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Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing

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Published/Copyright: July 31, 2006
Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 44 Issue 8

Abstract

Background: Despite remarkable advances in technology and laboratory automation, results of laboratory testing still suffer from a high degree of preanalytical variability. Although there is no definitive evidence, the use of small-gauge needles for venipuncture is usually discouraged to reduce the chance of producing unsuitable specimens.

Methods: The purpose of this investigation was to assess the influence of the needle size used to collect venous blood on the measurement of 14 common analytes, including free hemoglobin, the most representative enzymes, protein-bound substances and electrolytes. Results for venous blood samples collected from 20 fasting voluntary physicians using either a 23- (0.60mm×19mm) or 25-gauge-needle (0.50mm×19mm) butterfly devices with polyvinyl chloride tubing (1.40mm×300mm) were compared with reference specimens collected using a 21-gauge-needle (0.80mm×19mm) butterfly device with polyvinyl chloride tubing (1.40mm×300mm).

Results: All means for paired samples collected using the smaller needles did not differ significantly from the reference specimen by paired Student's t-test analysis. Passing-Bablok regression analysis and Pearson's or Spearman (creatine kinase, aspartate aminotransferase, alanine aminotransferase and chloride) correlation were acceptable for most of the analyses, although a lower correlation coefficient was observed for electrolytes. In addition, when expressed as a percentage of the mean for paired samples, the s(y,x) value exceeded the desirable bias for free hemoglobin, glucose, lactate dehydrogenase, aspartate aminotransferase, sodium, chloride, calcium and magnesium (in samples collected using both 23 G and 25 G needles) and potassium (in samples collected using a 25 G needle). Although Bland-Altman plot analysis and ±1.96 SD agreement intervals for the set of differences between values was acceptable overall, the bias was rather broad for free hemoglobin and several critical electrolytes (calcium, chloride, potassium, sodium), exceeding the respective limits for desirable bias.

Conclusions: The results of our investigation indicate that 23 G needles, if handled correctly, will not introduce any statistically or clinically significant error to the measurement results compared to a 21 G needle. For the 25 G needle, we observed increased variability for potassium compared to a 23 G needle. Small-bore needles of 25 G or less cannot be universally recommended when collecting venous blood for clinical chemistry testing and should be reserved for selected circumstances, such as in patients with problematical venous accesses and newborns. In such cases, however, the bias introduced by the use of smaller needles should always be taken into consideration when interpreting test results.

Clin Chem Lab Med 2006;44:1009–14.

Keywords: clinical chemistry; laboratory testing; needle; preanalytic variability; quality
Corresponding author: Prof. Giuseppe Lippi, MD, Istituto di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Ospedale Policlinico G.B. Rossi, Piazzale Scuro, 10, 37134 Verona, Italy Phone: +39-045-8074516, Fax: +39-045-8201889,

References

1. Plebani M. Towards quality specifications in extra-analytical phases of laboratory activity. Clin Chem Lab Med 2004; 42:576–7.10.1515/CCLM.2004.099Search in Google Scholar

2. Bonini PA, Plebani M, Ceriotti F, Francesca Rubboli F. Errors in laboratory medicine. Clin Chem 2002; 48:691–8.10.1093/clinchem/48.5.691Search in Google Scholar

3. Lippi G, Guidi GC, Mattiuzzi C, Plebani M. Preanalytical variability: the dark side of the moon in laboratory testing. Clin Chem Lab Med 2006; 44:358–65.10.1515/CCLM.2006.073Search in Google Scholar

4. Frost MC, Meyerhoff ME. Implantable chemical sensors for real-time clinical monitoring: progress and challenges. Curr Opin Chem Biol 2002; 6:633–41.10.1016/S1367-5931(02)00371-XSearch in Google Scholar

5. Ernst DJ, Ernst C. Phlebotomy tools of the trade. Home Healthc Nurse 2002; 20:151–3.10.1097/00004045-200203000-00005Search in Google Scholar PubMed

