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1.
Biochem Med (Zagreb) ; 30(1): 011002, 2020 Feb 15.
Artigo em Inglês | MEDLINE | ID: mdl-31839729

RESUMO

Rejection of the sample with repeated blood withdrawal is always an unwanted consequence of sample nonconformity and preanalytical errors, especially in the most vulnerable population - children. Here is presented a case with unexpected abnormal coagulation test results in a 2-year-old child with no previously documented coagulation disorder. Child is planned for tympanostomy tubes removal under the anaesthesia driven procedure, and preoperative coagulation tests revealed prolonged prothrombin time, activated partial thromboplastin time and thrombin time, with fibrinogen and antithrombin within reference intervals. From the anamnestic and clinical data, congenital coagulation disorder was excluded, and with further investigation, sample mismatch, clot presence and accidental ingestion of oral anticoagulant, heparin contamination or vitamin K deficiency were excluded too. Due to suspected EDTA carryover during blood sampling another sample was taken the same day and all tests were performed again. The results for all tests were within reference intervals confirming EDTA effect on falsely prolongation of the coagulation times in the first sample. This case can serve as alert to avoid unnecessary loss in terms of blood withdrawal repetitions and discomfort of the patients and their relatives, tests repeating, prolonging medical procedures, and probably delaying diagnosis or proper medical treatment. It is the responsibility of the laboratory specialists to continuously educate laboratory staff and other phlebotomists on the correct blood collection as well as on its importance for the patient's safety.


Assuntos
Transtornos da Coagulação Sanguínea/diagnóstico , Coleta de Amostras Sanguíneas/normas , Testes de Coagulação Sanguínea , Pré-Escolar , Erros de Diagnóstico , Ácido Edético/química , Humanos , Tempo de Tromboplastina Parcial , Fase Pré-Analítica , Tempo de Protrombina , Valores de Referência
2.
Ann Biol Clin (Paris) ; 77(2): 131-154, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30998194

RESUMO

This document provides a joint recommendation for venous blood sampling of the European federation of clinical chemistry and laboratory medicine (EFLM) Working Group for preanalytical phase (WG-PRE) and Latin American working group for preanalytical phase (WG-PRE-LATAM) of the Latin America confederation of clinical biochemistry (COLABIOCLI). It offers guidance on the requirements for ensuring that blood collection is a safe and patient-centered procedure and provides practical guidance on how to successfully overcome potential barriers and obstacles to its widespread implementation. The target audience for this recommendation are healthcare staff members directly involved in blood collection. This recommendation applies to the use of a closed blood collection system and does not provide guidance for the blood collection with an open needle and syringe and catheter collections. Moreover, this document neither addresses patient consent, test ordering, sample handling and transport nor collection from children and unconscious patients. The recommended procedure is based on the best available evidence. Each step was graded using a system that scores the quality of the evidence and the strength of the recommendation. The process of grading was done at several face-to-face meetings involving the same mixture of stakeholders stated previously. The main parts of this recommendation are: 1) Pre-sampling procedures, 2) Sampling procedure, 3) Post-sampling procedures and 4) Implementation. A first draft of the recommendation was circulated to EFLM members for public consultation. WG-PRE-LATAM was also invited to comment the document. A revised version has been sent for voting on to all EFLM and COLABIOCLI members and has been officially endorsed by 33/40 EFLM and 21/21 COLABIOCLI members. We encourage professionals throughout Europe and Latin America to adopt and implement this recommendation to improve the quality of blood collection practices and increase patient and workers safety.


Assuntos
Coleta de Amostras Sanguíneas/normas , Química Clínica/normas , Técnicas de Laboratório Clínico/normas , Flebotomia/normas , Fase Pré-Analítica/normas , Adulto , Coleta de Amostras Sanguíneas/métodos , Química Clínica/organização & administração , Criança , Técnicas de Laboratório Clínico/métodos , Europa (Continente) , Humanos , América Latina , Flebotomia/métodos , Fase Pré-Analítica/métodos , Sociedades Médicas/organização & administração , Sociedades Médicas/normas , Manejo de Espécimes/métodos , Manejo de Espécimes/normas
3.
Ann Biol Clin (Paris) ; 77(2): 174-178, 2019 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-30998198

