title: Reduction of gross hemolysis in catheter-drawn blood using Greiner Holdex tube holder.
abstract: BACKGROUND
  Blood collection through intravenous lines frequently causes spurious hemolysis. Due to specific structure, the tube holder Holdex (Greiner Bio-One GmbH, Kremsmuenster, Austria) is supposed to prevent erythrocyte injury in samples collected from catheters, so that we planned a specific study to support this hypothesis.
  
  
  METHODS
  Blood was collected from emergency department (ED) patients with 20-gauge catheter. In patients with odd order numbers, first and second tubes were collected with conventional holder (BD Vacutainer One Use Holder, Becton Dickinson, Milan, Italy) and the third with Holdex, whereas in even patients first and second tubes were drawn with Holdex and the third using BD Vacutainer One Use Holder. The first tube was discarded, whereas the second and third were centrifuged and serum was tested for potassium, lactate dehydrogenase (LD) and hemolysis index.
  
  
  RESULTS
  The final study population consisted in 60 ED patients. Concentrations of potassium (4.25 vs. 4.16 mmol/L; P = 0.031), LD (498 vs. 459 U/L; P = 0.039) and cell-free hemoglobin (0.42 vs. 0.22 g/L; P = 0.042) were higher in samples collected with BD Vacutainer One Use Holder than with Holdex. The mean bias of cell-free hemoglobin was -0.4 g/L in samples collected with Holdex. Although the frequency of samples with cell-free hemoglobin > 0.5 g/L was identical (17/60 vs. 17/60; P = 1.00), the frequency of those with concentrations > 3.0 g/L was higher using BD Vacutainer One Use Holder than Holdex (4/60 vs. 0/60; P = 0.042).
  
  
  CONCLUSIONS
  The use of Holdex for drawing blood from intravenous lines may be effective for reducing gross hemolysis.
authors.affiliation: Clinical Chemistry Laboratory, Academic Hospital of Parma, Parma, Italy. glippi@ao.pr.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Lippi
authors.forename: Paola
authors.initials: P
authors.lastname: Avanzini
authors.forename: Rosalia
authors.initials: R
authors.lastname: Aloe
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Cervellin
mesh_terms: D000328:Adult; D000368:Aged; D015536:Down-Regulation; D016529:Emergency Nursing / Q000295:instrumentation; D004636:Emergency Service, Hospital; D005260:Female; D006461:Hemolysis / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D018962:Phlebotomy / Q000295:instrumentation*; D062666:Vascular Access Devices