Common Blood Draw Challenges and How to Overcome Them

Laboratory blood tests are a cornerstone of the evaluation of acutely ill patients. However, errors with blood draws are common, particularly within critical care settings, like the neonatal intensive care unit (NICU) and emergency department.

Hemolysis, the destruction of red blood cells during sample collection, is a significant concern, contributing to up to 70 percent of preanalytical errors.¹ When ruptured, these red blood cells release their contents into the blood, altering electrolyte levels, including potassium. This can lead to inaccurate results, which can have potentially serious implications for patient care.

Traditionally, hemolysis detection has been limited to lab-based instruments. However, recent advancements, like the GEM Premier 7000 with iQM3, have introduced point-of-care testing capable of detecting hemolysis at the bedside. This enables rapid decision-making and reduces the reliance on laboratory testing, ultimately improving patient care.

Preventing hemolysis largely depends on proper specimen collection technique and training. Common causes include inadequate skin preparation, improper handling of sample tubes, forceful blood draws, and excessive squeezing of the draw site. By focusing on these areas and providing appropriate guidance, healthcare institutions can minimize hemolysis rates and enhance the accuracy of blood test results.

How to combat common blood draw errors

At its core, the occurrence of hemolysis is a technique and training issue. It is often a direct consequence of poor specimen collection or handling techniques.

Here are the most common mistakes that lead to hemolysis, along with tips on how to prevent it:

1. Poorly prepared skin: The foundation of a clean blood draw starts with proper skin preparation. Always ensure the draw site is thoroughly cleaned and completely dry before needle insertion. Residual alcohol or improper cleansing can compromise the sample, leading to contamination or hemolysis that affects test results.
2. Improper handling of the sample tube: Once the sample is collected, handling it correctly is crucial. Instead of shaking the tube—an action that can damage blood cells and compromise sample integrity—gently invert it the recommended number of times to ensure thorough mixing of the additives, without introducing unnecessary stress on the cells.
3. Forceful or unsteady blood draws: The speed and pressure used during a blood draw can make all the difference. Rapid or forced blood collection increases the likelihood of hemolysis, where red blood cells rupture and skew test results. Instead, use steady and controlled pressure to maintain the integrity of the sample.
4. Excessive squeezing of the draw site: Particularly when working with pediatric patients or delicate veins, avoid squeezing or “milking” the draw site. Over manipulation can damage cells, dilute the sample with interstitial fluid, and lead to unreliable results. A gentle, patient approach preserves both sample quality and patient comfort.

Toward greater awareness, detection, and prevention

There is a tremendous opportunity for greater awareness of this critical problem. The availability of hemolysis detection at the point of care helps clinicians make critical care decisions faster, while helping relieve the burden on the lab. It also provides important user feedback so that hospitals can work toward preventing preanalytical errors. Ultimately, whole blood hemolysis detection can help reduce inappropriate patient management, optimize staff time, and reduce costs.^2–6

References:

1. Lippi G, Salvagno GL, Favaloro EJ, Guidi GC. Survey on the prevalence of hemolytic specimens in an academic hospital according to collection facility: opportunities for quality improvement. Clin Chem Lab Med. 2009;47(5):616–618. doi:10.1515/CCLM.2009.132.
2. O’Hara M, Wheatley EG, Kazmierczak SC. The impact of undetected in vitro hemolysis or sample contamination on patient care and outcomes in point-of-care testing: a retrospective study. J Appl Lab Med. 2020;5(2):332–341. doi:10.1093/jalm/jfz020.
3. Phelan MP, Hustey FM, Good DM, Reineks EZ. Seeing red: blood sample hemolysis is associated with prolonged emergency department throughput. J Appl Lab Med. 2020;5(4):732–737. doi:10.1093/jalm/jfaa073.
4. Wilson M, Adelman S, Maitre JB, et al. Accuracy of hemolyzed potassium levels in the emergency department. West J Emerg Med. 2020;21(6):272–275. doi:10.5811/ westjem.2020.8.46812.
5. Milutinović D, Andrijević I, Ličina M, Andrijević L. Confidence level in venipuncture and knowledge on causes of in vitro hemolysis among healthcare professionals. Biochem Med. 2015;25(3):401–409. doi:10.11613/BM.2015.040.
6. Phelan MP, Ramos C, Walker LE, et al. The hidden cost of hemolyzed blood samples in the emergency department. J Appl Lab Med. 2021;6(6):1607–1610. doi:10.1093/jalm/jfab035.