Year of Publication

2013

Season of Publication

Spring

Paper Type

Doctoral Project

College

Brooks College of Health

Degree Name

Doctor of Nursing Practice (DNP)

Department

Nursing

NACO controlled Corporate Body

University of North Florida. School of Nursing

First Advisor

Dr. Kathaleen C. Bloom

Second Advisor

Dr. Patrick Monaghan

Third Advisor

Dr. M. Catherine Hough

Department Chair

Dr. Lillia M. Loriz

College Dean

Dr. Pamela C. Chally

Abstract

The practice of obtaining blood as part of the placement of a new peripheral venous access device (p-VAD) is a frequent practice in the emergency department (ED). Of the concerns related to this practice is the possibility of laboratory specimen rejection due to p-VAD catheter size, use of the wrong collection device, and the absence of a standardized collection process. The objective of this study, therefore, was to examine the effect of the use of evidence-based venipuncture and p-VAD blood collection protocols on the rejection rate of blood specimens drawn by staff in the adult areas of an urban academic medical center ED.

A convenience sample of 28 ED nurses and 39 ED technicians (51.94% of all eligible ED employees) consented to using these evidence based protocols when they collected blood from adult ED patients. Blood specimen rejections rates were measured for four consecutive weeks prior to and at weeks 1-4, 5-8, 9-12, and 1-12 after the evidence-based blood collection practices training intervention. Laboratory analysis of all specimens was automated with rejection results provided in the form of computerized reports.

There was a significant decrease in the 12-week rejection rates for two of the three ED adult care areas, with the overall ED adult area rejection rate significantly decreased from 3.19% to 2.38% (X2at Df1, p < .05). The most common reasons for rejection were hemolysis (65.39%) and clotting (10.68%) followed by specimen mis-labeling, tube missing, insufficient quantity for testing, incorrect packaging, specimen contamination or dilution, and label missing, Though the use of theses evidence based blood collection protocols significantly decreased the overall rejection rate, the high percent of rejections due to hemolysis may further be reduced by having all ED staff use these protocols, and by exploring other collection techniques in the literature that have been found to significantly decrease rejection rates.

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