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Instructions on appropriate fasting prior to phlebotomy; effects on patient awareness, preparation, and biochemical parameters

  • Nélia S.V. Andrade EMAIL logo , Sinead N. Curtin , Ashiq Masih , Brid Fitzgibbon , Katie Herbert , Mary Gowen , Margaret Lehane and Seán J. Costelloe ORCID logo
Published/Copyright: February 10, 2023
Diagnosis
From the journal Diagnosis Volume 10 Issue 2

Abstract

Objectives

This study investigated the effect of appropriate pre-phlebotomy instructions on patients’ awareness of the need to fast, their fasting status at phlebotomy, and the measurement of specific biochemical analytes and indices.

Methods

While booking their phlebotomy appointments, two-hundred outpatients, with a wide range of pre-existing medical conditions, were recruited and randomly assigned to either control or intervention groups. The control group received no instructions while the intervention group was verbally instructed to fast for precisely 12 h prior to their appointment. Serum samples were collected from participants to quantify common biochemical analytes and serum indices, some of which were known to be influenced by fasting status, such as triglyceride and the lipaemic index. At the same appointment, participants completed a survey assessing their perception of, and adherence to, fasting requirements.

Results

In the intervention group, 99% responded that they had fasted before phlebotomy vs. 16% of controls. Subjects stated they fasted for 12 h in 51% of the intervention group and 7% of the controls. Median concentrations for potassium and total bilirubin were statistically, but not clinically, significantly different. In the study, a single patient in the intervention group was found to have a lipaemic sample.

Conclusions

Without instruction, it appears few patients will fast appropriately prior to blood collection. This study suggests that most patients recall and adhere to verbal instructions regarding fasting. Though many in the control group stated they did not fast, triglyceride concentration and lipaemia were not significantly different from the intervention group, and biochemical analyses appear unaffected by fasting status.

Keywords: fasting; lipaemia; pre-analytics; results; survey
Corresponding author: Nélia S.V. Andrade, Department of Clinical Biochemistry, Cork University Hospital, Wilton Road, Cork, Republic of Ireland, E-mail:

Acknowledgments

Sincere thanks to the dedicated work of the CUH phlebotomy team and patients involved in this research.

  1. Research funding: None declared.

  2. Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.

  3. Competing interests: Authors state no conflict of interest.

  4. Informed consent: Informed consent was obtained from all individuals included in this study.

  5. Ethical approval: Research involving human subjects complied with all relevant national regulations, and institutional policies and is in accordance with the tenets of the Helsinki Declaration (as revised in 2013), and has been approved by the Clinical Research Ethics Committee of the Cork Teaching Hospitals: approval numbers ECM 4 (z) 12/01/2021 and ECM 3 (oo) 09/02/2021.

References

1. Kulkarni, KK, Bhandari, AP, Unni, AK. Questionnaire-based study to assess knowledge of preanalytical phase of laboratory testing among trainee doctors in a Tertiary Care Hospital Medical College. J Lab Phys 2020;12:178–83. https://doi.org/10.1055/s-0040-1720945.Search in Google Scholar PubMed PubMed Central

2. Da Rin, G. Pre-analytical workstations: a tool for reducing laboratory errors. Clin Chim Acta 2009;404:68–74. https://doi.org/10.1016/j.cca.2009.03.024.Search in Google Scholar PubMed

3. Plebani, M. Total testing process: roots and state-of-the-art. Diagnosis 2020;7:19–20. https://doi.org/10.1515/dx-2019-0066.Search in Google Scholar PubMed

4. Giavarina, D, Lippi, G. Blood venous sample collection: recommendations overview and a checklist to improve quality. Clin Biochem 2017;50:568–73. https://doi.org/10.1016/j.clinbiochem.2017.02.021.Search in Google Scholar PubMed

