Can We Draw Blood From Iv Line

JRSM Open. 2022 May; xi(5): 2054270419894817.

Blood sampled from existing peripheral 4 cannulae yields results equivalent to venepuncture: a systematic review

Finnian D Lesser

¹Acute Medical Unit, Conquest Hospital, Hastings, East Sussex Healthcare Trust, Saint Leonards-on-sea TN37 7RD, United kingdom of great britain and northern ireland

David A Lanham

²MRC Unit for Lifelong Wellness and Ageing at UCL and Astute Medical Unit, University Higher London NHS Foundation Trust, London NW1 2BU, UK

Daniel Davis

²MRC Unit for Lifelong Health and Ageing at UCL and Astute Medical Unit, University College London NHS Foundation Trust, London NW1 2BU, United kingdom

Supplementary Materials

sj-pdf-1-shr-x.1177_2054270419894817 - Supplemental material for Claret sampled from existing peripheral 4 cannulae yields results equivalent to venepuncture: a systematic review

GUID: 509FA36F-FC66-4003-ACAB-5B67DAC0B351

Supplemental material, sj-pdf-i-shr-x.1177_2054270419894817 for Blood sampled from existing peripheral IV cannulae yields results equivalent to venepuncture: a systematic review by Finnian D Bottom, David A Lanham and Daniel Davis in JRSM Open

Summary

Objectives

To plant whether blood samples taken from used peripheral intravenous cannulae are clinically interchangeable with venepuncture.

Design

Systematic review. PubMed, Spider web of Science and Embase were searched for relevant trials.

Setting

Trials which compared blood samples from used peripheral intravenous cannulae to venepuncture and provided limits of agreement or data which allowed calculation of limits of understanding.

Participants

Vii trials with 746 participants. Blood tests included 13 unremarkably ordered biochemistry, haematology and blood gas measurements.

Main effect measures

95% limits of agreement. Data were pooled using inverse variance weighting and compared to a clinically adequate range estimated past expert opinion from previous trials.

Results

Limits of agreement for blood samples from used peripheral intravenous cannulae were inside the clinically adequate range for sodium, chloride, urea, creatinine and haematology samples. Limits of agreement for potassium were ±0.47 mmol/Fifty which exceeded the clinically acceptable range. Peripheral intravenous cannula samples for blood gas assay gave limits of understanding which far exceeded the clinically acceptable range.

Conclusions

Blood sampling from used peripheral intravenous cannulae is a reasonable clinical practise for haematology and biochemistry samples. Potassium samples from used peripheral intravenous cannulae can be used in situations where error upwardly to ±0.47 mmol/L is acceptable. Peripheral intravenous cannula samples should non exist used for blood gas assay.

Keywords: Venepuncture, blood sampling, peripheral venous cannula, phlebotomy

Introduction

Venepuncture carries a certain corporeality of pain and a small take chances of complications. Given many patients have an in-situ peripheral intra-venous cannula, sampling blood from this obviates the need for repeated venepuncture if in that location are clinically equivalent and reliable results. In full general, this is not common do due to concerns regarding the validity of results.^one Other considerations include the method used for obtaining samples, prior or concurrent utilise of the cannula for fluid administration, the aspiration volume needing to be discarded and whatever demand for special equipment.

Whether assay results from peripheral intravenous cannula and venepuncture are clinically equivalent is quantified using limits of understanding, expressed as the range inside which 95% of values will prevarication in comparison to a reference standard measurement.² The limits of agreement are then compared with a clinically acceptable range usually divers by consensus.

In social club to assess the quantity and quality of studies comparing blood samples from existing PIV with venepuncture, we undertook a systematic review. We focused on studies of sufficient quality to influence clinical do.

Methods

Search strategy

Relevant keywords and terms were adult through a scoping search in PubMed, eventually expanding to three databases (PubMed, ISI Web of Science and Embase). Two reviewers screened titles and abstracts (FL and DL). The abstracts were categorised into 'non relevant' and 'potentially relevant' and all 'potentially relevant' studies were reviewed in full. References of included studies were also hand searched (Effigy 1). The total search strategy for PubMed is shown in Appendix 1.

Menses diagram showing search strategy. Source: Adapted from PRISMA flow diagram.¹¹

Written report option

Inclusion criteria

1. Studies that compared human claret samples fatigued from peripheral intravenous cannulae and venepuncture.

2. Studies reporting numerical results for at least one of the following tests: sodium, potassium, chloride, urea (or claret urea nitrogen), creatinine, haemoglobin, haematocrit, white cell count, platelets, international normalised ratio, pH, fractional pressure oxygen, fractional pressure carbon dioxide.

