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Cited by 66Clinical Laboratory Practices and Quality ControlPatient Safety and Medication ErrorsHealthcare Quality and Management

Impact of the phlebotomy training based on CLSI/NCCLS H03-A6 – procedures for the collection of diagnostic blood

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Lima-Oliveira, Gabriel, Lippi, Giuseppe, Salvagno, Gian Luca, Montagnana, Martina, Picheth, Geraldo, Guidi, Gian Cesare·2012·Biochemia Medica
DOI 10.11613/bm.2012.036PMC PMC3900046
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Abstract

INTRODUCTION: The activities involving phlebotomy, a critical task for obtaining diagnostic blood samples, are poorly studied as regards the major sources of errors and the procedures related to laboratory quality control. The aim of this study was to verify the compliance with CLSI documents of clinical laboratories from South America and to assess whether teaching phlebotomists to follow the exact procedure for blood collection by venipuncture from CLSI/NCCLS H03-A6 - Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture might improve the quality of the process. MATERIALS AND METHODS: A survey was sent by mail to 3674 laboratories from South America to verify the use of CLSI documents. Thirty skilled phlebotomists were trained with the CLSI H03-A6 document to perform venipuncture procedures for a period of 20 consecutive working days. The overall performances of the phlebotomists were further compared before and after the training program. RESULTS: 2622 from 2781 laboratories that did answer our survey used CLSI documents to standardize their procedures and process. The phlebotomists' training for 20 days before our evaluation completely eliminated non-conformity procedures for: i) incorrect friction of the forearm, during the cleaning of the venipuncture site to ease vein location; ii) incorrect sequence of vacuum tubes collection; and iii) inadequate mixing of the blood in primary vacuum tubes containing anticoagulants or clot activators. Unfortunately the CLSI H03-A6 document does not caution against both unsuitable tourniquet application time (i.e., for more than one minute) and inappropriate request to clench the fist repeatedly. These inadequate procedures were observed for all phlebotomists. CONCLUSION: We showed that strict observance of the CLSI H03-A6 document can remarkably improve quality, although the various steps for collecting diagnostic blood specimens are not a gold standard, since they may still permit errors. Tourniquet application time and forearm clench should be verified by all quality laboratory managers in the services. Moreover, the procedure for collecting blood specimens should be revised to eliminate this source of laboratory variability and safeguard the quality.

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  • The time of tourniquet application may be longer than 1 min if the CLSI recommended procedure (putting gloves on after applying a tourniquet) is followed.

    “However, there is evidence that the time of tourniquet application may then be longer than 1 min if this CLSI recommended procedure is followed [49].”

    From Joint EFLM-COLABIOCLI Recommendation for venous blood sampling (2018) · cites this paper as [49]

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Authors
Lima-Oliveira, G., Lippi, G., Salvagno, G. L., Montagnana, M., Picheth, G., & Guidi, G. C.
Affiliations
  • University of Verona (IT)
  • Ospedale di Parma (IT)
  • Universidade Federal do Paraná (BR)
Corresponding author
Lima-Oliveira, Gabriel
ORCID
Venue
Biochemia Medica
Publisher
Croatian Society for Medical Biochemistry and Laboratory Medicine
Published
2012
Volume
22
Issue
3
Pages
342-351
ISSN
  • 1330-0962 (ISSN-L)
  • 1846-7482
DOI
10.11613/bm.2012.036
PMC
PMC3900046
OpenAlex
W2158547629
Cited by
66
References
4
Citations by year
2026: 1 · 2025: 1 · 2024: 3 · 2023: 4 · 2022: 2 · 2021: 1 · 2020: 6 · 2019: 4 · 2018: 2 · 2017: 6 · 2016: 9 · 2015: 2 · 2014: 12 · 2013: 11 · 2012: 1
FWCI
5.57
Type
journal article
Language
en
Open access
Licence
cc-by
Locations
  • Biochemia Medica (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, other-oa)
  • PubMed Central (publishedVersion, cc-by-nc)
  • PubMed (publishedVersion)
  • University of Zagreb University Computing Centre (SRCE) (submittedVersion, other-oa)
  • Padua Research Archive (University of Padova) (submittedVersion, cc-by)
Topics
  • Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
  • Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
  • Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
Keywords
phlebotomy training, venipuncture, blood sampling, laboratory quality control, tourniquet application time, laboratory variability
MeSH terms
Blood Specimen Collection, Humans, Phlebotomy

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