RESUMO

Nowadays, laboratories have more efficient haematology analyzers. These analyzers have to be used in the most efficient and the most adapted way according to the internal organisation of laboratories and prescribers' expectations. The aim of this study was to evaluate the performance of the blast flag on ADVIA 2120/2120i, and to suggest what to do, depending on the flag intensity, to identify positive samples the most surely and the most rapidly as possible. MATERIALS AND METHODS: Seven hospital laboratories were included in this prospective study, 148 144 samples of hospital patients were tested during this 4 months study. RESULTS: Sensitivity and specificity of the blast flag are respectively 89,04% and 98,97%. A good correlation between the flag level and the blast count on blood smear is noticed. CONCLUSION: This study could be helpful for laboratories using ADVIA 2120/2120i, to adapt their procedures, depending on the level of the flag provided by the analyser.


Assuntos
Alarmes Clínicos , Leucócitos/citologia , Coleta de Amostras Sanguíneas/normas , Alarmes Clínicos/normas , França , Testes Hematológicos/métodos , Testes Hematológicos/normas , Humanos , Laboratórios/normas , Ensaio de Proficiência Laboratorial , Contagem de Leucócitos , Leucócitos/patologia , Limite de Detecção , Reprodutibilidade dos Testes , Sensibilidade e Especificidade
4.
Bioanalysis ; 11(6): 525-532, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30973017

RESUMO

Following the completion of a detailed experimental protocol into the potential inhomogeneity of capillary liquid microsamples, which was performed at seven European Bioanalysis Forum member companies, the summary and conclusion on the data are reported here. It has been demonstrated that it is possible to generate homogeneous samples using these microsampling techniques; that the resultant microsamples can be accurate and precise and that capillary liquid microsampling data can be consistent with conventional larger volume plasma samples. However, the data contain some variability which is contributed to by the different range of experiences that each investigating site had with these techniques. Therefore, knowledge of the compounds, well-designed experiments and experience with these techniques are essential for the delivery of high quality data.


Assuntos
Análise Química do Sangue/métodos , Coleta de Amostras Sanguíneas/métodos , Análise Química do Sangue/normas , Coleta de Amostras Sanguíneas/instrumentação , Coleta de Amostras Sanguíneas/normas , Europa (Continente) , Humanos , Preparações Farmacêuticas/sangue , Reprodutibilidade dos Testes
5.
Bioanalysis ; 11(6): 533-542, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30973018

RESUMO

Aim: Microsampling in preclinical pharmacokinetics (PK) studies is currently widely adopted across the pharmaceutical industry. Materials & methods: The European Bioanalysis Forum liquid microsampling consortium member companies assessed the accuracy and precision of handheld pipettes and microcapillaries at volumes of less than 10 µl. The following key factors on pipetting performance were also evaluated: Pipette type (positive displacement, air displacement and microcapillary), experience of user and the liquid type. Water was selected as a best-case scenario for accuracy and precision determination and blood plasma as a 'real world' bioanalysis sample type. Conclusion: Accuracy and precision on the pipetted volume decreased at lower volumes and experienced laboratory technicians performed better compared with the infrequent users. With respect to the pipetting devices used, microcapillaries showed better or equivalent accuracy and precision compared with handheld pipettes across the volume range 1-8 µl independent of the matrix used.


Assuntos
Análise Química do Sangue/métodos , Coleta de Amostras Sanguíneas/instrumentação , Análise Química do Sangue/normas , Coleta de Amostras Sanguíneas/normas , Europa (Continente) , Humanos , Preparações Farmacêuticas/sangue , Reprodutibilidade dos Testes
6.
Rev. esp. quimioter ; 32(2): 130-136, abr. 2019. tab, graf
Artigo em Inglês | IBECS | ID: ibc-182814

