title: Neonatal Intensive Care Unit Quality Initiative:  Identifying Preanalytical Variables Contributing to Specimen Hemolysis and Measuring the Impact of Evidence-Based Practice Interventions.
abstract: OBJECTIVE
  Blood specimen hemolysis is a major cause of sample recollection in the neonatal intensive care unit. We aimed to reduce the hemolysis rate from 6.3% at baseline to less than 4% within the 9 months' duration of the study.
  
  
  METHODS
  Intravenous infusion of lipid emulsion during sample collection, sample collection site, and blood sample transportation methods were investigated as possible contributors to hemolysis. Subsequently, two practice improvements were implemented: pausing lipid emulsion infusion prior to collection and slowing withdrawal rates through arterial catheters.
  
  
  RESULTS
  Samples were more likely to be hemolyzed if they were collected during lipid infusion and subsequently transported by pneumatic tube or collected through an arterial catheter. Retrospective analysis demonstrated a decreased number of tests cancelled due to specimen hemolysis (3.5%) after our interventions.
  
  
  CONCLUSIONS
  We identified three variables contributing to hemolysis and instituted two clinical practice interventions to significantly reduce test cancellations due to hemolysis.
authors.affiliation: From the Department of Laboratory Medicine and Pathology Department of Pathology and Laboratory Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors.forename: Nicole V
authors.initials: NV
authors.lastname: Tolan
authors.affiliation: From the Department of Laboratory Medicine and Pathology Sonora Quest Laboratories, Tempe, AZ.
authors.forename: Erin J
authors.initials: EJ
authors.lastname: Kaleta
authors.affiliation: Division of Neonatal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Fang
authors.affiliation: Division of Neonatal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Colby
authors.affiliation: Division of Neonatal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: William A
authors.initials: WA
authors.lastname: Carey
authors.affiliation: From the Department of Laboratory Medicine and Pathology.
authors.forename: Brad S
authors.initials: BS
authors.lastname: Karon
authors.affiliation: From the Department of Laboratory Medicine and Pathology baumann.nikola@mayo.edu.
authors.forename: Nikola A
authors.initials: NA
authors.lastname: Baumann
mesh_terms: D001800:Blood Specimen Collection / Q000379:methods* / Q000592:standards; D006461:Hemolysis; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000592:standards; D011786:Quality Control; D012189:Retrospective Studies; D013048:Specimen Handling / Q000379:methods*
keywords: Arterial catheter draws; Clinical chemistry; Clinical practice intervention; Lipid emulsion infusion; Neonatal ICU; Quality improvement; Sample transport; Specimen hemolysis