Showing papers on "Phlebotomy published in 2019"

Time Trial Performance Is Sensitive to Low-Volume Autologous Blood Transfusion.

Abstract: PurposeThis study tested the hypothesis that autologous blood transfusion (ABT) of ~50% of the red blood cells (RBC) from a standard 450-mL phlebotomy would increase mean power in a cycling time trial. In addition, the study investigated whether further ABT of RBC obtained from another 450-m

Phenotypic and functional stability of leukocytes from human peripheral blood samples: considerations for the design of immunological studies

Abstract: Human peripheral blood mononuclear cells (PBMCs) are extensively used for research of immune cell functions, identification of biomarkers and development of diagnostics and therapeutics for human diseases, among others. The assumption that “old blood samples” are not appropriate for isolation of PBMCs for functional assays has been a dogma in the scientific community. However, partial data on the impact of time after phlebotomy on the quality and stability of human PBMCs preparations impairs the design of studies in which time-controlled blood sampling is challenging such as field studies involving multiple sampling centers/sites. In this study, we evaluated the effect of time after phlebotomy over a 24 h time course, on the stability of human blood leukocytes used for immunological analyses. Blood samples from eight healthy adult volunteers were obtained and divided into four aliquots, each of which was left in gentle agitation at room temperature (24 °C) for 2 h (control), 7 h, 12 h and 24 h post phlebotomy. All samples at each time point were independently processed for quantification of mononuclear cell subpopulations, cellular viability, gene expression and cytokine secretion. A 24 h time delay in blood sample processing did not affect the viability of PBMCs. However, a significantly lower frequency of CD3+ T cells (p < 0.05) and increased LPS-induced CXCL10 secretion were observed at 12 h post-phlebotomy. Alterations in TNFα, CCL8, CCR2 and CXCL10 gene expression were found as early as 7 h after blood sample procurement. These data reveal previously unrecognized early time-points for sample processing control, and provide an assay-specific time reference for the design of studies that involve immunological analyses of human blood samples.

Effect of phlebotomy versus oral contraceptives containing cyproterone acetate on the clinical and biochemical parameters in women with polycystic ovary syndrome: a randomized controlled trial.

Abstract: Reduction of the body iron stores can improve hyperandrogenemia and insulin resistance. This study aimed to compare clinical and para-clinical responses to the treatment of phlebotomy using oral contraceptive pills (OCs) containing cyproterone acetate in women with PCOS. In this randomized clinical trial, 64 patients with PCOS were randomly assigned to the phlebotomy and OCs groups (n = 32 in each group). The intervention group, using a single treatment procedure, underwent venesection of 450 mL of whole blood at the early follicular phase of the spontaneous or progesterone-induced menstrual cycle. The control group received OCs pills for 3 months from the 1th day of spontaneous or progesterone-induced menstrual cycle onwards for 3 weeks, followed by a pill-free interval of 7 days. The women were evaluated after the 3-month intervention. The primary outcome measure was a change in the HOMA-IR and free androgen index (FAI). Secondary outcomes were changes in the Ferriman-Gallwey (FG) score and other clinical, biochemical and hormonal changes from the baseline (pre-treatment) to week 12. In the phlebotomy group, 27 (84.3%) and in the OCs group 30 (93.7%) of the women completed the 3-month follow-up. The median HOMA-IR significantly decreased from 3.5 to 2.7 in the phlebotomy, and from 3.1 to 2.8 in the OCs group, and the changes were comparable between the groups. Median changes in the FAI significantly decreased in both groups, but the differences were not statistically significant between the groups (P = 0.061). With regard to secondary outcomes, mean FG scores in both groups significantly decreased [from 16.8 (6) to 13.3 (7.4), P < 0.028] in the phlebotomy group and [from 14.3 (7) to 9.8 (7.6) in the OCs group, P = 0.001] after 3 months of treatment, but such changes had no statistically significant differences between the groups. During treatment, menstrual cycles became regular in all women in the OCs group and in 12.27 (44.4%) of the women in the phlebotomy group, and the difference was statistically significant (P = 0.001). Despite no statistically significant differences in lipid profiles between the groups at the baseline, triglycerides were significantly higher in the OCs group compared to the phlebotomy at end of follow up (p = 0.019). Both treatment modalities had similar beneficial effects on insulin resistance and on androgenic profiles. However, OCs was reported more effective in treating menstrual irregularities and phlebotomy had less adverse effects on triglyceride concentrations. Code: IRCT2013080514277N1 .