RESUMO

Introduction: Evaluate the efficacy of an information system addressed to nursing staff to lower the blood culture contamination rate. Methods: A blind clinical trial was conducted at Internal Medicine and Emergency Departments during 2011. After following a reeducation program in BC extraction, participants were randomly selected in a 1:1 ratio. Every participant of the experimental group was informed of each worker's individual performance; whereas the control group was only informed of the global results. Results: A total of 977 blood extractions were performed in 12 months. Blood culture contamination rate was 7.5%. This rate was higher in the Emergency Department than in Internal Medicine (10% vs. 3.8%; p=0.001). Factors associated with the higher risk of contamination were, in the univariate analysis, the extraction through a recently implanted blood route and the time of professional experience, while those associated with a lower risk were the extraction in Internal Medicine and through a butterfly needle. On multivariate analysis, extraction through a recently placed access was an independent risk factor for an increased contamination rate (OR 2.29; 95%CI 1.18-4.44, p=0.014), while individual information about the blood culture results (OR 0.11; 95%CI 0.023-0.57; p=0.008), and more than 9 years of professional experience were asso-ciated with fewer contaminations (OR 0.30; 95%CI 0.12-0.77; p=0.012). In the intervention group the contamination rate diminished by a 26 %. Conclusions: Drawing blood cultures through a recently taken peripheral venous access increased their risk of contamination. The intervention informing the nurse staff of the contamination rate is effective to decrease it


Objetivos: Evaluar la eficacia de un sistema de información dirigido al personal de enfermería, en la reducción de la tasa de contaminación de los hemocultivos. Métodos: Durante el año 2011, se realizó un ensayo clínico en los servicios de Medicina Interna y de Urgencias. Después de seguir un programa de reeducación en la extracción de los hemocultivos, los participantes, fueron aleatorizados en una proporción de 1:1. En el grupo de intervención se informó del porcentaje de hemocultivos contaminados de cada profesional y en el grupo control se aportaba la información del porcentaje global de contaminaciones. Resultados: Durante un periodo de 12 meses se realizaron 977 extracciones. La tasa de contaminación de los hemocultivos fue del 7,5%. Esta tasa fue mayor en Urgencias que en Medicina Interna (10% versus 3,8%, p=0,001). Los factores asociados con mayor riesgo de contaminación fueron, en el análisis univariable: la extracción a través de una vía sanguínea recientemente implantada y el tiempo de experiencia profesional; mientras que los que se asociaron con menor riesgo fueron la extracción en Medicina Interna (versus en Urgencias) y a través de una palomilla. En el análisis multivariable, la extracción de los hemocultivos de una vía recientemente implantada se relacionó de forma independiente con un incremento de las contaminaciones (OR 2,29, IC 95% 1,18-4,44, p=0,014),mientras que la información individual sobre los resultados de los hemocultivos (OR 0.11; IC 95% 0,023-0,57; p=0,008) y la experiencia profesional mayor de 9 años, lo hizo con menos contaminaciones (OR 0,30, IC 95% 0,12-0,77, p=0,012). En el grupo de intervención la tasa de contaminaciones se redujo en un 26%. Conclusión: La extracción de hemocultivos a través de una vena periférica recientemente implantada aumentó el riesgo de contaminación de los mismos. La intervención informativa a los enfermeros de la tasa de contaminación de los hemocultivos, es eficaz para disminuirla


Assuntos
Humanos , Manejo de Espécimes/normas , Contaminação Biológica/prevenção & controle , Preservação de Amostras/métodos , Hemocultura/normas , Processo de Enfermagem/normas , Coleta de Amostras Sanguíneas/normas , Métodos Analíticos de Preparação de Amostras/normas , Contaminação de Equipamentos/prevenção & controle
7.
Rev. lab. clín ; 12(1): 38-52, ene.-mar. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-176973

RESUMO

Este documento describe las causas de error más frecuentes en la medición de marcadores tumorales séricos proteicos en sus diferentes fases: preanalítica, analítica y postanalítica y recomendaciones para detectar y solventar problemas, así como la interpretación de los resultados de los marcadores tumorales en la práctica clínica


This document describes the most frequent causes of error in the measurement of 13 serum protein tumour markers in their different phases: preanalytical, analytical and 14 postanalytic and recommendations to detect and solve problems, as well as the 15 interpretation of the results of the Tumor Markers in clinical practice


Assuntos
Humanos , Biomarcadores Tumorais/análise , Técnicas de Laboratório Clínico/métodos , Neoplasias/diagnóstico , Padrões de Prática Médica , Perfil de Impacto da Doença , Reprodutibilidade dos Testes , Coleta de Amostras Sanguíneas/normas , Preservação de Amostras/métodos
9.
J Cardiothorac Vasc Anesth ; 33(5): 1224-1229, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30655204

