The Effect of Luer-Lock Adapter on Hemolysis Rates in the Emergency Department

Blood testing in the emergency department (ED) is critical for effective patient management. Hemolysis, a common preanalytical error, compromises laboratory results, increases workloads and resource utilization, and causes patient discomfort due to repeat testing.

This study evaluates the impact of Luer Lock adapters on hemolysis rates in ED blood samples, compared with the standard intravenous injector method. While prior studies suggest Luer Lock adapters reduce hemolysis, this investigation focuses on their performance in high pressure emergency settings, where hemolysis poses a persistent challenge to clinical decision making.

A prospective observational study was conducted at Ege University Hospital, including patients aged 18 and older requiring biochemistry testing. Blood samples were collected using both the standard injector method and BD Vacutainer Luer Lock® adapters. Hemolysis rates were assessed using the McNemar test, with statistical significance set at P < 0.05. A sample size of 210 was calculated, and data were analyzed using R software.

Among 517 ED patients, the overall hemolysis rate was 12.4%. Hemolysis was more frequent with the Luer Lock method (12.4%) compared to the injector method (8.1%, P = 0.011). LDH hemolysis occurred in 98.4% of hemolyzed samples, and all potassium hemolysis cases coincided with LDH hemolysis. The Luer Lock method exhibited higher hemolysis rates for both LDH (12.2%) and potassium (5.2%) than the injector method (LDH 7.5%, potassium 2.1%, P < 0.001).

Contrary to previous findings, the Luer Lock adapter was associated with increased hemolysis rates. Addressing hemolysis requires consistent procedures, skilled staff, and future research on equipment and handling factors in clinical practice.