Hypovolemic phlebotomy in liver surgery is associated with decreased red blood cell transfusion.

Abstract: Background Perioperative red blood cell (RBC) transfusion is associated with poor outcomes in liver surgery. Hypovolemic phlebotomy (HP) is a novel intervention hypothesized to decrease transfusion requirements. The objective of this study was to examine this hypothesis. Methods Consecutive patients who underwent liver resection at one institution (2010–2016) were included. Factors found to be predictive of transfusion on univariate analysis and those previously published were modeled using multivariate logistic regression. Results A total of 361 patients underwent liver resection (50% major). HP was performed in 45 patients. Phlebotomized patients had a greater proportion of primary malignancy (31% vs 18%) and major resection (84% vs 45%). Blood loss was significantly lower with phlebotomy in major resections (400 vs 700 mL). Nadir central venous pressure was significantly lower with HP (2.5 vs 5 cm H2O). On multivariate logistic regression, HP (OR 0.20, 95% CI 0.068–0.57, p = 0.0029), major liver resection (OR 2.91, 95% CI 1.64–5.18, p = 0.0003), preoperative hemoglobin Conclusion Hypovolemic phlebotomy appears to be strongly associated with a reduction in RBC transfusion requirements in liver resection, independent of other known risk factors.

Comparison of the Effect of Yakson Touch and Oral Glucose on the Severity of Phlebotomy Pain in Preterm Infants

Abstract: Background: Infants are exposed to different painful procedures during hospitalization in the neonatal intensive care unit (NICU). Due to the harmful effects of pain on infants, NICUs require methods by the aid of which the pain in infants can be controlled. Yakson touch and oral glucose are among non-pharmacological methods for pain relief in infants. In this regard, the present study was conducted to compare the effect of Yakson touch and oral glucose on the severity of phlebotomy pain in preterm infants.Methods: In this randomized clinical trial, 99 preterm infants hospitalized in NICU were randomly allocated to three groups, including Yakson touch (n=33), oral glucose (n=33), and control (n=33). In the oral glucose group, 1 cc of 50% glucose was orally given to the infants 1 min before phlebotomy. In the Yakson touch group, touching was performed for 5 min, and then the phlebotomy was performed. The infants in the control group did not receive a specific treatment. Infant pain level was determined before and after the phlebotomy using video recording based on Neonatal Infant Pain Scale. The data were analyzed using the analytical statistical tests, including the analysis of variance, Chi-square, Wilcoxon, and Kruskal-Wallis, in SPSS software (version 20).Results: The mean scores of pain in the two experimental groups were significantly lower than that of the control group (P=0.001), but there was no significant difference between the two experimental groups (P>0.05).Conclusion: According to our findings, both two methods (i.e., Yakson touch and oral glucose) can reduce phlebotomy pain in preterm infants hospitalized in intensive care unit. It is recommended to use Yakson touch in case of lack of access to glucose.

Reducing Phlebotomy Utilization With Education and Changes to Computerized Provider Order Entry.

Abstract: INTRODUCTION Daily phlebotomy is often a standard procedure in hospitalized patients. Recently, this practice has begun receiving attention as a potential target for efforts focused on eliminating overuse. Several organizations have published their efforts in this arena. Interventions have included education, feedback, and changes to computerized provider order entry (CPOE) but have yielded mixed results. METHODS A quality improvement initiative to reduce the utilization of daily phlebotomy was conducted at a 505-bed Academic Medical Center. This project involved a combination of educational interventions and changes to CPOE. The primary end point evaluated was the daily performance of complete blood counts (CBCs) and basic metabolic profiles (BMPs) on medical and surgery units relative to the corresponding hospital census. RESULTS Over the course of this project from August 1, 2013, to September 23, 2016, there was a 15.2% reduction in CBCs (p < .001 for linear trend) and 13.1% reduction in BMPs. DISCUSSION Our results suggest that layering multimodal interventions that involve both "hard-wired" changes to CPOE and education and performance feedback can result in decreased utilization of phlebotomy.

Predicting Patient Waiting Time in Phlebotomy Units Using a Deep Learning Method

Abstract: Phlebotomy units are one of the places with the highest patient density in a hospital. Because the patients from different outpatient clinics of the hospital come to the phlebotomy units to have phlebotomies performed on them. Accurately predicting waiting times can increase patient satisfaction and enable staff members to more accurately evaluate and respond to patient flow. In this study, we examined the applicability of a machine learning model to estimate waiting times in a phlebotomy unit. We used the waiting times in the Phlebotomy Unit of Izmir University of Health Sciences Tepecik Training And Research Hospital as our data set. In our study, our model predicted patient waiting times using an artificial Neural Network algorithm. As a result, we succeeded in predicting how long the patient would wait in the waiting room with 88% accuracy.