6. Thurgate C, Heppell S. Needle phobia – changing venepuncture practice in ambulatory care. Paediatr Nurs 2005; 17:15–8.10.7748/paed.17.9.15.s22Search in Google Scholar PubMed

7. Wilcox GJ, Barnes A, Modanlou H. Does transfusion using a syringe infusion pump and small-gauge needle cause hemolysis? Transfusion 1981; 21:750–1.10.1046/j.1537-2995.1981.21682085769.xSearch in Google Scholar PubMed

8. Sharp MK, Mohammad SF. Scaling of hemolysis in needles and catheters. Ann Biomed Eng 1998; 26:788–97.10.1114/1.65Search in Google Scholar PubMed

9. Sharp MK, Mohammad SF. Hemolysis in needleless connectors for phlebotomy. ASAIO J 2003; 49:128–30.10.1097/00002480-200301000-00021Search in Google Scholar PubMed

10. National Committee for Clinical Laboratory Standards. Reference and selected procedures for the quantitative determination of hemoglobin in blood: approved standard, 3rd ed. NCCLS document H15-A3. Wayne, PA: NCCLS, 2000.Search in Google Scholar

11. Pearson E, D'Agostino RB, Bowman K. Tests for departure from normality: comparison of powers. Biometrika 1977; 64:231–46.10.1093/biomet/64.2.231Search in Google Scholar

12. Bland JM, Altman DG. Measuring agreement in method comparison studies. Stat Methods Med Res 1999; 8:135–60.10.1177/096228029900800204Search in Google Scholar

13. Ricos C, Alvarez V, Cava F, Garcia-Lario JV, Hernandez A, Jimenez CV, et al. Current databases on biologic variation: pros, cons and progress. Scand J Clin Lab Invest 1999; 59:491–500.10.1080/00365519950185229Search in Google Scholar

14. Laessig RH, Hassemer DJ, Paskey TA, Schwartz TH. The effects of 0.1% and 1.0% erythrocytes and hemolysis on serum chemistry values. Am J Clin Pathol 1976; 66:639–44.10.1093/ajcp/66.4.639Search in Google Scholar

15. Deryagin BV, Gutop YV. Theory of the breakdown (rupture) of free films. Kolloidn Zh 1962; 24:370–4.Search in Google Scholar

16. Evans E, Heinrich V, Ludwig F, Rawicz W. Dynamic tension spectroscopy and strength of biomembranes. Biophys J 2003; 85:2342–50.10.1016/S0006-3495(03)74658-XSearch in Google Scholar

17. Montoya JP, Merz SI, Bartlett RH. Significant safety advantages gained with an improved pressure-regulated blood pump. J Extra Corpor Technol 1996; 28:71–8.Search in Google Scholar

18. Chambers SD, Bartlett RH, Ceccio SL. Hemolytic potential of hydrodynamic cavitation. J Biomech Eng 2000; 122:321–6.10.1115/1.1286560Search in Google Scholar PubMed

19. Prabhu S, Kazarian T, Hakobyan N, Jabbar A, Dunham T, Valentino LA. Needles and needleless devices for infusion of anti-haemophilic factor concentrate: impact on protein structure and function. Haemophilia 2006; 12:58–61.10.1111/j.1365-2516.2005.01168.xSearch in Google Scholar PubMed

20. Dugan L, Leech L, Speroni KG, Corriher J. Factors affecting hemolysis rates in blood samples drawn from newly placed IV sites in the emergency department. J Emerg Nurs 2005; 31:338–45.10.1016/j.jen.2005.05.004Search in Google Scholar PubMed

21. Miller MA, Schlueter AJ. Transfusions via hand-held syringes and small-gauge needles as risk factors for hyperkalemia. Transfusion 2004; 44:373–81.10.1111/j.1537-2995.2004.00653.xSearch in Google Scholar PubMed

22. Lubran MM. Comparison of two methods of measurements of the same substance: an evaluation of some statistical procedures. Ann Clin Lab Sci 1982; 12:134–42.Search in Google Scholar