RESUMO

OBJECTIVE: To quantify the degree of lethal and sublethal damage to red blood cells (RBCs) by cell saver (CS) processing among different conditions of shed blood in cardiac surgery. DESIGN: Prospective randomized, double-blinded, controlled study. SETTING: Single university hospital. PARTICIPANTS: Twenty rabbits were divided randomly into non-heparinized and heparinized groups. Thereafter, each group was subdivided into non-gauze and gauze groups based on whether the blood was collected with gauze and squeezed out. INTERVENTIONS: Blood from each group was aspirated directly from the heart and underwent CS processing. Mechanical fragility index (MFI) and percent hemolysis were measured pre- and post-CS processing. MEASUREMENTS AND MAIN RESULTS: In RBCs after CS processing, the MFI and percent hemolysis were increased significantly in both the non-heparinized and heparinized groups compared to pre-CS processing. The MFI was significantly higher in the heparinized group than in the non-heparinized group (p = 0.002). However, no differences in percent hemolysis were detected between groups (p = 0.696). The MFI and percent hemolysis of the non-gauze and gauze groups did not differ. CONCLUSION: This study reports the increase in sublethal and lethal injuries to RBCs from heparinized and non-heparinized blood after CS processing. CS-processed heparinized blood contained more sublethally injured RBCs compared to CS-processed non-heparinized blood. RBCs collected by squeezing blood-saturated gauze did not exhibit additional trauma. Further investigation is required to determine the clinical implications of transfusing rescued but injured RBCs using a CS.


Assuntos
Coleta de Amostras Sanguíneas/métodos , Coleta de Amostras Sanguíneas/normas , Eritrócitos/fisiologia , Animais , Método Duplo-Cego , Transfusão de Eritrócitos/métodos , Transfusão de Eritrócitos/normas , Estudos Prospectivos , Coelhos , Distribuição Aleatória
10.
Clin Chim Acta ; 488: 196-201, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30439354

RESUMO

Stability data of toxics or drugs in gel-based or mechanical separation blood collection tubes are lacking, especially for therapeutic drug monitoring and clinical toxicology procedures. According to ISO 15189 accreditation standard, laboratories need to master the entire preanalytical process including the stability of analytes in a specific tube. Here we explored the impact of BD PST™ II and Barricor™ separator tubes on the stability of 167 therapeutic compounds and common drugs of abuse in plasma samples using LC-MS/MS. Forty drugs were significantly affected by the use of PST™ II tubes, including antidepressants (11/26), neuroleptics (9/13), cardiovascular drugs (5/26), anxiolytics and hypnotics (4/25) and some drugs of abuse (5/26). Six compounds exhibited significant reduction by the mechanical Barricor™ tubes. Ten drugs exhibited low (<85%) but non-significant recoveries due to inter-assay variability. Besides, a logP > 3.3 was determined as a cut-off value to predict a potential lack of stability in PST™ II gel tubes with an 86.4% sensitivity and a 61.4% specificity. As a consequence, determination of drugs with a logP > 3.3 should be carried out with caution in plasma samples withdrawn on PST™ II. The study showed the Barricor™ and non-gel tubes cause less drug interference and are recommended for the drugs studied.


Assuntos
Ansiolíticos/sangue , Antidepressivos/sangue , Coleta de Amostras Sanguíneas , Fármacos Cardiovasculares/sangue , Hipnóticos e Sedativos/sangue , /sangue , Coleta de Amostras Sanguíneas/normas , Cromatografia Líquida , Avaliação Pré-Clínica de Medicamentos , Monitoramento de Medicamentos , Géis/química , Humanos , Espectrometria de Massas em Tandem
11.
Technol Health Care ; 27(2): 209-221, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30452430