3. Studies using the Bland–Altman method for limits of agreement or providing data which allowed the calculation of limits of agreement.ⁱⁱ

Exclusion criteria

1. Manufactures not in English.

2. Studies which used newly inserted peripheral intravenous cannula for blood sampling unless intravenous fluids had been infused through the cannula prior to sampling.

3. Studies which took samples while infusions were running through the cannula or did not wait afterwards stopping infusions.

4. Delay of greater than 5 min betwixt samples for comparison.

5. Studies which did not discard at least 2 mL of aspirate prior to blood sampling.

6. Studies which required special equipment for blood sampling from peripheral intravenous cannula (for example double stopcock techniques).

Data collection and extraction

Relevant data were extracted from included papers in duplicate (FL and DL), including publication year, patient population, number of patients, blood tests carried out, discard volume prior to sampling, await time between stopping infusions and sampling, aspiration method and cannula estimate besides as the assay results. Tests measured in non-SI units were converted to SI units. Claret urea nitrogen results were converted to urea by multiplying by 2.14 and then converting to SI units.

The 95% limits of agreement was the main consequence of interest. If not reported direct, information technology was calculated

Limits of understanding = Meandifference ± 1 . 96 × SDofdifferencesfrommean

Limits of understanding values were so pooled using changed variance weighting

variance ( pooled ) = ( variance report 1 × northward written report 1 ) + ( variance study ii × n study ii ) … ( n study 1 - ane ) + ( n study two - 1 ) …

Clinically acceptable limits of agreement

The clinically acceptable errors in blood sampling are non fully established and vary depending on patient situation and the clinicians' tolerance for error. 4 studies specified such ranges established through clinician survey.^3–six We used a mean of these values to ascertain clinically adequate limits for this review.

Results

Literature search provided 1857 articles for abstract review with 130 duplicates (Figure 1). Hand-searching identified a further six studies for abstract review. There were 21 papers which were excluded at total text review for failure to run across the inclusion criteria or meeting the exclusion criteria (Appendix 2). Ultimately, seven studies were included with total individuals due north = 746 from a combination of adult inpatient, adult emergency department, paediatric inpatient and salubrious volunteers (Table i).

Table ane.

Summary of included studies.

Year	Starting time author	n	Population	Infusions prior to blood sampling	Discard volume (mL)	Wait time after stopping infusion	Sampling technique	PIV approximate (French)
1998	Fincher	53	Medical inpatient adults	Non specified	3	60 min	Syringe	18, 20
2001	Himberger	64	Emergency section adults	At least 100 mL	v	i min	Syringe and needle	16,xviii,twenty
2001	Zlotowski	33	Healthy volunteers	200 mL normal saline	12	two min	Syringe and needle	xviii
2007	Corbo	81	Emergency department adults	Not stated	5	two min	Vacutainer and needleless adapter	xviii, xx, 22
2010	Berger-Achituv	40	Inpatient paediatrics	At least 100 mL	2	1 min	Syringe	20, 22, 24
2014	Ortells-Abuye	272	Inpatient ward or short stay unit adults	Medications or IV fluids	4	15 due south	Syringe	xvi, 18, 20, 22
2014	Hambleton	259	Emergency department adults	Unspecified	2	2 min	Vacutainer with luer adapter	18, 20

Characteristics of included studies

Studies comparing venepuncture to peripheral intravenous cannula used different methods and protocols (Tabular array 1). The minimum discard volume in the studies was two mL. Cannula sizes varied from sixteen to 22 French. All cannulae had been used prior to sampling but there was variation in volume and contents of infusion prior to sampling. Sampling devices used were either syringe or vacutainer systems.

Biochemistry

Sodium, chloride, urea and creatinine pooled limits of agreement were all within the clinically acceptable fault range (Table 2). In some cases, the pooled limits of agreement was essentially lower than the clinically acceptable error range (e.g. creatinine in µmol/L limits of agreement = −13, +12; clinically acceptable range = ±26). However, potassium limits of agreement exceeds the clinically acceptable error range (in mmol/Fifty limits of agreement = −0.48, +0.46; clinically acceptable range = ±0.35).

Table 2.

Results for renal function and electrolytes. Showing 95% limits of understanding for included papers, pooled 95% limits of agreement and clinically accepted range for comparing.