Demand management of weekend haematology and clinical biochemistry requests.

Abstract: Background Increasing demand for laboratory testing at weekends is common but little is known about its appropriateness. Methods An audit was conducted in a large district hospital of routine haematology and clinical biochemistry requests ordered over two weekends. Appropriateness was assessed by review of ordered tests compared with clinical records by a qualified chemical pathologist. Results Profiles requested on phlebotomy included full blood count (76%), renal profile (91%), C-reactive protein (41%), liver function tests (18%) and another test in 18%. Phlebotomy was likely unnecessary in 47.5% of episodes while 60.8% of requested assays were graded probably unnecessary or unnecessary. At ward level the number of requests averaged 37 (median 32; range 2-76) totalling 446 separate profiles or assays. There was no difference in phlebotomy requests by ward (P = 0.19). Differences were observed in ordered tests (P = 0.005) which were caused by one outlier ward with a low request rate. Conclusions A large number of unnecessary common tests seem to be carried out at weekends as part of the routine care. Implementation of demand management through education and if necessary electronic limitation of requests may be useful to control laboratory workloads.

Flushing of an intravenous catheter: a cause for unreliable laboratory results.

Abstract: Introduction Phlebotomy is an error-prone process in which mistakes are difficult to reveal. This case report describes the effect on laboratory results originating from a blood sample collected in close proximity to an intravenous catheter. Materials and methods A 69-year-old male patient was referred to the Emergency department where pneumonia was suspected. Phlebotomy was performed to collect blood samples to assess electrolytes, renal function, liver function, infection and haematological parameters. Results The laboratory analysis showed reduced potassium and calcium concentrations. To prevent life-threatening cardiac failure the clinician decided to correct those electrolytes. Remarkably, the electrocardiogram showed no abnormalities corresponding to hypokalaemia and hypocalcaemia. This observation, in combination with an overall increase in laboratory parameters with the exception of sodium and chloride, led to the suspicion of a preanalytical error. Retrospectively, an intravenous catheter was inserted in close proximity of the puncture place but no continuous infusion was started prior to phlebotomy. However, the intravenous catheter was flushed with sodium chloride. Since potential other causes were excluded, the flushing of the intravenous catheter with sodium chloride prior to phlebotomy was the most probable cause for the deviating laboratory results and subsequently for the unnecessary potassium and calcium suppletion. Conclusion This case underlines the importance of caution in the interpretation of laboratory results obtained from specimens that are collected in the proximity of an intravenous catheter, even in the absence of continuous infusion.

Perceptions on the feasibility of decentralizing phlebotomy services in community anti-retroviral therapy group model in Lusaka, Zambia.

Abstract: The focus of the community anti-retroviral therapy Group model is on drug refill, adherence and support groups. However, laboratory services are completely neglected in this model, and stable patient still have to go to the clinic for blood draws after drugs refills from the community. Due to the introduction of new ART drugs, the guidelines now recommend the use of viral loads to guide decision in switching all patients from NNRTI to dolutegravir based first line ART regimens. But the national viral load testing coverage stands at 37% and and falls short of meeting the global UNAIDS and phlebotomy delivery system is congested. The purpose of this study was to identify the perceptions in decentralizing phlebotomy services into the community anti-retroviral therapy Group model. A qualitative case study design was used. Data were collected through ten Focused group discussions among community anti-retroviral therapy Group members, community and health care workers at anti-retroviral therapy clinics and in-depth interviews with five key informants. Data were managed with the help of Nvivo version 10 and analyzed using thematic method. Positive perceptions were identified as those which contributed to decongesting phlebotomy rooms, reduced missing phlebotomy appointments, work Load, and lost results. Improved quality of phlebotomy service delivery and testing coverage, innovative access to laboratory services and encouraged patient’s accountability. The negative perceptions were compromised sample integrity, inability to perform prevention control and patients less contact with clinicians. The study has demonstrated that decentralizing phlebotomy services within the CAG model has greater potential to improve the quality of services delivery for patients. In addition, it has perceived threats on the quality of specimen collected, patient’s safety, and health care.

