Drawing blood from peripheral intravenous cannula compared ... · comes; haemolysis of blood samples, equivalence of blood sam‐ ples and contamination of blood culture samples.
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Drawing blood from peripheral intravenous cannula compared with venepuncture: A systematic review and meta‐analysis
Linda L. Coventry RN, MS, PhD, Post‐Doctoral Research Fellow1,2 | Alycia M. Jacob BA, Research Assistant3 | Hugh T. Davies RN, MS, PhD, Lecturer3 | Laurita Stoneman RN, Clinical Support Nurse, Transfusion Trainer4 | Samantha Keogh RN, BSc(Hons), PhD, Professor of Nursing2,5 | Elisabeth R. Jacob RN, MEd., PhD, Associate Dean Nursing3
AbstractAims: To synthesize the evidence evaluating if blood samples are similar when obtainedfromperipheralintravenouscannulacomparedwithvenepuncture.Design: Asystematicreviewandmeta‐analysiswasundertaken.Data sources: Searcheswereconducted indatabases forEnglish languagestudiesbetweenJanuary2000–December2018.Review methods: ThesearchadheredtotheMeta‐analysisofObservationalStudiesinEpidemiologyguidelines.ThemethodologicalqualityofstudieswasassessedusingJoannaBriggscriticalappraisalinstruments.TheoverallqualityoftheevidencewasassessedusingtheGRADE.Results: Sixteenstudieswereidentified.Findingssuggesthaemolysisratesarehigherinbloodsampled fromperipheral intravenouscannula.However,haemolysis ratesmaybelowerifaperipheralintravenouscannulabloodsamplingprotocolisfollowed.Forequivalenceofblood test results,even thoughsome resultswereoutside thelaboratory,allowableerrorandwereoutsidetheBland–AltmanLevelofAgreement,noneofthesevalueswouldhaverequiredclinical intervention.Withregardtothecontaminationratesofbloodcultures,theresultswereequivocal.Conclusion: Furtherresearchisrequiredtoinformtheevidenceforbestpracticerec‐ommendations,including,ifaprotocolfordrawingbloodfromaperipheralcannulaisofbenefitforspecificpatientpopulationsandinothersettings.Impact: Venepuncture can provoke pain, anxiety and cause trauma to patients.Guidelinesrecommendbloodsamplesfromperipheralintravenouscannulabetakenonlyoninsertion.Anecdotalevidencesuggestsdrawingbloodfromexistingcannulasmaybeacommonpractice.Furtherresearchisrequiredtoresolvethisissue.
Patients admitted tohospital are frequently subjected tomultipleinvasive tests including venepuncture and peripheral intravenouscannula(PIVC)insertion.Patientsmayrequiremultiplebloodteststoassistindiagnosisandmanagementofmedicalconditionsandtheappropriatemethodofobtainingthebloodsamplecanbeatopicofdebate.Venepuncturecanprovokeanxiety,bepainfulanduncom‐fortable,causebruising,haematoma,infections,vasovagalreactionsandinrarecasesperipheralnervedamage(Buowari,2013;Tsukudaetal.,2016).Intheemergencydepartment(ED)itisacommonprac‐ticeforstafftotakethebloodsamplefromaPIVCwhenanewlineisplaced.Thisreducestheneedforanadditionalpainfulvenepunc‐ture.ItisestimatedthatoverabillionPIVCsworldwideareinsertedeachyear(Alexandrouetal.,2018).
1.1 | Background
Current Australian (Clinical Excellence Commission, 2013;GovernmentofWesternAustraliaDepartmentofHealth,2017;QueenslandGovernmentDepartmentofHealth,2015)andUKnational (RoyalCollegeofNursing,2016)guidelinesstatethatbloodsamplesmaybedrawn fromaPIVCdirectlyafter inser‐tion,butnotatothertimes.Twoguidelines(Gorskietal.,2016;GovernmentofWesternAustraliaDepartmentofHealth,2017)alsostateconsiderobtainingabloodsamplefromaPIVCinanemergency,whenthepatienthas limitedvascularaccess,or isatincreasedriskofbleeding,orreceivingthrombolytictherapy.Irrespectiveofcurrentguidelines,anecdotalevidencesuggeststhatwithdrawingbloodfromPIVCmaybeacommonpractice.Patientsmayoftenneedmultipleblood tests tomonitor theircondition. Examples include the patient with gastrointestinalbleedingmayneedrepeathaemoglobin;thepatientwithacutecoronarysyndromemayneedrepeattroponin;andthepatientrequiring glucose tolerance testing requires repeat blood glu‐cosetests.
AdvantagesofwithdrawingbloodfromaPIVCincludeconve‐nienceofaccess,decreasedstaffworkload,lowcostandlesspainforthepatientduetoanadditionalvenepuncture.Disadvantagesmayincluderiskofhaemolysis,non‐equivalenceofthebloodtestresults, riskof infectionand risk to thepatencyof thecannula.Haemolysis,or redcellbreakdown,canpotentially lead to inac‐curate blood test results andmay require a secondblooddrawthat leadstodelay intreatment, increasedstaffworkload,addi‐tionalcostsandunnecessarypaintopatientsduetotherequire‐mentof repeatedblood tests. TheAmericanSocietyofClinicalPathologybenchmarkforbestpracticedefinethattheacceptablerateofsamplerejectionduetohaemolysisis2%orless(Loweetal.,2008;Phelan,Reineks,Schold,Kovach,&Venkatesh,2016).Estimatesofhaemolysisratesrangefromlessthan1‐36%(Phelanetal.,2016).
A recently published systematic review (McCaughey et al.,2017) explored differences in haemolysis rates; however, they
did not conduct meta‐analysis.We found no published system‐atic review that analysed the equivalence of blood test results.Asystematicreview(Snyderetal.,2012)examinedeffectivenessforreducingbloodculturecontaminationratesandsearchedtheliterature up to 2011, so an updatewas timely. Although blooddrawsviavenepunctureareconsideredastandardpractice,acriti‐calevaluationofthepotentialvalueofblooddrawsusingthePIVCtechniqueisrequired.Therefore,asystematicreviewincludingameta‐analysiswasconductedtogiveanevidence‐basedanswertotheresearchquestion.
2 | THE RE VIE W
2.1 | Aims
The aimof this reviewwas to synthesize the evidence evaluatingifhaemolysisrates,equivalenceofbloodresultsandcontaminationrates,betweenbloodsamplesobtainedfromPIVCarecomparablewithvenepuncture.Assuch,thisreviewquestionis:Arehaemoly‐sisrates,bloodtestresultsandcontaminationratescomparableforbloodsamplesobtainedbyPIVCandvenepunctureforpatients inacutehealthservices?
