How can we fix it?

• Understand the causes
• Draw labs based on new protocol

Understand the causes of hemolysis

Draw from larger gauges - 20 and larger

TORNIQUET TIME

Vacutainers cause less hemolysis than syringes

Wet alcohol/chlorohexidine on the skin damages RBCs

ORDER OF THE DRAW

Draw from the AC as first choice

Tube inversion matters!

DO NOT LAY OR STORE TUBES ON THEIR SIDES

With 1,194 hours of CMP redraws this year we need a change based on evidence

Our New Protocol

Starting IVs

• When placing 18 or 20 gauge: Collect a specimen
• When placing 22 or 24 gauge: Use venipuncture from different site for specimen collection
• WHY? The likelihood of a hemolysis from smaller bore IVs is too great. Do not risk delays in patent care.

Patient arriving via EMS

• Butterfly for a specimen or start a second line (if the need is anticipated)
• WHY? Obtaining specimen from existing IV catheters has a much greater hemolysis rate than venipunture. Do not risk delays in patent care due to hemolyzed specimens.

Lab calls ...

• They say: "The specimen is grossly hemolyzed."
• What do you do?
• Draw from a DIFFERENT site using venipuncture
• Why? The likelihood of repeat hemolysis is very high if the specimen is drawn the same way as the first time.