RESUMO

BACKGROUND: Blood sampling is frequently used in health to evaluate diagnosis and treatments. The first blood drawing is most important skill for nursing students. Nursing students gain these skills during their first years of education. OBJECTIVE: To identify the self-confidence and self-efficacy levels of first year nursing students when performing taking blood on their peers for the first time. METHODS: The sample (n= 70) of this descriptive and cross-sectional research comprised first year nursing students. The research was conducted in two stages; theoretical training and laboratory work and students' first taking blood on their peers. A Student Information Form, Blood drawing Skill Practice Evaluation Control Form, Self-Confidence Scale, and General Self-Efficacy Scale were used for data collection. Percentage calculations and the Mann-Whitney U test were used for data analysis. RESULTS: The total mean score of the students' self-confidence was 130.09 ± 15.94 (Min = 91, Max = 157), and total mean score of self-efficacy was identified as 31.71 ± 3.92 (Min = 20, Max = 39). No statistically significant difference was detected between the students' sex and high school type regarding self-confidence and self-efficacy total mean scores (p> 0.05). CONCLUSIONS: It was observed that students' self-confidence and self-efficacy levels were high when performing taking blood on their peers for the first time.


Assuntos
Coleta de Amostras Sanguíneas/enfermagem , Competência Clínica , Autoeficácia , Estudantes de Enfermagem/psicologia , Coleta de Amostras Sanguíneas/normas , Protocolos Clínicos , Estudos Transversais , Feminino , Fidelidade a Diretrizes , Humanos , Masculino , Guias de Prática Clínica como Assunto
12.
J Cardiothorac Vasc Anesth ; 33(4): 976-984, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30279065

RESUMO

OBJECTIVE: Perioperative coagulation testing often is performed with arterial samples even though device reference ranges typically are established in venous samples. Although limited studies exist comparing coagulation parameters across sampling sites, viscoelastic testing devices have demonstrated some differences. The objective of this study was to compare coagulation parameters determined using the Quantra System for venous and arterial samples. DESIGN: Prospective, observational study. SETTING: Tertiary care university hospital. PARTICIPANTS: The study comprised 30 adult patients undergoing cardiac surgery. INTERVENTIONS: Paired arterial and venous samples were obtained at 2 of the following time points: baseline, during bypass, or after protamine reversal of heparin. Quantra measurements included Clot Time (CT), Heparinase Clot Time (CTH), Clot Time Ratio (CTR), Clot Stiffness (CS), and Fibrinogen (FCS) and Platelet (PCS) Contributions to clot stiffness. MEASUREMENTS AND MAIN RESULTS: The relationship and agreement between matched data pairs were established and statistical analysis was performed via paired t tests. CTR, CS, FCS, and PCS were unaffected by the sampling site, whereas CT and CTH demonstrated statistically significant differences between arterial and venous samples (p < 0.001). Arterial clot times were prolonged relative to the venous ones with a mean percent error of 14.2 % and 11.9 %, respectively. These results are in general agreement with those reported for other viscoelastic testing devices. CONCLUSIONS: This study demonstrates that Quantra clot stiffness-based parameters (CS, FCS, PCS) are unaffected by sampling site, whereas the clot time parameters (CT and CTH) show good correlation in the presence of a bias. CTR, a ratio of CT and CTH, also is unaffected.


Assuntos
Coagulação Sanguínea/fisiologia , Coleta de Amostras Sanguíneas/normas , Procedimentos Cirúrgicos Cardíacos/normas , Monitorização Intraoperatória/normas , Idoso , Testes de Coagulação Sanguínea/métodos , Testes de Coagulação Sanguínea/normas , Coleta de Amostras Sanguíneas/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória/métodos , Projetos Piloto , Estudos Prospectivos
13.
J Pharm Biomed Anal ; 163: 188-196, 2019 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-30317075

RESUMO

Hematocrit-related issues remain a major barrier for (regulatory) acceptance of the classical dried blood spot (DBS) analysis in the bioanalytical and clinical field. Lately, many attempts to cope with these issues have been made. Throughout this review, an overview is provided on new strategies that try to cope with this hematocrit effect (going from avoiding to minimizing), on methods estimating a DBS volume, and on methods estimating or measuring the hematocrit of a DBS. Although many successful strategies have been put forward, a combination of different technologies still provides the most complete solution. Therefore, further efforts and the availability of a straightforward guideline for analytical and clinical method validation should help to overcome the hurdles still associated with DBS sampling.