Thisreview includedstudiesthat investigatedthefollowingout‐comes; haemolysis of blood samples, equivalenceof blood sam‐plesandcontaminationofbloodculturesamples. Itwasdecideda priori for equivalence of blood samples that only studies thatconductedBland–Altmanplotsandanalysedmeandifferencesinbloodtestresultswouldbeincluded(Bland&Altman,1986).Otheroutcomeswe considered but did not find any research onwereriskof:catheterocclusion,phlebitis,dislodgement,devicefailure,catheter‐relatedbloodstreaminfections,infiltration,blockageandcannulapatency.
| 3COVENTRY ET al.
2.2.5 | Types of studies
This review considered published observational studies includingrandomized control trials, non‐randomized control trials, quasi‐ex‐perimentalstudies,beforeandafterstudies,prospectiveandretro‐spectivecohortstudiesandanalyticalcross‐sectionalstudies.Thisreviewalsoconsidereddescriptivestudydesignsforinclusion.
2.3 | Search methods
Thesearchstrategyadheredto theMeta‐analysisofObservationalStudies in Epidemiology study guidelines (Stroup et al., 2000) andwas undertaken using the databases CINAHL, Cochrane Library,MEDLINE, Scopus, ISI Web of Science and Joanna Briggs. Twosearches were conducted. The first search (January 2000–April2017)wasperformedusingacombinationofsearchterms,includingintravenouscatheterORintravenouscannulaORperipheralvenouscatheter OR peripheral venous cannula AND phlebotomy OR ve‐nepunctureORdirectvenouspuncture.Thesecondsearch(January2000–December2018)wasperformedtoupdatetheliteratureandincluded theoutcomemeasures in the search strategy. In addition,totheabovetermswealsoincludedriskfactors,infection,phlebitis,morbidity mortality, dwell time, device failure, device malfunction,occlusion,blockage,infiltration,extravasationanddislodgementwithassociatedBoolean logic. The search strategywas adapted for the
a Therewasahighriskofbias:astheexposure(PIVC)couldhavebeenfromaPIVConinsertion,newlyinserted,oranexistingPIVC;theoutcome(haemolysis)wasmeasureddifferently–eithervisuallyor
automated;somestudiesdidnotcontrolforconfounding.
b TheFunnelplotisnotsymmetrical,suggestingthatpublicationbiasmaybeofconcern.
c Therewasahighriskofbiasas:theexposure(PIVC)couldhavebeenfromanewlyinsertedPIVC,oranexistingPIVC;theoutcome(equivalence)wasmeasureddifferentlyamongstudies.Somedefined
d WewereonlyabletocombinethreestudiesandthusunabletodoaFunnelPlot.TheGRADEHandbookrecommends,“Itisextremelydifficulttobeconfidentthatpublicationbiasisabsentandalmost
e Therewasahighriskofbiasas:theexposure(PIVC)couldbefromarecentlyinsertedPIVCoranexistingPIVC.
f Therewasseriousinconsistencyintheresultsofthetwostudies.
g Therewasseriousimprecisionconsideringthesmallnumberofstudiesandwideconfidenceintervals.
h WeconductedanarrativereviewandwereunabletodoaFunnelPlot.TheGRADEHandbookrecommends,“Itisextremelydifficulttobeconfidentthatpublicationbiasisabsentandalmostasdifficult
Studies selected for retrieval were assessed by two independentreviewers formethodological validity prior to inclusion in the re‐view.Weused thestandardizedJoannaBriggs Institute (JBI)criti‐cal appraisal instrument from the JBI Meta‐Analysis of StatisticsAssessment andReview Instrument (JBIMAStARI). Any disagree‐mentsthatarosebetweenthereviewerswereresolvedthroughdis‐cussion.Elevenstudieswereexcluded(Appendix3).
2.6 | Data abstraction
Datawere extracted from the included studies by two reviewerstocheckaccuracy.Thedataextractedincludeddetailsaboutstudyyear,studycountry,studyaim,studysetting,studydesign,interven‐tionsandcomparators.Datawereextractedseparatelyforstudiesinvestigatinghaemolysis,accuracyofbloodresultsandcontamina‐tionofbloodcultures.Dataincludedsampletype,samplesize,meth‐ods,resultsandauthorrecommendations.
2.7 | Synthesis
Meta‐analysis was conducted for studies examining haemolysis.Forrest plots were produced to display the effect measures ofeach study that were expressed as prevalence, odds ratio (OR)with95%confidenceintervals(CIs).TheORistheratiooftheoddsofhaemolysisoccurring inabloodsampleobtainedfromaPIVCcomparedwiththeoddsofhaemolysisoccurringinabloodsampleobtainedbyvenepuncture.Aratioofoneimpliesthehaemolysisof ablood sample is equally likely if obtainedbybothPIVCandvenepuncture, a ratio of greater than one implies haemolysis ismore likely inabloodsampleobtained fromPIVCanda ratioofless than one implies haemolysis is less likely if blood sample isobtainedbyPIVC.
Meta‐analysis was also conducted for three studies (Corboet al., 2007; Hambleton et al., 2014; Zlotowski et al., 2001) ex‐amining equivalence of blood results. We attempted to contactthe authors for raw data and were unsuccessful for two studies(Himberger&Himberger,2001;Ortells‐Abuyeetal.,2014).Foronestudy(Hambletonetal.,2014)weusedRevMancalculator(ReviewManager(RevMan),2014)toinputthestandarddeviationandcon‐ductstatisticalmeta‐analysis.Effectsizeswereexpressedaspooledmeandifferencesandtheir95%CI.Resultswerepooledusingfixedeffectsmodels.Heterogeneitymeasuresthevariabilityamongthecombinedstudiesandthechi‐squaretestandthe I2 statisticwereusedtoassessheterogeneity.Thepooledresultwasconsideredhet‐erogeneousifthe I2statisticwas>40%andthepvaluewas<0.05(Higgins&Green,2011).
Publication bias may occur when studies with non‐significantfindingsarenotsubmittedbytheinvestigatororarerejectedbytheeditorsofthejournal(Gordis,2009).When10ormorestudieswerecombined,publicationbiaswasassessedusingfunnelplotsandin‐terpretedbyvisualinspection(Higgins&Green,2011).
TheoverallqualityoftheevidencewasassessedusingtheGradingof Recommendations Assessment, Development and Evaluation(GRADE)assessment(Guyattetal.,2008).AGRADEassessmentin‐cludesassessmentofriskofbias,inconsistencyofresults,indirectnessofevidence,imprecisionofresults,thelikelihoodofpublicationbias,themagnitudeoftheeffectandtheeffectofplausibleresidualcon‐founding.Theoverallqualityofthebodyoftheevidenceisthengradedashigh,moderate,loworverylow.Twoindependentreviewers(LCandHD)performedtheGRADEassessments,differenceswerediscussedandconsensusagreed(Table1).Anarrativesummaryofequivalenceofbloodresultsandcontaminationofbloodcultureswasconducted.
