Hemolyzed Laboratory Specimens in the Emergency Department: An Underappreciated, but Frequent Problem

Area of Science:

• Emergency Medicine
• Clinical Pathology
• Medical Device Analysis

Background:

• Hemolysis of blood samples in emergency departments (ED) causes treatment and disposition delays.
• Identifying factors contributing to hemolysis is crucial for improving patient care efficiency.

Purpose of the Study:

• To determine the frequency of blood sample hemolysis in ED patients.
• To identify variables, particularly those related to peripheral intravenous catheter (PIVC) insertion, that predict hemolysis.

Main Methods:

• Observational cohort study across three institutions with over 270,000 annual ED visits.
• Included adults with PIVC inserted in the ED requiring laboratory analysis.
• Analyzed electronic health record data for hemolysis and PIVC-related outcomes.

Main Results:

• Over 141,000 patient encounters were analyzed; 17.2% of samples showed hemolysis.
• Smaller gauge (22G) catheters increased hemolysis odds (OR 1.78) versus 20G.
• Larger gauge (18G) catheters decreased hemolysis odds (OR 0.94).
• Hand/wrist PIVC placement increased hemolysis odds (OR 2.06) versus antecubital.
• Hemolysis was associated with a higher rate of PIVC failure (OR 1.06).

Conclusions:

• Lab hemolysis is a frequent issue in ED settings, impacting patient care.
• Catheter gauge and PIVC placement location are significant predictors of hemolysis.
• Clinicians should consider these factors to minimize hemolysis, reduce delays, and prevent prolonged hospital stays.