Assuntos
Coleta de Amostras Sanguíneas/instrumentação , Teste em Amostras de Sangue Seco/métodos , Estudos de Validação como Assunto , Coleta de Amostras Sanguíneas/métodos , Coleta de Amostras Sanguíneas/normas , Teste em Amostras de Sangue Seco/normas , Guias como Assunto , Hematócrito , Humanos
14.
Eur J Clin Microbiol Infect Dis ; 38(2): 325-330, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30536210

RESUMO

The introduction of dedicated phlebotomy teams certified for blood collection has been reported to be highly cost-effective by reducing contamination rates. However, data on their effects on blood volume and true positive rate are limited. Therefore, we investigated the effect of replacing interns with a phlebotomy team on blood culture results. We performed a 24-month retrospective, quasi-experimental study before and after the introduction of a phlebotomy team dedicated to collecting blood cultures in a 2700-bed tertiary-care hospital. The microbiology laboratory database was used to identify adult patients with positive blood culture results. During the study period, there were no changes in blood collection method, blood culture tubes, and the application of antiseptic measures. Blood volume was measured by the BACTEC™ FX system based on red blood cell metabolism. A total of 162,207 blood cultures from 23,563 patients were analyzed, comprising 78,673 blood cultures during the intern period and 83,534 during the phlebotomy team period. Blood volume increased from a mean of 2.1 ml in the intern period to a mean of 5.6 ml in the phlebotomy team period (p < 0.001). Introduction of the phlebotomy team also reduced contamination rate (0.27% vs. 0.45%, p < 0.001) and led to a higher true positive rate (5.87% vs. 5.01%, p < 0.05). The increased true positive rate associated with the phlebotomy team involved both gram-positive and gram-negative bacteria. The introduction of a dedicated phlebotomy team can increase blood volumes, reduce blood culture contamination rate, and increase true positive rate.


Assuntos
Hemocultura/normas , Coleta de Amostras Sanguíneas/estatística & dados numéricos , Pessoal de Laboratório Médico/estatística & dados numéricos , Flebotomia/normas , Melhoria de Qualidade , Adulto , Bacteriemia/diagnóstico , Hemocultura/estatística & dados numéricos , Coleta de Amostras Sanguíneas/normas , Volume Sanguíneo , Erros de Diagnóstico/prevenção & controle , Erros de Diagnóstico/estatística & dados numéricos , Hospitais de Ensino , Humanos , Pessoal de Laboratório Médico/normas , Flebotomia/estatística & dados numéricos , Estudos Retrospectivos
15.
Int J Lab Hematol ; 41(1): 55-59, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30216710

RESUMO

INTRODUCTION: Point-of-care (POC) international normalized ratio (INR) values above an institutional cutoff are confirmed in the laboratory using a gold standard venous specimen. This can be problematic in a pediatric setting. METHOD: In this study, 449 consecutive POC INR results were compared to an INR performed in the laboratory on a capillary citrate specimen collected from the same finger-stick. The results were statistically analyzed. RESULTS: The mean INR values from the CoaguChek XS and laboratory were 2.85 ± 1.19 and 2.63 ± 1.11, respectively. There was a good correlation between the methods with r = 0.97. Bland-Altman analysis indicated a bias of 0.22 favoring the CoaguChek XS, with 95% limits of agreement -0.29 to 0.72. Passing and Bablok method comparison resulted in a slope of 0.91 (y = 0.91x + 0.02). An INR of ≤0.5 was found between the methods in 89% of cases and 84% agreement was noted (κ = 0.69). CONCLUSION: Comparing the capillary INR laboratory results to studies involving a venous specimen, the capillary specimen performed with equivalence. Thus, a capillary citrate specimen can be collected from the same finger-stick used to perform the POC INR for confirmation in the laboratory. This avoids the trauma of a venous collection in such a situation.


