Table 3.
Level of compliance to good practice techniques for blood collection and analysis in field settings
| Good practice | Level of compliance | Notes | |
|---|---|---|---|
| Controls | Perform daily QC testing by measuring and recording the results for each of the low, normal, and high‐range control vials | +++ | Performed and noted every morning prior to leaving for the data collection. |
| Equipment | Phlebotomists use powder‐free gloves | +++ | Powder‐free gloves provided to phlebotomists. |
| Storage of microcuvettes in humidity‐controlled container until ready to use | +++ | Microcuvettes were kept in a sealed container, which was kept in a dark equipment bag. Microcuvette container typically used in less than a week. Data collection performed from September to December during temperate climate (10−25 °C). | |
| Clean Hemocue daily | ++ | Phlebotomists instructed to clean Hemocue every evening. | |
| Fingerstick and Hemocue procedure for capillary sample | Use middle or ring finger | ++ | Phlebotomists trained to prick middle or ring finger, and finger with no ring. |
| Massage finger | ++ | Phlebotomists trained to stimulate blood flow by massaging finger from knuckle to fingertip. | |
| Wipe finger with alcohol | ++ | Phlebotomists instructed to let alcohol air‐dry before sticking the finger. | |
| Stick the selected finger with the lancet | ++ | Phlebotomists instructed to prick the side of fingertip with enough pressure to get proper blood flow. | |
| Wipe away the first drop of blood with a clean gauze pad | ++ | ||
| Fill the microcuvette with the third drop | ++ | Phlebotomists instructed to fill the microcuvette with the second or third drop. | |
| Let blood drop flow into the microcuvette | ++ | Phlebotomists were trained not to “milk” the finger so as not to dilute the blood drop with interstitial fluid. | |
| Fill microcuvette fully | ++ | Phlebotomists were trained to fill microcuvette fully in one continuous process. | |
| Inspect cuvette for air bubbles | ++ | Phlebotomists were trained to avoid air bubbles. | |
| Procedure for Hemocue assessment on venous sample | Mix venous blood in vial | ++ | Phlebotomists were trained to gently invert vial twice before taking a drop of blood. |
| Using a pipette, place drop of blood on the plastic film | ++ | Phlebotomists were trained to place a drop of blood on plastic slide. | |
| Fill microcuvette in one continuous process with drop of blood | ++ | Phlebotomists were trained to fill microcuvette fully in one continuous process. | |
| Inspect cuvette for air bubbles | ++ | Phlebotomists were trained to avoid air bubbles. |
note: Developed based on documented sources of error and good practice guides for sample collection and processing.11, 17, 18
+++, 100% compliance (observed); ++, phlebotomists trained on proper protocol, but daily observation of all not feasible. High compliance concluded based on daily observations of quality monitor.