3 | RESULTS
3.1 | Characteristics of included studies
The16studieswerecriticallyappraised(Table2)formethodologicalqualityusingtheJBIcriticalappraisaltools.Theoverallmethodolog‐icalqualityoftheincludedstudieswasgenerallypoor.Differencesamongthestudies included ifbloodsampleswereobtainedon in‐sertion,fromanewlyinserted,oranexistingPIVC.Theoutcomeofhaemolysiscouldhavebeenmeasuredeitherbyvisualinspectionorbyautomatedspectrometry.Confoundingfactorswerenotalwaysidentified and strategies to account for confounding factorswerenotalwaysincluded.
Theaimsofthestudiescanbesummarizedasfirstlyto:examineblood sample haemolysis rates between blood samples drawn viavenepuncturecomparedwithPIVC(Barnardetal.,2016;Corboetal.,2007;Dietrich,2014;Grant,2003;Loweetal.,2008;Munnixetal.,2010;Ongetal.,2008;Ortells‐Abuyeetal.,2014;Phelanetal.,2018;Seemann&Reinhardt,2000;Wollowitzetal.,2013;Zlotowskietal.,2001).Secondly,toexamineequivalenceofbloodtestresultsbetweenbloodsamplesdrawnviaPIVCcomparedwithvenepunc‐ture (Corbo et al., 2007; Hambleton et al., 2014; Himberger &Himberger,2001;Ortells‐Abuyeetal.,2014;Zlotowskietal.,2001).Thirdly, to examine blood culture contamination between bloodsamplesdrawnviavenepuncturecomparedwithPIVC(Kelly&Klim,2013;Selfetal.,2012).
Meta‐analysiswasconductedforthestudiesexamininghaemo‐lysis.Forthestudiesassessingequivalence,meta‐analysiswascon‐ductedforthreestudies(Corboetal.,2007;Hambletonetal.,2014;Zlotowskietal.,2001).Datacouldnotbeaggregatedfortwostud‐ies (Himberger &Himberger, 2001;Ortells‐Abuye et al., 2014) ofequivalenceandthestudiesexaminingbloodculturecontamination.
8 | COVENTRY ET al.
TA B L E 3 Summaryofcharacteristicsofincludedstudies
AuthorCountry Setting Data Collection Sample type Sample size Methods
Therefore, a narrative review is presented, asmeta‐analysis couldnotbeperformed.
StudieswereconductedintheUSA(Corboetal.,2007;Dietrich,2014;Grant,2003;Himberger&Himberger,2001;Loweetal.,2008;Phelanetal.,2018;Seemann&Reinhardt,2000;Selfetal.,2012;Wollowitzetal.,2013),Europe(Barnardetal.,2016;Hambletonetal.,2014;Munnixetal.,2010;Ortells‐Abuyeetal.,2014),Australia(Kelly&Klim,2013)andSingapore(Ongetal.,2008).Mostofthestudieswereprospective(Barnardetal.,2016;Corboetal.,2007;Dietrich,2014;Grant,2003;Hambletonetal.,2014;Himberger&Himberger, 2001;Kelly&Klim, 2013; Lowe et al., 2008;Munnix etal.,2010;Ongetal.,2008;Ortells‐Abuyeetal.,2014;Seemann&Reinhardt,2000;Wollowitzetal.,2013;Zlotowskietal.,2001)andretrospectiveinnature(Phelanetal.,2018;Selfetal.,2012).Manystudiesusedthesamegroupofpatients,thatis,onegroupofpa‐tientshadbloodsamplesfrombothPIVCandvenepuncture(Corboetal.,2007;Hambletonetal.,2014;Himberger&Himberger,2001;Ortells‐Abuyeetal.,2014;Seemann&Reinhardt,2000;Selfetal.,2012;Zlotowskietal.,2001).Otherstudiesusedseparategroupsofpatientsforbloodsamples,thatis,onegroupofpatientsbloodwassampled fromaPIVCandaseparategroupofpatientshadbloodsampled by venepuncture (Barnard et al., 2016; Dietrich, 2014;Grant,2003;Kelly&Klim,2013;Loweetal.,2008;Munnixetal.,2010;Ongetal.,2008;Phelanetal.,2018;Wollowitzetal.,2013).
Most studies were conducted in an emergency department(Barnardetal.,2016;Corboetal.,2007;Dietrich,2014;Grant,2003;Hambletonetal.,2014;Himberger&Himberger,2001;Kelly&Klim,2013;Loweetal.,2008;Munnixetal.,2010;Ongetal.,2008;Phelanetal.,2018;Selfetal.,2012;Wollowitzetal.,2013;Zlotowskietal.,2001).Onestudywasconductedinaninpatientwardandshortstayunit (Ortells‐Abuye et al., 2014) and one study in amedicalward(Seemann&Reinhardt,2000).
Many studies clearly articulated protocols for collecting bloodsamples (Corbo et al., 2007;Hambleton et al., 2014;Himberger&Himberger, 2001; Kelly & Klim, 2013; Ortells‐Abuye et al., 2014;Seemann&Reinhardt,2000;Selfetal.,2012;Wollowitzetal.,2013;Zlotowski et al., 2001) and others did not. Most studies sampledbloodfromexistingPIVCs(Corboetal.,2007;Hambletonetal.,2014;Himberger&Himberger,2001;Ortells‐Abuyeetal.,2014;Seemann&Reinhardt,2000;Selfetal.,2012;Wollowitzetal.,2013);andafewstudiessampledbloodonPIVCinsertion(Loweetal.,2008;Munnixet al., 2010).Two studies (Dietrich, 2014; Grant, 2003) comparedbloodsampledfrombothexistingPIVCsandonPIVCinsertion;andtwostudies(Kelly&Klim,2013;Zlotowskietal.,2001)statedbloodwas sampled from newly inserted PIVC (Table 3).The results havebeenpresentedaccordingtostudiesinvestigatinghaemolysis,equiv‐alenceofbloodresultsandcontaminationofbloodcultures.
3.2 | Haemolysis
TheratesofhaemolysisfrombloodsamplesobtainedbetweenPIVCandvenepuncturewasreportedin10studies(Figure2).Meta‐analy‐sisfoundthattheoddsratioofhaemolysiswere4.58(CI,3.61–5.80)timesmorelikelyinbloodsamplesobtainedviaPIVCcomparedwithvenepuncture. There was evidence of both clinical and statistical
F I G U R E 2 ForestplotofstudiesusingORincomparinghaemolysisinbloodsamplestakenviaPIVCcomparedwithvenepuncture.CI,confidenceinterval;M‐H,Mantel‐Haenszel;OR,oddsratio[Colourfigurecanbeviewedatwileyonlinelibrary.com]
CI, confidence interval; M-H, Mantel-Haenszel; OR, odds ratio
heterogeneity(chi‐square=33.96,p = 0.0002; I2=71%)andassuchresults must be interpretedwith caution. Sensitivity analysis wasconductedonfivestudiesthatfollowedaprotocolforwithdrawingbloodfromaPIVC.Thefindingsweresimilar(OR6.46;95%CI,4.21–9.91).Therewasnoevidenceofheterogeneity (chi‐square=1.22,p=0.75;I2=0%).