Assuntos
Coleta de Amostras Sanguíneas/normas , Técnicas de Laboratório Clínico/métodos , Coeficiente Internacional Normatizado/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Capilares , Humanos , Variações Dependentes do Observador , Veias
16.
Am J Clin Pathol ; 151(2): 164-170, 2019 01 07.
Artigo em Inglês | MEDLINE | ID: mdl-30260386

RESUMO

Objectives: Underfilling of blood culture bottles decreases the sensitivity of the culture. We attempt to increase average blood culture fill volumes (ABCFVs) through an educational program. Methods: Partnerships were established with four hospital units (surgical intensive care unit [SICU], medical intensive care unit [MICU], medical intermediate care unit [MIMCU], and hematology and oncology unit [HEME/ONC]). ABCFVs were continuously tracked and communicated to each unit monthly. Educational sessions were provided to each unit. Results: ABCFVs for the SICU, MICU, MIMCU, and HEME/ONC were 4.8, 5.0, 5.0, and 6.3 mL/bottle, respectively. After the final education session, the SICU, MICU, MIMCU, and HEME/ONC were able to maintain an ABCFV of 6.8, 8.1, 7.9, and 8.2 mL/bottle, respectively. Conclusions: Partnering with a specific unit and providing monthly volume reports with educational sessions has a direct positive correlation on increasing ABCFVs. Increasing ABCFVs has the potential to decrease false-negative blood cultures, time to detection of positive blood cultures, and time to appropriate and specific antimicrobial therapy, as well as improve patient outcomes in high-acuity patient care units.


Assuntos
Hemocultura/tendências , Coleta de Amostras Sanguíneas/tendências , Modelos Estatísticos , Software , Hemocultura/instrumentação , Hemocultura/normas , Coleta de Amostras Sanguíneas/instrumentação , Coleta de Amostras Sanguíneas/normas , Serviço Hospitalar de Educação , Reações Falso-Negativas , Pessoal de Saúde , Unidades Hospitalares , Humanos , Laboratórios Hospitalares , Recursos Humanos de Enfermagem no Hospital , Assistência ao Paciente , Sensibilidade e Especificidade
17.
J Clin Lab Anal ; 33(2): e22670, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30191594

RESUMO

BACKGROUND: The ratio of target cfDNA in total plasma is low. The abundant gDNA background resulting from blood cell lysis caused by improper operation has become a major obstacle to accurately measure cfDNA. In this study, we investigated the storage capacity of three blood cell collection tubes (BCTs) in the prevention of genomic DNA contamination caused by white blood cell rupture and evaluated their performance when they were utilized combining with highly sensitive mutation detection technology. METHODS: Blood samples were drawn from six healthy blood donors and stored in three types of BCTs (BD K2 -EDTA tube, Roche tube, and Streck tube). Plasma samples were isolated at specific time points (day 0, day 3, day 7, and day 14) for content analysis. RESULTS: Roche BCT was more capable for preventing cfDNA contamination caused by white blood cell disruption within 14 days, comparing with BD K2 -EDTA tube and Streck tube. Severe white blood cell lysis and gDNA contamination were found in the BD tube. The impacts of Roche and Streck tubes on the quantity and complexity of next-generation sequencing (NGS) libraries did not differ significantly within 3 days, satisfying most of our daily demands. In addition, the rupture of WBC was not synchronized with hemolysis in BCTs. CONCLUSION: This study showed that capacities of blood collection tubes differed considerably in preservation of blood samples. Therefore, suitable blood collection devices should be selected to minimize gDNA contamination and to standardize blood samples processing for achieving more accurate and reliable clinical analysis of cfDNA.


Assuntos
Coleta de Amostras Sanguíneas/instrumentação , Coleta de Amostras Sanguíneas/normas , Ácidos Nucleicos Livres/sangue , Biópsia Líquida/instrumentação , Biópsia Líquida/normas , Hemólise , Humanos , Leucócitos/química , Leucócitos/citologia , Neoplasias/diagnóstico
18.
Transfusion ; 59(3): 972-980, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30549289