23. Lippi G, Salvagno GL, Brocco G, Guidi GC. Preanalytical variability in laboratory testing: influence of the blood drawing technique. Clin Chem Lab Med 2005; 43:319–25.10.1515/CCLM.2005.055Search in Google Scholar PubMed

24. Lippi G, Guidi GC. Effect of specimen collection on routine coagulation assays and D-dimer measurement. Clin Chem 2004; 50:2150–2.10.1373/clinchem.2004.036244Search in Google Scholar PubMed

Received: 2006-2-22
Accepted: 2006-5-8
Published Online: 2006-7-31
Published in Print: 2006-8-1

©2006 by Walter de Gruyter Berlin New York

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https://doi.org/10.1515/CCLM.2006.172
Keywords for this article
clinical chemistry; laboratory testing; needle; preanalytic variability; quality

Articles in the same Issue

  1. Laboratory medicine in the 2000s: programmed death or rebirth?
  2. Polymorphisms of the inflammatory system and risk of ischemic cerebrovascular events
  3. Haptoglobin polymorphism in patients with preeclampsia
  4. Fifteen polymorphisms in endothelin-1, endothelin-2 and endothelin-receptor-A genotyped by four duplex assays and seven simple assays on a LightCycler using hybridization probes
  5. Optimization of an enzymatic method for the determination of lysosomal N-acetyl-β-D-hexosaminidase and β-glucuronidase in synovial fluid
  6. An improved laboratory protocol to assess subarachnoid haemorrhage in patients with negative cranial CT scan
  7. Association of aminothiols with the clinical outcome in hemodialysis patients: comparison of chromatography and immunoassay for homocysteine determination
  8. Poor prognosis indicated by nucleated red blood cells in peripheral blood is not associated with organ failure of the liver or kidney
  9. Detection of citrate overdose in critically ill patients on citrate-anticoagulated venovenous haemofiltration: use of ionised and total/ionised calcium
  10. Unchanged androgen-binding properties of sex hormone-binding globulin in male patients with liver cirrhosis
  11. Relationship between serum uric acid, creatinine, albumin and gestational diabetes mellitus
  12. Aminothiols in human brain tumors
  13. Measurement of carnitine in hemodialysis patients – adaptation of an enzymatic photometric method for an automatic analyzer
  14. A robust liquid chromatography tandem mass spectrometry method for total plasma homocysteine determination in clinical practice
  15. Establishment of reference distributions and decision values for thyroid antibodies against thyroid peroxidase (TPOAb), thyroglobulin (TgAb) and the thyrotropin receptor (TRAb)
  16. Effects of a long-distance run on cardiac markers in healthy athletes
  17. α-Tocopherol supplementation reduces the elevated 8-hydroxy-2-deoxyguanosine blood levels induced by training in basketball players
  18. Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing
  19. The ratio of apoB/apoAI, apoB and lipoprotein(a) are the best predictors of stable coronary artery disease
  20. Evaluation of the analytical performance of the advanced method for cardiac troponin I for the AxSYM platform: comparison with the old method and the Access system
  21. Preliminary performance evaluation of blood gas analyzers
  22. A cost-effectiveness evaluation of reticulocyte measurement in new outpatients with or without hematologic disorders
  23. Guidelines for setting up an External Quality Assessment Scheme for blood smear interpretation. Part II: survey preparation, statistical evaluation and reporting
  24. Free light chain testing in follow-up of multiple myeloma
  25. Blood reactive oxygen metabolites (ROMs) and total antioxidant status (TAS) in patients with laryngeal squamous cell carcinoma after surgical treatment
  26. SIBioC 2006 38th National Congress of the Italian Society of Clinical Biochemistry and Clinical Molecular Biology, Turin, Italy, September 19–22, 2006
  27. Third Santorini Biologie Prospective Conference 2006: From Human Genetic Variations to Prediction of Risks and Responses to Drugs and the Environment, Santorini Island, Greece, September 29 - October 2, 2006
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