George Paul L.

Nayan 1PMT

Reflection: Blood venous sample collection: Recommendations overview and a checklist to improve
quality by Giavarina and Lippi

Fundamentally as a student, in anything I ought understand, I think that experiencing them and
rendering sufficient amount of time would strengthen my knowledge and let me formulate my own
opinions. As I exert greater time and effort, these opinions are to gradually approach the truth.

Medical Technologists take one of the most challenging tasks a healthcare provider can offer to
his/her patient- Phlebotomy. For instance, when doing this, the story neither ends nor starts from the
extraction of blood itself but rather from moments before and towards after that. We call these moments
phases. You have pre-analytical phase which is everything before the sample reach the lab-includes
extraction, analytical phase or laboratory testing part, and the post-analytical phase or the part where the
results is released. Phlebotomists play a huge role in pre-analytical and analytical phases and inevitably,
errors happen where most of them takes place before and during extraction.

The article emphasized that the effects of errors are crucial and therefore must be addressed
properly. Biological samples are usually the ones to indicate whether a phlebotomist is doing it the right
way. There are variables to be accounted. Pre-analytically, phlebotomists deal with issues related to
sample collection. One of which is patient and sample identification errors. I found out that when patients
have similar names errors are most likely to happen and the results may be attributed to the wrong
patient. Furthermore, problems occur during blood sample draw. The devices and materials used for
drawing blood play a key role for securing the integrity of the specimen. Containers’ main job is to contain
the samples while keeping their physical, chemical and biological properties are preserved as well as the
additives included in some of them. It is also encouraged to practice single syringe use among patients. I
also learned that labels on primary blood tubes should at least have these basic information: type of
additive, drawing volume and expiry date.

Practically, I discovered some do’s and don’ts. I should not take any random information like room
number or even diagnosis to identify a patient rather, I must use at least 2 identifiers defined by the
organization. I should ask the patients properly and introduce close ended questions like “what is your
name?” “what is your date of birth” and not open ended ones such as “your name is..” Moreover, testing
the patient through the deliberate use of a different name for confirmation should not be practiced as it
makes the patient feel uncomfortable. I should label the samples near the patient one at a time and it is
should be done immediately before or after extraction. When needed, I also have the responsibility to
explain to the patient the importance of the test to be done. Lastly, any distraction must be eliminated.

I have also read about the recommended syringe gauge for certain age groups. Adults with regular
veins are given 21 gauge- a finer one compared to the children who have it at 23 gauge. However, drawing
blood from catheters are discouraged since it increases the risk of spurious hemolysis or the breakdown
of blood after the sample collection however it can be reduced by lowering the negative pressure for
aspirating blood from catheters. When using containers, mistakes in identification also happens. Despite
the identifiers in tubes some phlebotomists get them mixed up. This is risky since some tubes contain
additives which are unsuitable for certain tests. That’s why proper order of draw should be practiced.
 Insufficient sample volumes are also committed. This limits the performance of all the tests
needed. This mostly takes place in pediatric draws but can also occur in adults since easier venous access
precedes greater challenge in identifying and technical difficulties. Hence, physicians and phlebotomists
must have a clear information about the proper volume needed so lesser requests are to be sent and
priorities are to be established better that is: the greater the volume requirement, the lesser priority it
bears.

I should also keep in mind the techniques selected. If it is too sensitive with the results under low
concentrations, I can dilute it as long as I report an accurate calculation but it remains limited with other
tests. Undue clotting error can also occur wherein coagulation process takes place in blood tubes
containing anticoagulants. It may be because a prolonged venipuncture or failing to properly mix the tube
after collection. Hemolyzed samples where the red blood cell breaks down and release it contents (usually
hemoglobin) in plasma/serum results in abnormal readings. Errors can also happen inside the body during
intravascular hemolysis. This is due to systemic diseases (liver complications, hematologic disorders,
cancer, autoimmune diseases, etc.) Extravascular hemolysis happens as well and this is from a myriad of
causes like improper or absence of mixing, incorrect needle gauge, traumatic draw, transport duration,
time between collection and centrifugation, storage, temperature and many more.

One reason these errors are so prevalent is the lack of standardized requirement around the globe
to practice phlebotomy. Training should include education about sampling, patient management,
sampling techniques and safety information. With this, the article provided a 12 item check list. The first
and last question talks about your safety as a phlebotomist (PPE) and safe discard of the potentially
infectious material, the second may reveal fasting time and recording of physical activity hours before the
collection. The third to fifth talks about the patient and sample identification, items 6 and 7 are focused
on optimizing the various blood collection phases through proper preparation of materials, 8 and 9
discusses sampling techniques and spurious bias of analytes (ex. Because of prolonged tourniquet time)
as well as the behavioral and relational aspects with the patient and the progress of alertness regarding
the patient’s health during and after the extraction, and items 10 and 11 focuses on the quality of the
sample through the blood-to-anticoagulant or blood-to-additive ration.

Sample collection is a very critical part in the pre-analytical phase and also involves other
healthcare providers. It must be observed with proper training, education and support. Having a
standardized procedure greatly helps in improving the quality of laboratory science as a whole. I agree
with the article in empowering a culture of awareness of the problems and great risk perception to
perform my future duties as a learning and professional medical technologist.