Haemolysis was measured by either visual techniques (Grant,2003; Lowe et al., 2008; Seemann & Reinhardt, 2000), automatedtechniques (Barnardetal.,2016;Corboetal.,2007;Dietrich,2014;Munnixetal.,2010;Phelanetal.,2018;Wollowitzetal.,2013),orthemeasurementtechniquewasnotreported(Ongetal.,2008;Ortells‐Abuye et al., 2014; Zlotowski et al., 2001). Blood sample rejection
TA B L E 4 Haemolysisassessmentmethods,rejectionratesandauthorsrecommendations
rates for haemolysis varied between collection methods: from ve‐nepuncture between 0‐6.8%; from newly inserted PIVC between0‐20%;fromexistingPIVCbetween0.8‐24.4%;andfromstudiesthatfollowed a protocol between 0‐5.6%. Two studies (Dietrich, 2014;Loweetal.,2008)reportedthattheacceptablerateofsamplerejec‐tionforhaemolysiswasdefinedbya2%benchmarkbestpracticesetbytheAmericanSocietyofClinicalPathology.
Afewstudies(Barnardetal.,2016;Grant,2003;Loweetal.,2008;Munnixetal.,2010;Ongetal.,2008;Phelanetal.,2018;Wollowitzetal.,2013)conductedsub‐analyses;however,inonestudy(Munnixetal.,2010)nostatisticalanalysiswasperformedmakingitdifficulttoascertainthesignificanceoffindings.Twostudies(Grant,2003;Ongetal.,2008)foundthattheuseofavacutainercomparedwithsyringe resulted in higher PIVC haemolysis rates and one study
(Phelanet al., 2018) foundnodifferences. Three studies (Barnardetal.,2016;Phelanetal.,2018;Wollowitzetal.,2013)foundblooddrawnfromtheantecubitalfossawerelesslikelytobehaemolysedwhencomparedwithblooddrawn fromother sites, incontrast toanotherstudy(Loweetal.,2008)whofoundnodifferencesrelatedtoblooddrawsite.Twostudies(Phelanetal.,2018;Wollowitzetal.,2013)foundthattheuseoflargergaugeneedleswerelesslikelytohavehaemolysed samples comparedwith a smaller gaugeneedle,incontrasttoanotherstudybyOngetal.,2008whofoundnodif‐ferences related toneedlegauge size.The samestudy (Wollowitzetal.,2013)alsofoundthatthebloodsamplesweremorelikelytobehaemolysed if thebloodcollectiontubewas less thanhalf full.Twostudies(Phelanetal.,2018;Wollowitzetal.,2013)foundifthetourniquet timewasgreater than1minbloodsamplesweremore
a CLIA,‘ClinicallaboratoryImprovementAmendments’areasetofregulationsthataresetoutbytheCentreforDiseaseControlandFoodandDrugAdministrationintheUnitedStates,andareusedto
b LaboratoryAcceptedSystematicError,UsedtheInternationalOrganizationforStandardization.ISO15189:2007:Medicallaboratories—particularrequirementsforqualityandcompetence.Available
equivalenceofbloodtestsbetweenPIVCandvenepuncture(Table5).Therewerenosignificantmeandifferencesinmostbloodtestswiththeexceptionofplateletsandbicarbonate(meanvalueswerelowerin the PIVC group compared with the venepuncture group) andchloride(meanvaluewashigher inthePIVCgroupcomparedwiththe venepuncture group). Statistical heterogeneity was not pre‐sent in any pooled analyses except potassium,where the I2 value was87%.This result showed the substantial heterogeneitywhichmustbe interpretedwithcareasthere isconsiderablevariation inthecombinedorpooledresultsanditmaybemisleadingtoreportacombinedsummarymeasure.Twostudies(Himberger&Himberger,2001;Ortells‐Abuyeetal.,2014)wereunable tobecombined formeta‐analysisandthefollowingdataareanarrativesynthesisofthefindingsofallfivestudiesreportingbloodtestequivalence.
Itisworthnotingthat,studiesdefinedtheclinicallyacceptedinter‐valdifferently;twostudies(Corboetal.,2007;Himberger&Himberger,2001)usedtheClinicalLaboratoryImprovementAmendments(CLIA),thatareasetofregulationssetoutbytheCentreforDiseaseControlandtheFoodandDrugAdministration,thatofferindustrystandardsforlaboratorytestingquality.Onestudy(Hambletonetal.,2014)usedtheLaboratoryAcceptedSystematicError;inanotherstudy(Ortells‐Abuye et al., 2014), the investigators defined the clinically accept‐ableinterval;andinthelaststudy(Zlotowskietal.,2001);anexpertpaneloffiveemergencyphysiciansdefinedtheclinicallyacceptableinterval.Similarly,fourstudies(Corboetal.,2007;Hambletonetal.,2014;Himberger&Himberger,2001;Ortells‐Abuyeetal.,2014)usedBland–Altman95%levelofagreement(LOA)andonestudy(Zlotowskietal.,2001)usedBland–Altman99%LOA.
Twostudies(Corboetal.,2007;Himberger&Himberger,2001)summarized the resultsasnot requiringclinical intervention,even
though some values were outside the laboratory allowable errorandwereoutsideBland–AltmanLOA.Onestudy(Hambletonetal.,2014)summarizedtheresultsasallparameterswerewithinthelab‐oratory's accepted error except for venous blood gases. Similarly,another study (Ortells‐Abuye et al., 2014) also summarized bloodresults,whichcouldbeconsideredequivalentwiththeexceptionofvenousbloodgases.Incontrast,onestudy(Zlotowskietal.,2001)foundbloodsamplesforpotassium,bicarbonateandglucosewerenotclinicallyequivalent.
In addition, three studies (Corbo et al., 2007;Himberger&Himberger, 2001; Zlotowski et al., 2001) reported that the as‐piration of PIVC success rates were between 90% and 100%;with one study (Corbo et al., 2007) further analysing aspira‐tion success for 18‐, 20‐ and 22‐gauge needles (100%, 91.3%,66.7% respectively). Another study (Hambleton et al., 2014)reportedbloodsamplesfromPIVCswithandwithout infusionsand venepuncture were similar; and one study (Himberger &Himberger,2001)reportednocomplicationswiththePIVCwithanyofthestudyparticipantsandconcludedwithdrawingbloodfromaPIVCwassafeandeffectivemethodofobtainingbloodsamples(Table6).