Evaluation of Phlebotomy-Related Anxiety, Pain andSafety in A Mexican General Hospital Using WingedBlood Collection Sets

Abstract: A The medicinal laboratory workflow heavily depends on phlebotomy, rendering it a crucial step in which a blood sample has to be obtained with efficiency and in the best conditions in order to obtain a representative sample from the patients to perform blood analysis. The new technologies and quality indices in laboratories set both in hospitals or as points-of-care, show clear and promising tendencies to improve and personalize sample collection for each patient. Specifically, venous blood collection is, if not the most frequently requested, one of the most important samples needed to perform medicinal laboratory analysis [1]. Every phlebotomy has certain quality requirements that must be complied with as the minimum necessary to ensure the two main purposes in a medicinal laboratory: patient satisfaction and results with diagnostic value [2]. As new technologies become available, the laboratories see the need to keep improving their patients’ experience as well as ensuring sample quality, always aiming to meet intraand interindividual variability and personalize each phlebotomy and test [1].

Fasting Status of Patients Undergoing Ambulatory Laboratory Testing.

Abstract: Many studies use glucose values from electronic medical record data to identify patients with prediabetes and diabetes (1–3). Since diagnostic criteria are based on fasting glucose (4), investigators often choose to assume that patients were fasting if phlebotomy was performed in the morning. We sought to assess the validity of the assumption that outpatient morning measurements are fasting measures. We surveyed adult patients (age ≥18 years) presenting for phlebotomy at the Johns Hopkins Outpatient Center between 7:00 a.m. and noon over 2 weeks in November 2018. Patients responded to a four-question written survey provided by the registration staff. The survey asked 1 ) about their fasting status, 2 ) whether the ordering provider instructed them to fast, 3 ) whether they were getting a glucose and/or cholesterol test (“If you know which blood test(s) you are getting done, please select ones that are included on the list below,” with answer options of “glucose” and “cholesterol panel”), and 4 ) what …

Quality Improvement Intervention for Universal Lipid Screening in Children Aged 9 to 11 Years.

Abstract: We performed a quality improvement intervention to increase universal lipid screening in well-child visits (age 9 to 11 years): 12-month preintervention; phase 1 (8 months) with provider education, group monthly chart review with feedback, and electronic health record cues to order lipids; and phase 2 (16 months) with electronic health record cues and examination room phlebotomy. Outcomes were compared with clinics having no intervention. In phase 1, immediate treatment effect on the regression line for provider behavior (proportion of visits with lipids ordered) showed 34% increase in intervention and 7% decrease in comparison clinics; patient behavior (phlebotomy completed) showed 19% increase in intervention and 5% decrease in comparison clinics. At the beginning of phase 2, the intervention clinic had average 44% orders entered and 33% phlebotomy completed per well-child visit, and these proportions were maintained. Provider education and chart review with feedback were associated with the greatest gains in outcomes.

The results of a close follow-up of trainees to gain a good blood collection practice.

Abstract: Background Phlebotomy is one of the most important steps in the preanalytical phase of a clinical laboratory process. In order to decrease phlebotomy errors, this specific procedure should be taught in detail by laboratory organizations. Our study aims to practice the training program on venous blood sampling and observe the close follow-up results. Methods In this observational study, 127 students who started their summer internship in Antalya Education and Research Hospital were given a one-day theoretical phlebotomy training in accordance with the Venous Blood Sampling Guidelines. After the theoretical training, phlebotomy applications of 10 students who were working in the field of out-patient blood sampling were observed both with and without their knowledge. A comprehensive checklist related to phlebotomy was created by the trainers in Antalya Education and Research Hospital and the observers answered each question as yes or no. For the statistical analysis, IBM SPSS Statistics 21.0 was used. Results After the theoretical education, the trainees were observed but no significant difference was found between the first and the second informed observations (p = 0.125). The students were observed three times more in the following week without their knowledge. There was a statistically significant difference between the first and the third unannounced observations (p=0.001). Conclusions In order to perform phlebotomy correctly, apart from theoretical education, a close follow-up is necessary too.

Impact of Nursing Education on Phlebotomy Blood Loss and Hospital-Acquired Anemia: A Quality Improvement Project.