5. Nikolac, N, Simundic, AM, Kackov, S, Serdar, T, Dorotic, A, Fumic, K, et al.. The quality and scope of information provided by medical laboratories to patients before laboratory testing: survey of the Working Group for patient preparation of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Clin Chim Acta 2015;450:104–9. https://doi.org/10.1016/j.cca.2015.08.001.Search in Google Scholar PubMed

6. Hepburn, S, Jankute, M, Cornes, MP, Rios, NR, Stretton, A, Costelloe, SJ. Survey of patient perception of preanalytical requirements for blood testing in the UK and RoI. Ann Clin Biochem: Int J Lab Med 2020;58:132–40. https://doi.org/10.1177/0004563220982325.Search in Google Scholar PubMed

7. Kackov, S, Šimundić, AM, Gatti-Drnić, A. Are patients well informed about the fasting requirements for laboratory blood testing? Biochem Med 2013;23:326–31. https://doi.org/10.11613/bm.2013.040.Search in Google Scholar PubMed PubMed Central

8. Simundic, AM, Cornes, M, Grankvist, K, Lippi, G, Nybo, M. Standardisation of collection requirements for fasting samples for the working group on preanalytical phase (WG-PA) of the European federation of clinical chemistry and laboratory medicine (EFLM). Clin Chim Acta 2014;432:33–7. https://doi.org/10.1016/j.cca.2013.11.008.Search in Google Scholar PubMed

9. Lima-Oliveira, G, Salvagno, GL, Lippi, G, Gelati, M, Montagnana, M, Danese, E, et al.. Influence of a regular, standardised meal on clinical chemistry analytes. Ann Lab Med 2012;32:250–6. https://doi.org/10.3343/alm.2012.32.4.250.Search in Google Scholar PubMed PubMed Central

10. LIH – Beckman Coulter. LIH reagent, OSR62166 datasheet [Online]. Beckman Coulter; 2012. Available from: https://www.beckmancoulter.com/wsrportal/techdocs?docname=/cis/BAOSR6x166/%25%25/EN_LIH_BAOSR6x166_US.pdf [Accessed 7 Jul 2021].Search in Google Scholar

11. Farrell, CJL, Carter, AC. Serum indices: managing assay interference. Ann Clin Biochem: Int J Lab Med 2016;53:527–38. https://doi.org/10.1177/0004563216643557.Search in Google Scholar PubMed

12. Nikolac, N. Lipemia: causes, interference mechanisms, detection and management. Biochem Med 2014;24:57–67. https://doi.org/10.11613/bm.2014.008.Search in Google Scholar

13. Simundic, AM, Bölenius, K, Cadamuro, J, Church, S, Cornes, MP, van Dongen-Lases, EC, et al.. Joint EFLM-COLABIOCLI recommendation for venous blood sampling. Clin Chem Lab Med 2018;56:2015–38. https://doi.org/10.1515/cclm-2018-0602.Search in Google Scholar PubMed

14. Greiner, Bio-One. Vacuette® tube 3 ml CAT serum clot activator [Online]; 2021. Available from: https://shop.gbo.com/en/row/products/preanalytics/venous-blood-collection/vacuette-tube/serum/cat-serum-clot-activator/454095.html [Accessed 6 Jul 2021].Search in Google Scholar

15. Knopfholz, J, Disserol, CC, Pierin, AJ, Schirr, FL, Streisky, L, Takito, LL, et al.. Validation of the Friedewald formula in patients with metabolic syndrome. Cholesterol 2014;2014:1–5. https://doi.org/10.1155/2014/261878.Search in Google Scholar PubMed PubMed Central

16. Analyse-it. Statistics add-in software for statistical analysis in excel [Online]; 2012. Available from: http://analyse-it.com/ [Accessed 21 Jul 2021].Search in Google Scholar

17. Ggplot2 [Internet]. Create elegant data visualisations using the grammar of graphics [Online]; 2020. Available from: https://ggplot2.tidyverse.org/ [Accessed 21 Jun 2022].Search in Google Scholar

