title: Effectiveness of practices to reduce blood sample hemolysis in EDs: a laboratory medicine best practices systematic review and meta-analysis.
abstract: OBJECTIVE
  To complete a systematic review of emergency department (ED) practices for reducing hemolysis in blood samples sent to the clinical laboratory for testing.
  
  
  RESULTS
  A total of 16 studies met the review inclusion criteria (12 published and 4 unpublished). All 11 studies comparing new straight needle venipuncture with IV starts found a reduction in hemolysis rates, [average risk ratio of 0.16 (95% CI=0.11-0.24)]. Four studies on the effect of venipuncture location showed reduced hemolysis rates for the antecubital site [average risk ratio of 0.45 (95% CI=0.35-0.57].
  
  
  CONCLUSIONS
  Use of new straight needle venipuncture instead of IV starts is effective at reducing hemolysis rates in EDs, and is recommended as an evidence-based best practice. The overall strength of evidence rating is high and the effect size is substantial. Unpublished studies made an important contribution to the body of evidence. When IV starts must be used, observed rates of hemolysis may be substantially reduced by placing the IV at the antecubital site.
authors.affiliation: Battelle Centers for Public Health Research and Evaluation, USA. heyern@battelle.org
authors.forename: Nicholas J
authors.initials: NJ
authors.lastname: Heyer
authors.forename: James H
authors.initials: JH
authors.lastname: Derzon
authors.forename: Linda
authors.initials: L
authors.lastname: Winges
authors.forename: Colleen
authors.initials: C
authors.lastname: Shaw
authors.forename: Diana
authors.initials: D
authors.lastname: Mass
authors.forename: Susan R
authors.initials: SR
authors.lastname: Snyder
authors.forename: Paul
authors.initials: P
authors.lastname: Epner
authors.forename: James H
authors.initials: JH
authors.lastname: Nichols
authors.forename: Julie A
authors.initials: JA
authors.lastname: Gayken
authors.forename: Dennis
authors.initials: D
authors.lastname: Ernst
authors.forename: Edward B
authors.initials: EB
authors.lastname: Liebow
mesh_terms: D001800:Blood Specimen Collection / Q000379:methods / Q000592:standards*; D057785:Catheters / Q000706:statistics & numerical data; D016208:Databases, Factual; D004636:Emergency Service, Hospital / Q000592:standards*; D055317:Evidence-Based Practice / Q000592:standards*; D006461:Hemolysis; D006801:Humans; D017056:Medical Laboratory Personnel / Q000592:standards; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D015397:Program Evaluation / Q000379:methods*; D013594:Syringes / Q000706:statistics & numerical data