Abstract: BACKGROUND Phlebotomy blood loss resulting in hospital-acquired anemia remains a significant problem in the critically ill population. A quality improvement project focused on decreasing phlebotomy blood loss and increasing nursing knowledge regarding blood conservation strategies was undertaken in the intensive care unit of a community hospital. METHODS The project followed a quasi-experimental design. Data were gathered using electronic chart review and surveys before and after educational sessions. Intensive care unit nurses attended educational sessions focused on increasing knowledge regarding phlebotomy blood loss, hospital-acquired anemia, blood conservation strategies, and utilization of blood conservation devices. RESULTS The study showed a statistically significant increase in nursing knowledge regarding hospital-acquired anemia, phlebotomy blood loss, and blood conservation device use (P < .001) and a statistically significant change in blood conservation device application practice in the posteducation period when compared with the preeducation period (P = .016). CONCLUSION The findings of this project support the added value of dedicated blood conservation education to nurses to promote increased knowledge, increased blood conservation device utilization, and decreases in phlebotomy blood loss.

Investigations in Kidney Disease

Abstract: Blood tests • Estimated Glomerular Filtration Rate (eGFR) -The best measure of your kidney function. It shows how well your kidneys are cleaning the blood. Your eGFR is usually estimated (eGFR) from the results of the creatinine blood test. eGFR is reported in millilitres per minute per 1.73m2(mL/min/1.73m2). An e GFR of 100 mL/min/1.73m2 is in the normal range so it is useful to say that 100 mL/min/1.73m2 is about equal to ‘100% kidney function’. An eGFR of 50 mL/min/1.73m2 could be called ‘50% kidney function’. • Creatinine A waste product made by the muscles. It is usually removed from the blood by the kidneys and passes out in the urine. When the kidneys aren’t working well, creatinine stays in the blood. Creatinine varies with age, gender and body weight so is not an accurate way of measuring overall kidney function. When on dialysis creatinine levels are always high.

PhleAid: Automated Phlebotomy Assistant

Abstract: 1 Authorship & Contributions 2

Improvement of blood culture contamination rate, blood volume, and true positive rate after introducing a dedicated phlebotomy team

Abstract: 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.

Experience in management of porphyria cutanea tarda in a tertiary referral Brazilian hospital from 2002 to 2017.

Abstract: Background Porphyria cutanea tarda (PCT) is the most common porphyria worldwide. The known acquired precipitating factors that induce PCT include alcoholism, hepatitis C virus infection, human immunodeficiency virus infection, and estrogen intake. Hereditary hemochromatosis is considered an inherited risk factor. The aim of this study was to describe and analyze precipitating factors and family history, with emphasis on PCT management. Methods A retrospective study of 87 patients with PCT was conducted between January 2002 and December 2017. Results A male predominance of 1.8 : 1 was found. The median age at diagnosis was 49 years (range 18-71). Family history of PCT was observed in 19.5% of patients. Two or more acquired precipitating factors were present in 42.5%. Patients were treated with antimalarial monotherapy (72.4%), antimalarial combined with phlebotomy (22.9%), and only with phlebotomy (4.6%). Acquired precipitating factors and inherited factors were not associated with treatment group. There was a difference in 24 h-UP normalization rate between treatment groups; combined therapy takes longer than antimalarial monotherapy, 38 months versus 15 months, respectively (CI 95%, 6.5-63.5 vs. 12.9-17) (log-rank test, P = 0.004). Conclusion Precipitating factors did not seem to be associated with treatment choice; however, all acquired and inherited precipitating factors should be investigated, and the choice between phlebotomy and/or antimalarials should be individualized. All dermatologists treating PCT patients should observe transferrin saturation and ferritin levels to search for underlying hereditary hemochromatosis.

Clinical characteristics of a Turkish family with congenital erythrocytosis due to an EPOR mutation: Is routine phlebotomy indicated in children and adolescents?

Abstract: Here we present two siblings, a 9-year-old boy and a 15-year-old girl at presentation, with congenital erythrocytosis due to an EPOR c.1316G>A (p.Trp439Term) mutation. The patients had nausea, abdominal pain, and headache when they presented with hemoglobin levels of 23 g/dL and 19.4 g/dL, respectively. Their father, paternal uncle, and probably the paternal aunt and grandmother had congenital erythrocytosis. The siblings generally preferred to visit hospital when hyperviscosity symptoms developed and had intermittent phlebotomies. Their compliance to anti-aggregant and hematinic treatment was not satisfactory. Within the 11-year follow-up period, the siblings had no thrombohemorrhagic complications, whereas their 39-year-old uncle had a stroke. In addition to antiaggregant treatment, phlebotomy during hyperviscosity symptoms may be safe in children and adolescents; routine phlebotomies may be recommended to adults to prevent thrombohemorrhagic complications.