3.4 | Contamination of blood cultures
Twostudies(Kelly&Klim,2013;Selfetal.,2012)examinedtherateof contaminationofblood cultures if theblood samplewas takenfromaPIVCcomparedwithvenepuncture(Table7).Onestudy(Kelly& Klim, 2013) reported blood cultures could be taken accuratelyfromaPIVCwithin1hrofPIVCinsertionwhencomparedwithve‐nepuncture.Incontrast,theotherstudy(Selfetal.,2012)reported
Afunnelplotwasusedtoassesspublicationbiasforthestudiesonhaemolysis. The plot is not symmetrical, suggesting that publica‐tionbiasmaybeofconcern.Figure3displaysthefunnelplotforthepooledORofhaemolysis.
In this systematic review,we highlighted variations in draw‐ingbloodfromaPIVC(oninsertion,newlyinserted,oranexistingPIVC),inhowtheoutcomeofhaemolysiswasmeasured(visuallyorautomated)andsomestudiesdidnotcontrolforconfounding(e.g.
vacutainervs.syringe,needlegauge,siteofblooddrawnetc.).Thevisualmethodofdetectinghaemolysisissubjectiveanddependson the individual's visual acuity and colour perception (Dietrich,2014). The outcome of equivalence was measured differentlyamong the studies (e.g. clinical acceptable intervals and Bland–Altmanplots).Thesevariationscertainly impede the strengthofrecommendationsthatcanbedrawnacrossstudies.Nonetheless,there was sufficient homogeneity to allowmeta‐analysis of thestudiesofhaemolysis.
Meta‐analysis foundtheoddsofhaemolysiswere4.58timesmore likely in blood samples obtained via PIVC compared withvenepuncture.Thisfinding issimilartoothersystematicreviews(Heyeretal.,2012;McCaugheyetal.,2017).Inourstudy,haemo‐lysisratesforbloodobtainedviavenepuncturewerelowandlessthan2.7%innineof10studies.Interestingly,thehaemolysisratesforbloodobtainedviaPIVCvariedgreatlyalsobetween0%and24.4%,withfivestudies(Corboetal.,2007;Dietrich,2014;Loweetal.,2008;Ortells‐Abuyeetal.,2014;Zlotowskietal.,2001)thatfollowed a protocol forwithdrawingblood reportinghaemolysisratesbetween0‐5.6%.Eventhoughoursensitivityanalysiscon‐ductedon the five studies that followedaprotocolwere similar(OR6.46)wecontendhaemolysisrateslessthan5%areapproach‐ingtheAmericanSocietyofClinicalPathologybenchmarkof2%.Acceptinghaemolysisratesoflessthan5%inpatientsknowntobeadifficultvenepunctureorwhorequiremultipleblooddrawsmaybeconsideredapragmaticoption. Inaddition,onestudy (Grant,2003)thatreportedahighhaemolysisrate(20%)implementedaclinicalpracticechangeandencouragedphlebotomiststosamplebloodwithasyringeinsteadofavacutainerandthentransferthebloodtoatubeviaaneedlelessconnector.Audits followingthispracticechangeshowedhaemolysisrateshaddecreasedbetween4‐5%.Other variables thatmay be important regarding haemo‐lysisratesincludesiteoftheblooddrawn,theneedlegauge,the
F I G U R E 3 FunnelplotforthepooledORofhaemolysis.Abbreviations:SE(log[OR]):StandardError(logarithm[OddsRatio])[Colourfigurecanbeviewedatwileyonlinelibrary.com]
Abbreviations: SE(log[OR]): Standard Error (logarithm[Odds Ratio])
Mostofthestudiesconsideredbloodsamplesfromvenepunc‐tureandPIVCwereequivalent.Irrespectiveofthelaboratoryclin‐icallyacceptederrororBland–Altmananalyses it seems logical toevaluateequivalencewithwhetherthedifferenceintestswouldre‐quireclinicalintervention.Non‐equivalenceofvenousbloodgaseshasbeensuggestedduetohandlingerror.Inthat,contactwithairmaycausechangesinbloodresults.Thebloodsampleneedstobetransferredfromasyringetoabloodgassyringe,thebloodgassy‐ringeneeds tobe filledwith thecorrectamountofbloodandex‐cessairneedstoberemoved.Thestudy(Zlotowskietal.,2001)thatreportednon‐equivalence forpotassium,bicarbonateandglucosesuggestedthismayberelatedtohaemodilution,astheycomparedtheresultsafteradministeringanormalsalinesolutionbolus.
We only found two studies that evaluated contamination ofblood cultures between venepuncture and PIVC.One study sup‐portedobtainingbloodculturesfromPIVCandtheotherstudydidnot.Consideringanothermeta‐analysis(Snyderetal.,2012)evaluat‐ingvenepuncturewithintravenouscathetersrecommendedagainstobtainingbloodfromanintravenouscatheterduetoincreasedcon‐taminationrates,wealsosupportthisrecommendation.Thismeta‐analysis(Snyderetal.,2012)wasdifferenttooursinthatitincludedintravenouscatheterscomprisingofcentrallines,arteriallinesandportacathetersandincludedstudieswithpaediatricpatients.
4.1 | Limitations
This reviewhas some limitations.Somestudiesexaminingequiva‐lenceofbloodtestresultswereexcludedastheirdataanalysesre‐portedpairedttestsandcorrelationcoefficients.Itwasdetermineda priori the most appropriate analyses were the Bland–Altmanmethod(Bland&Altman,1986).ThisreviewwaslimitedtoEnglishlanguage studies, a limitation that may also introduce bias. EventhoughwefollowedtheMeta‐analysisofObservationalStudies inEpidemiology guidelines (Stroup et al., 2000) there remains somesubjectivityinconsensusagreementforratingstudyqualityforin‐clusionandgradingtheoverallstrengthoftheevidence.
The range of settings in the reviewed studies has implicationsforclinicalandstatisticalheterogeneitywithsystematicreviewsandmeta‐analysesbutenhancesgeneralizability.Theresultsofthisreviewhavegeneralizabilitylimitedtoadultpatientsinacutecareandemer‐gencysettings.Limitationsoutsidethecontrolofthereviewauthorsincluded:allthestudieswerefromsingleinstitutions;somestudieshadsmallsamplesizes;manystudiesdidnotincludeunstablepatients;andmostofthelaboratoryresultsanalysedfellinsidethenormalrange.Inaddition,awidevarietyofpracticeswereobservedfordrawingbloodfromaPIVCandnotallstudiescontrolledforconfoundingvariables.
4.2 | Recommendations for practice
The resultsof this reviewcanhelpguide clinical practice in sev‐eral ways. This systematic review showed that five studies with
Hospitals shouldalsobeencouraged toaudithaemolysis ratesregularlyintheirdepartments,notonlytoincreasestaffawareness,but also to potentially implement clinical practice change to de‐creasehaemolysisratesifrequired.