RESUMO

BACKGROUND: Wrong blood in tube (WBIT) errors are a preventable cause of ABO-mismatched RBC transfusions. Electronic patient identification systems (e.g., scanning a patient's wristband barcode before pretransfusion sample collection) are thought to reduce WBIT errors, but the effectiveness of these systems is unclear. STUDY DESIGN AND METHODS: Part 1: Using retrospective data, we compared pretransfusion sample WBIT rates at hospitals using manual patient identification (n = 16 sites; >1.6 million samples) with WBIT rates at hospitals using electronic patient identification for some or all sample collections (n = 4 sites; >0.5 million samples). Also, we compared WBIT rates after implementation of electronic patient identification with preimplementation WBIT rates. Causes and frequencies of WBIT errors were evaluated at each site. Part 2: Transfusion service laboratories (n = 18) prospectively typed mislabeled (rejected) samples (n = 2844) to determine WBIT rates among samples with minor labeling errors. RESULTS: Part 1: The overall unadjusted WBIT rate at sites using manual patient identification was 1:10,110 versus 1:35,806 for sites using electronic identification (p < 0.0001). Correcting for repeat samples and silent WBIT errors yielded overall adjusted WBIT rates of 1:3046 for sites using manual identification and 1:14,606 for sites using electronic identification (p < 0.0001), with wide variation among individual sites. Part 2: The unadjusted WBIT rate among mislabeled (rejected) samples was 1:71 (adjusted WBIT rate, 1:28). CONCLUSION: In this study, using electronic patient identification at the time of pretransfusion sample collection was associated with approximately fivefold fewer WBIT errors compared with using manual patient identification. WBIT rates were high among mislabeled (rejected) samples, confirming that rejecting samples with even minor labeling errors helps mitigate the risk of ABO-incompatible transfusions.


Assuntos
Registros Eletrônicos de Saúde/normas , Erros Médicos/estatística & dados numéricos , Bancos de Sangue/estatística & dados numéricos , Coleta de Amostras Sanguíneas/normas , Humanos , Estudos Retrospectivos
19.
Diagnosis (Berl) ; 6(1): 25-31, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-29794250

RESUMO

Several lines of evidence now confirm that the vast majority of errors in laboratory medicine occur in the extra-analytical phases of the total testing processing, especially in the preanalytical phase. Most importantly, the collection of unsuitable specimens for testing (either due to inappropriate volume or quality) is by far the most frequent source of all laboratory errors, thus calling for urgent strategies for improving blood sample quality and managing data potentially generated measuring unsuitable specimens. A comprehensive overview of scientific literature leads us to conclude that hemolyzed samples are the most frequent cause of specimen non-conformity in clinical laboratories (40-70%), followed by insufficient or inappropriate sample volume (10-20%), biological samples collected in the wrong container (5-15%) and undue clotting (5-10%). Less frequent causes of impaired sample quality include contamination by infusion fluids (i.e. most often saline or glucose solutions), cross-contamination of blood tubes additives, inappropriate sample storage conditions or repeated freezing-thawing cycles. Therefore, this article is aimed to summarize the current evidence about the most frequent types of unsuitable blood samples, along with tentative recommendations on how to prevent or manage these preanalytical non-conformities.


Assuntos
Análise Química do Sangue/métodos , Coleta de Amostras Sanguíneas/normas , Erros Médicos , Fase Pré-Analítica/métodos , Hemólise , Humanos , Laboratórios/organização & administração
20.
Diagnosis (Berl) ; 6(1): 51-56, 2019 03 26.
Artigo em Inglês | MEDLINE | ID: mdl-30138113

RESUMO

Following an ordered clinical chemistry plasma/serum test, ideally the venous blood specimen is adequately collected at a health care facility, then swiftly transported to and readily handled, analyzed and sometimes interpreted at a clinical chemistry laboratory followed by a report of the test result to the ordering physician to finally handle the result. However, often there are practical as well as sample quality reasons for short- or long-term storage of samples before and after analysis. If there are specific storage needs, the preanalytical handling practices are specified in the laboratory's specimen collection instructions for the ordered test analyte. Biobanking of specimens over a very long time prior to analysis includes an often neglected preanalytical challenge for preserved quality of the blood specimen and also involves administrative and additional practical handling aspects (specified in a standard operating procedure - SOP) when demands and considerations from academic, industry, research organizations and authorities are included. This short review highlights some preanalytical aspects of plasma/serum short- and long- term storage that must be considered by clinicians, laboratory staff as well as the researchers.


Assuntos
Bancos de Espécimes Biológicos/normas , Coleta de Amostras Sanguíneas/normas , Plasma , Fase Pré-Analítica/normas , Soro , Humanos , Laboratórios , Pessoal de Laboratório Médico , Fase Pré-Analítica/métodos , Controle de Qualidade , Fatores de Tempo
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