack of control for confounding		 Practice (2 max): 2 Outcome (2 max): 2
As noted, lack of information process		 Results/findings (3 max): 2
Small sample size, potential confounders and non-independence of outcomes when multiple tubes collected.
*

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