4.3 | Recommendations for research
Large randomized controlledmultisite trials are required to defini‐tivelycompareeffectivenessofPIVCblooddrawscomparedwithve‐nepuncture.Aclusterdesignisrecommendedtoinvestigatetheeffectofablooddrawprotocol.Theclusterdesignwillmanagetheriskofcontaminationoftheblooddrawprotocolbetweentheinterventionandcontrolgroup.Allstudiesneedtoclearlyarticulate ifthebloodwassampledfromthePIVCon‐insertion,newlyinsertedorfromanexistingPIVC.ThestudiesneedtoevaluateifdrawingbloodfromaPIVCinfluencesprematurecannulafailure,causephlebitis,leadingtoblood‐streaminfectionsandeconomicanalysesshouldbeconducted.
Further research is requiredto investigate ifdrawingbloodfromaPIVCisofbenefitforspecificpatientpopulationsandinothersettingsbesidestheemergencydepartment.Someexam‐plesincludepatientswhoareknowntobeadifficultvenepunc‐ture; who have limited venous access; require multiple blooddraws;whoareobese,dehydratedoroedematous;andpatientsonanticoagulation therapywhoareat increased riskofbleed‐ing.Moreover,therehasbeenarecentsinglestudy(Mulloy,Lee,Gregas,Hoffman,&Ashley,2018)intoadevicethatattachestothe PIVC and threads a sterile catheter through the PIVC intothe vein allowing needle‐free blood draws. This study shouldbe replicated indifferentpatientpopulationsandaneconomicanalysisconducted.
5 | CONCLUSION
Hospitalizedpatientsoftenrequiremultiplebloodteststoassistindiagnosis andmanagement of their conditions. Findings from this
24 | COVENTRY ET al.
reviewsuggestbloodsamples forPIVCcomparedwithvenepunc‐turehavehigherhaemolysisrates;however,someindividualstudiesdemonstrated that if aprotocolwas followed, these ratesmaybelower. Blood test results may be considered equivalent as differ‐ences in resultswouldnotaffectclinical treatmentandbloodcul‐turesshouldnotbetakenfromPIVC.Furthermore,drawingbloodfromPIVCsmaybethebestavailableoptioninsomepatientgroups,however,furtherresearchisrequiredtoinformtheevidenceforbestpracticerecommendations.
SK and LC aremembers of theAVATAR group. AVATAR researchis supported by competitive government, university, hospital andprofessional organization research grants as well as industry un‐restricted donations, investigator initiated research/educationalgrants and occasional consultancy payments from the followingcompanies: 3M, Adhezion, Angiodynamics, Bard, Baxter, BBraun,BD, Carefusion, Centurion, Cook, Entrotech, Flomedical, Hospira,Mayo,Medtronic,ResQDevices,Smiths,Teleflex,Vygon.Thismanu‐scriptisindependentlypreparedandreflectsnocommercialentitynorpromotesparticularproductsunlessthesearesupportedbyre‐searchdata.Noconflictofinteresthasbeendeclaredbytheotherauthors.
AUTHOR CONTRIBUTIONS
LC, AJ, HD, LS, SK, EJ: Made substantial contributions to con‐ception anddesign, or acquisitionof data, or analysis and inter‐pretationofdata;LC,AJ,HD,LS,SK,EJ:Involvedindraftingthemanuscriptor revising itcritically for important intellectualcon‐tent; LC,AJ,HD, LS, SK,EJ:Given final approvalof theversiontobepublished.Eachauthorshouldhaveparticipatedsufficientlyintheworktotakepublicresponsibilityforappropriateportionsofthecontent;LC,AJ,HD,LS,SK,EJ:Agreedtobeaccountablefor all aspectsof thework in ensuring thatquestions related totheaccuracyorintegrityofanypartoftheworkareappropriatelyinvestigatedandresolved.
ORCID
Linda L. Coventry https://orcid.org/0000‐0002‐3598‐9942
Alycia M. Jacob https://orcid.org/0000‐0003‐2458‐6715
Hugh T. Davies https://orcid.org/0000‐0002‐0867‐2288
Elisabeth R. Jacob https://orcid.org/0000‐0002‐3506‐8422
R E FE R E N C E S
Alexandrou, E., Ray‐Barruel, G., Carr, P. J., Frost, S. A., Inwood, S.,Higgins,N.,…Rickard,C.M.;OMGStudyGroup.(2018).Useofshortperipheral intravenouscatheters:Characteristics,managementandoutcomes worldwide. Hospital Medicine, 13(5), E1–E7, https://doi.org/10.12788/jhm.3039
Barnard,E.B.G.,Potter,D.L.,Ayling,R.M.,Higginson,I.,Bailey,A.G.,&Smith,J.E. (2016).Factorsaffectingbloodsamplehaemolysis:Across‐sectional study. European Journal of Emergency Medicine, 23,143–146.https://doi.org/10.1097/mej.0000000000000195
Bland, J.M.,&Altman,D.G. (1986). Statisticalmethods for assessingagreementbetweentwomethodsofclinicalmeasurement.Lancet,1,307–310.https://doi.org/10.1016/S0140‐6736(86)90837‐8
Buowari, O. (2013). Complications of venepuncture. Advances in Bioscience and Biotechnology,4, 126–128. https://doi.org/10.4236/abb.2013.41A018
ClinicalExcellenceCommission. (2013).Guideline for PIVC insertion and post insertion care in adult patients. (GL2013_013). Sydney, NSW:NSWGovernmentHealth.Retrievedfromhttp://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2013_013.pdf.
D. (2016). Infusion Therapy Standards of Practice (Vol.39 Supp 1S).Norwood,MA:InfusionNursesSociety.
Government of Western Australia Department of Health. (2017).Insertion and management of peripheral intravenous cannulae in Western Australian Healthcare Facilities Policy. Western Australia:Department of Health. Retrieved from http://www.health.wa.gov.au/circularsnew/pdfs/13345.pdf.
Grant,M.S.(2003).TheeffectofblooddrawingtechniquesandequipmentonthehemolysisofEDlaboratorybloodsamples.Journal of Emergency Nursing,29(2),116–121.https://doi.org/10.1067/men.2003.66
Hambleton, V. L., Gomez, I. A., & Bernabeu Andreu, F. A. (2014).Venipuncture versus peripheral catheter: Do infusions alter labo‐ratoryresults?Journal of Emergency Nursing,40,20–26.https://doi.org/10.1016/j.jen.2012.03.014
Higgins,J.P.T.,&Green,S.(Eds).(2011).Cochrane handbook for systmatic reviews of interventions version 5.1.0[updatedMarch2011].Retrievedfromhttp://handbook.cochrane.org.