18. Bates, D, Chambers, J, Dalgaard, P, Gentleman, R, Kurt, H, Ihaka, R, et al.. The R project for statistical computing. R [Online]; 2022. Available from: https://www.R-project.org/ [Accessed 21 Jun 2022].Search in Google Scholar

19. Yadav, S, KC, S. Interference of drugs on clinical chemistry- shall we start thinking? J Nepal Chem Soc 2013;29:89–95. https://doi.org/10.3126/jncs.v29i0.9257.Search in Google Scholar

20. Santos, SL, Borges, RN, Barros, KB. Drugs that interfere with the results of laboratory tests: an integrative review of the literature. Rev Bras Anal Clin 2018;50:105–10. https://doi.org/10.21877/2448-3877.201800581.Search in Google Scholar

21. Ramos, LR, Oliveira, MV, Souza, CL. Preanalytical variables evaluation in laboratory tests of patients attended at the Vitória da Conquista Central Laboratory, Bahia, Brazil. J Bras Patol Med Lab 2020;56:1–8. https://doi.org/10.5935/1676-2444.20200009.Search in Google Scholar

22. Plumelle, D, Lombard, E, Nicolay, A, Portugal, H. Influence of diet and sample collection time on 77 laboratory tests on Healthy Adults. Clin Biochem 2014;47:31–7. https://doi.org/10.1016/j.clinbiochem.2013.11.002.Search in Google Scholar PubMed

23. Mainali, S, Davis, SR, Krasowski, MD. Frequency and causes of lipemia interference of clinical chemistry laboratory tests. Pract Lab Med 2017;8:1–9. https://doi.org/10.1016/j.plabm.2017.02.001.Search in Google Scholar PubMed PubMed Central

Supplementary Material

This article contains supplementary material (https://doi.org/10.1515/dx-2022-0131).

Received: 2022-11-28
Accepted: 2023-01-27
Published Online: 2023-02-10

© 2023 Walter de Gruyter GmbH, Berlin/Boston

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https://doi.org/10.1515/dx-2022-0131
Keywords for this article
fasting; lipaemia; pre-analytics; results; survey

Articles in the same Issue

  1. Frontmatter
  2. Editorials
  3. An equation for excellence in clinical reasoning
  4. Quantifying diagnostic excellence
  5. Review
  6. A scoping review of distributed cognition in acute care clinical decision-making
  7. Opinion Papers
  8. Context matters: toward a multilevel perspective on context in clinical reasoning and error
  9. Occam’s razor and Hickam’s dictum: a dermatologic perspective
  10. Original Articles
  11. Differences in clinical reasoning between female and male medical students
  12. Introducing second-year medical students to diagnostic reasoning concepts and skills via a virtual curriculum
  13. Bad things can happen: are medical students aware of patient centered care and safety?
  14. Impact of diagnostic checklists on the interpretation of normal and abnormal electrocardiograms
  15. Cerebrospinal fluid lactate as a predictive biomarker for tuberculous meningitis diagnosis
  16. Empowering quality data – the Gordian knot of bringing real innovation into healthcare system
  17. Collective intelligence improves probabilistic diagnostic assessments
  18. Why people fail to participate in annual skin cancer screening: creation of the perceptions of annual skin cancer screening scale (PASCSS)
  19. Instructions on appropriate fasting prior to phlebotomy; effects on patient awareness, preparation, and biochemical parameters
  20. Clinician factors associated with delayed diagnosis of appendicitis
  21. Real-world assessment of the clinical performance of COVID-VIRO ALL IN rapid SARS-CoV-2 antigen test
  22. Lack of a prompt normalization of immunological parameters is associated with long-term care and poor prognosis in COVID-19 affected patients receiving convalescent plasma: a single center experience
  23. Letters to the Editor
  24. Uncontrolled confounding in COVID-19 epidemiology
  25. VAPES: a new mnemonic for considering paroxysmal disorders
  26. Congress Abstracts
  27. SIDM2022 15th Annual International Conference
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