Himberger,J.R.,&Himberger,L.C.(2001).Issuesinaccuracyoflabora‐toryresults.Accuracyofdrawingbloodthroughinfusingintravenouslines.Heart & Lung: The Journal of Acute and Critical Care,30,66–73.https://doi.org/10.1067/mhl.2001.110535
Kelly,A.‐M.,&Klim,S.(2013).Takingbloodculturesfromanewlyestab‐lished intravenous catheter in the emergency department does notincreasetherateofcontaminatedbloodcultures.Emergency Medicine Australasia,25,435–438.https://doi.org/10.1111/1742‐6723.12121
Lowe, G., Stike, R., Pollack, M., Bosley, J., O'Brien, P., Hake, A., …Stover, T. (2008). Nursing blood specimen collection techniquesandhemolysis rates in anemergencydepartment:Analysisof ve‐nipuncture versus intravenous catheter collection techniques.Journal of Emergency Nursing,34, 26–32. https://doi.org/10.1016/ j.jen.2007.02.006
McCaughey,E.J.,Vecellio,E.,Lake,R.,Li,L.,Burnett,L.,Chesher,D.,…Georgiou,A.(2017).Keyfactorsinfluencingtheincidenceofhemoly‐sis:Acriticalappraisalofcurrentevidence.Critical Reviews in Clinical Laboratory Sciences, 54, 59–72. https://doi.org/10.1080/10408363.2016.1250247
Munnix, I.C.A., Schellart,M.,Gorissen,C.,&Kleinveld,H.A. (2010).Factors reducinghemolysis rates inbloodsamples from theemer‐gency department. Clinical Chemistry and Laboratory Medicine, 49,157–158.https://doi.org/10.1515/CCLM.2011.012
Ong,M.E.H.,Chan,Y.H.,&Lim,C.S. (2008).Observationalstudytodetermine factors associatedwithblood samplehaemolysis in theemergency department.Annals Academy of Medicine Singapore,37,745–748.
Ortells‐Abuye, N., Busquets‐Puigdevall, T., Díaz‐Bergara,M., Paguina‐Marcos,M.,&Sánchez‐Pérez, I. (2014).A cross‐sectional study tocomparetwobloodcollectionmethods:Directvenouspunctureandperipheralvenouscatheter.British Medical Journal Open,4,e004250.https://doi.org/10.1136/bmjopen‐2013‐004250
Phelan,M.P.,Reineks,E.Z.,Schold,J.D.,Hustey,F.M.,Chamberlin,J.,&Procop,G.W. (2018).Preanalytic factorsassociatedwithhemo‐lysisinemergencydepartmentbloodsamples.Archives of Pathology and Laboratory Medicine, 142, 229–235. https://doi.org/10.5858/arpa.2016‐0400‐OA
Phelan,M.P.,Reineks,E.Z.,Schold,J.D.,Kovach,A.,&Venkatesh,A.(2016). Estimated national volume of laboratory results affectedby hemolyzed specimens from emergency departments. Archives of Pathology and Laboratory Medicine, 140, 621–621. https://doi.org/10.5858/arpa.2015‐0434‐LE
Queensland Government Department of Health (2015). Guideline Peripheral intravenous catheter (PIVC). Brisbane Queensland:Queensland Health. Retrieved from https://www.health.qld.gov.au/__data/assets/pdf_file/0025/444490/icare‐pivc‐guideline.pdf
RoyalCollegeofNursing. (2016).Standards for infusion therapy,4thed.London,UK:RoyalCollegeofNursing.
Seemann, S., & Reinhardt, A. (2000). Blood sample collection from aperipheral catheter system compared with phlebotomy. Journal of Intravenous Nursing,23,290–297.
Self,W. H., Speroff, T., McNaughton, C. D.,Wright, P.W., Miller, G.,Johnson, J. G., … Talbot, T. R. (2012). Blood culture collectionthroughperipheralintravenouscathetersincreasestheriskofspec‐imen contamination among adult emergency department patients.Infection Control and Hospital Epidemiology,33,524–526.https://doi.org/10.1086/665319
Wollowitz,A.,Bijur,P.,Esses,D.,&Gallagher,J.(2013).Useofbutterflyneedles to draw blood is independentlyly associatedwithmarkedreductioninhemolysiscomparedtointravenouscatheter.Academic Emergency Medicine, 20, 1151–1155. https://doi.org/10.1111/acem.12245
Zlotowski,S.J.,Kupas,D.F.,&Wood,G.C.(2001).Comparisonoflab‐oratory values obtained bymeans of routine venipuncture versusperipheralintravenouscatheterafteranormalsalinesolutionbolus.Annals of Emergency Medicine,38,497–504.https://doi.org/10.1067/mem.2001.118015
How to cite this article:CoventryLL,JacobAM,DaviesHT,StonemanL,KeoghS,JacobER.Drawingbloodfromperipheralintravenouscannulacomparedwithvenepuncture:Asystematicreviewandmeta‐analysis.J Adv Nurs. 2019;00:1–27. https://doi.org/10.1111/jan.14078
APPENDIX 1ELEC TRONIC DATABA SE FIRS T SE ARCH S TR ATEGY ( JANUARY 20 0 0 –APRIL 2017)
MEDLINE search strategy(((MH“phlebotomy”))OR(“directvenouspuncture”)OR(“venepunc‐ture”)AND((MH“cannula”))OR((MH“Catheter”))OR(“intravenouscannula*”) OR (“intravenous catheter*”) OR (“peripheral venouscatheter*”)OR(“peripheralvenouscannula*”)OR(“peripheralcath‐eter*”)OR(“peripheralcannula*”))
CINAHL search strategy(((MH“phlebotomy”))OR(“directvenouspuncture”)OR(“venepunc‐ture”)AND((MH“cannula”))OR((MH“Catheter”))OR(“intravenouscannula*”) OR (“intravenous catheter*”) OR (“peripheral venouscatheter*”)OR(“peripheralvenouscannula*”)OR(“peripheralcath‐eter*”)OR(“peripheralcannula*”))
ELEC TRONIC DATABA SE SECOND SE ARCH S TR ATEGY (1 JANUARY 20 0 0 –31 DECEMBER 2018)
MEDLINE search strategy(((MH“phlebotomy”))OR(“directvenouspuncture”)OR(“venepunc‐ture”)AND((MH“cannula”))OR((MH“Catheter”))OR(“intravenouscannula*”)OR(“intravenouscatheter*”)OR(“peripheralvenouscath‐eter*”)OR(“peripheralvenouscannula*”)OR(“peripheralcatheter*”)OR(“peripheralcannula*”))AND“occlusion”OR(MH“phlebitis”)OR“dislodge*”OR“failure”OR“devicefailure”OR“infection*”OR(MH“Catheter‐Related Infections”)OR “Infiltration”OR “extravasation”OR “blockage” OR “leakage” OR “he#molysis” OR “accuracy” OR“equivalence”OR“contamination”
CINAHL search strategy((MH "Venipuncture") OR (MH "Phlebotomy") OR "venepunctureor venipuncture or phlebotomy") AND ((MH "Catheterization,Peripheral +") OR "catheteri#ation, peripheral" OR "peripheralintravenous catheter" OR "peripheral venous cannula" OR "pe‐ripheral venousdevice"OR "pivc"OR "piv")AND ((MH"CatheterOcclusion +") OR "occlusion" OR (MH "phlebitis+") OR phlebitisOR"dislodgement"ORfailureOR"devicefailure"OR"devicemal‐function"OR(MH"Catheter‐RelatedBloodstreamInfections")OR(MH "Catheter‐Related Infections")OR infectionOR "infiltration"OR"extravasation"OR"blockage"OR"leakage"OR"he#molysisofbloodsamples"OR"he#molysis inbloodtesting"OR"accuracy inbloodtest"OR"equivalenceinbloodtests"OR"contaminationofbloodcultures")
Cochrane Library(MH “Phlebotomy”) OR “venipuncture*”AND (MH “Catheters”) OR“Cannula” or (MH “Catheterization”) or (Peripheral Catheterization*)AND “occlusion” OR (MH “phlebitis”) OR “dislodge*” OR “failure”OR “infection*” OR “Infiltration” OR “extravasation” OR “blockage”OR “leakage”OR “he#molysis”OR “accuracy”OR “equivalence”OR“contamination”
Scopus("Phlebotomy" OR "venepuncture") AND ("Catheter*" OR"Intravenous Catheter") AND ("occlusion" OR "phlebitis" OR "dis‐lodge*"OR"failure"OR"infection*"OR"Infiltration"OR"extravasa‐tion"OR "blockage"OR "leakage"OR "he#molysis"OR "accuracy"OR"equivalence"OR"contamination")
IS I Web of ScienceTS=(Phlebotom* OR Venepuncture* OR Direct Venous Puncture)ANDTS=(Catheter*ORIntravenousCatheter*ORCatheteriz*)ANDTS=(occlusionORphlebitisORdislodge*ORfailureORinfection*ORInfiltrationORextravasationORblockageORleakageORhemolysisORhaemolysisORaccuracyORequivalenceORcontamination)
Alexandrou, E., Ray‐Barruel, G., Carr, P. J., Frost, S., Inwood, S.,Higgins,N., Rickard,C.M. (2015). International prevalence of theuseofperipheralintravenouscatheters.Journal of Hospital Medicine, 10(8),530‐533.https://doi.org/10.1002/jhm.2389Reasonforexclusion:Nodirectcomparisonbetweenthegroups,
Drawn by Emergency Department Personnel versus LaboratoryPhlebotomists. Laboratory Medicine, 33(5), 378‐380. https://doi.org/10.1309/PGM4‐4F8L‐2P1M‐LKPBReason for exclusion: The first part of the study compared ED
with non‐ED setting – unable to ascertain if the comparisonwasbetweenPIVCandvenepuncture.Thesecondpartofthestudyin‐cludedpaediatricpatients.Carraro,P.,Servidio,G.,&Plebani,M.(2000).Hemolyzedspeci‐
mens:areasonforrejectionoraclinicalchallenge?Clinical Chemistry, 46(2),306‐307.Reason for exclusion: Unclear if they compared between the
samples drawn from IV catheters have less hemolysiswhen5‐mL(vs10‐mL)collectiontubesareused.Journal of Emergency Nursing, 30(6),529‐533.https://doi.org/10.1016/j.jen.2004.10.004Reasonforexclusion:Nodirectcomparisonbetweenthegroups,
affectinghemolysisratesinbloodsamplesdrawnfromnewlyplacedIV sites in the emergency department. JEN: Journal of Emergency Nursing, 31(4),338‐418.https://doi.org/10.1016/j.jen.2005.05.004Reasonforexclusion:Nodirectcomparisonbetweenthegroups,
PIVCandvenepuncture.Dwyer, D. G., Fry, M., Somerville, A., & Holdgate, A. (2006).
Randomized,singleblindedcontroltrialcomparinghaemolysisratebetween two cannula aspiration techniques. Emergency Medicine Australasia, 18(5‐6),484‐488.https://doi.org/10.1111/j.1742‐6723. 2006.00895.xReasonforexclusion:Nodirectcomparisonbetweenthegroups,
Reason for exclusion: Contained data on an excluded group(paediatrics).Fang, L., Fang, S. H., Chung, Y. H., & Chien, S. T. (2008).
Collecting factors related to the haemolysis of blood speci‐mens. Journal of Clinical Nursing, 17(17), 2343‐2351. https://doi.org/10.1111/j.1365‐2702.2006.02057.xReason for exclusion: Contained data on an excluded group
forobtainingblood samples formeasurementofActivatedPartialThromboplastinTimes.Critical Care Nurse, 26(1), 30–38.Reasonforexclusion:Dataanalysisdidnot includeBland–Altman
plots.
Straszewski,S.,Sanchez,L.,McGillicuddy,D.,Boyd,K.,DuFresne,J.,Joyce,N.,...Mottley,J.(2011).UseofseparatevenipuncturesforIVaccessandlaboratorystudiesdecreaseshemolysisrates.Internal and Emergency Medicine, 6,357‐359.Reasonforexclusion:Thisstudyevaluatedapolicychange–we
were unsure if in the baseline data collection if blood could havebeencollectedbyeithervenepunctureorfromaPIVC.Zengin,N.,&Enç,N.(2008).Comparisonoftwobloodsampling
methods in anticoagulation therapy: venipuncture and peripheralvenouscatheter.Journal of Clinical Nursing, 17(3),386‐393.https://doi.org/10.1111/j.1365‐2702.2006.01858.xReasonforexclusion:Dataanalysisdidnot includemeandiffer‐
enceandBland–Altmanplots.
TheJournal of Advanced Nursing (JAN)isaninternational,peer‐reviewed,scientificjournal.JANcontributestotheadvancementofevidence‐basednursing,midwiferyandhealthcarebydisseminatinghighqualityresearchandscholarshipofcontemporaryrelevanceandwithpotentialtoadvanceknowledge for practice, education, management or policy. JAN publishes research reviews, original research reports and methodological andtheoreticalpapers.
• Most read nursing journal in the world:over3millionarticlesdownloadedonlineperyearandaccessibleinover10,000librariesworldwide(includingover3,500indevelopingcountrieswithfreeorlowcostaccess).
• Fast and easy online submission: onlinesubmissionathttp://mc.manuscriptcentral.com/jan.• Positive publishing experience:rapiddouble‐blindpeerreviewwithconstructivefeedback.• Rapid online publication in five weeks:averagetimefromfinalmanuscriptarrivinginproductiontoonlinepublication.• Online Open:theoptiontopaytomakeyourarticlefreelyandopenlyaccessibletonon‐subscribersuponpublicationonWileyOnlineLibrary,aswellastheoptiontodepositthearticleinyourownoryourfundingagency’spreferredarchive(e.g.PubMed).