Study	Sodium (mmol/L)		Potassium (mmol/Fifty)		Chloride (mmol/50)		Urea (mmol/L)		Creatinine (µmol/L)
	Lower jump	Upper spring	Lower jump	Upper leap	Lower bound	Upper bound	Lower bound	Upper bound	Lower spring	Upper leap
Fincher			−0.47	0.45
Himberger	−ii.5	3.3	−0.45	0.56	−3.3	three.9	−0.v	0.6	−16	18
Zlotowski	−2.2	2.7	−0.23	0.39	−one.9	i.eight	−0.6	0.7	−viii.7	8.seven
Corbo	−4.0	3.0	−0.70	0.lxx	−3.iii	two.nine
Berger-Achituv	−3.3	2.9	−0.42	0.43	−three.seven	2.9	−0.9	0.8
Ortells-Abuye	−2.6	3.1	−0.45	0.45			−1.i	ane.2
Hambleton	−3.5	3.half dozen	−0.46	0.xl	−2.half-dozen	3.0	−0.half dozen	0.6	−13	11
Pooled results	−2.9	3.three	−0.48	0.46	−two.viii	iii.0	−0.8	0.ix	−thirteen	12
Clinically adequate range	−4.3	4.3	−0.35	0.35	−vi.5	6.5	−1.1	1.ane	−26	26

Haematology and international normalised ratio

The pooled results for haematology and international normalised ratio were all within the clinically acceptable limits of agreement (Table 3).

Table 4.

Results for claret gas and pH. Showing 95% limits of agreement for included papers, pooled 95% limits of agreement and clinically accepted range for comparison.

Study	pH		pO2 (kPa)		pCO2 (kPa)
	Lower leap	Upper leap	Lower spring	Upper bound	Lower leap	Upper bound
Ortells-Abuye	−0.060	0.040	−5.four	ii.9	−0.8	1.4
Hambleton	−0.034	0.044	−2.nine	3.viii	−i.2	0.9
Pooled results	−0.050	0.040	−four.5	3.0	−0.ix	i.3
Clinically acceptable range	−0.1	0.1	−0.seven	0.vii	−0.vii	0.7

Table iii.

Results for haematology and international normalised ratio (INR). Showing 95% limits of understanding for included papers, pooled 95% limits of agreement and clinically accepted range for comparison.

Study	Haemoglobin (g/dL)		Haematocrit (%)		White cells (thou/L)		Platelets (1000/50)		INR
	Lower leap	Upper bound	Lower bound	Upper bound	Lower leap	Upper bound	Lower bound	Upper bound	Lower bound	Upper jump
Fincher			−0.6	0.9
Himberger	−0.lxx	0.70	−1.4	i.three	−0.eight	0.seven	−30	27
Zlotowski	−0.34	0.40	−1.0	1.2	−0.7	0.4	−13	13	−0.06	0.06
Corbo	−0.61	0.91	−1.4	one.7
Berger-Achituv	−0.66	0.57	−two.1	1.9	−1.one	1.1	−37	39
Ortells-Abuye	−0.65	0.65			−1.8	1.8	−30	34
Hambleton	−0.58	0.47	−0.six	0.five	−0.9	0.viii	−19	16	−0.12	0.11
Pooled results	−0.63	0.57	−0.74	0.64	−one.3	1.2	−25	26	−0.12	0.10
Clinically acceptable range	−0.nine	0.9	−3.5	iii.5	−1.5	1.v	−40	40	−0.twenty	0.xx

Blood gases and pH

The pooled limits of understanding for pH was within clinically acceptable range (Table 4). However, the pooled limits of agreement for pCO₂ exceeded the clinically adequate range (in kPa limits of agreement = −0.9, +1.3; clinically acceptable range = ±0.7) and limits of agreement pO₂ dramatically exceeded the clinical acceptable range (in kPa limits of agreement = −4.5, +three.0; clinically acceptable range = ±0.seven).

Discussion

Across pooled studies, we showed that assays from used peripheral intravenous cannula were reliable and clinically consistent with fresh venepuncture samples, except in the example of potassium and blood gases. Taken together, our findings suggest that peripheral intravenous cannula sampling could exist given greater consideration in clinical practice – at least for the tests described.

The results for potassium levels were not within clinically acceptable agreement limits for some patients. The 95% limits of agreement for potassium of −0.46 to + 0.47 mmol/Fifty shows that, for patients where a tight control of potassium is essential, samples from used peripheral intravenous cannula should exist used with circumspection. For most other patients, a sample from a peripheral intravenous cannula would be sufficient and the level of fault ±0.47 mmol/L is unlikely to affect patient outcomes. The cause for the higher level of error is not clear, though haemolysis or haemodilution was excluded as causes in the studies considered here. For blood gas analyses (pO₂ and pCO₂), the two studies reporting these suggested errors were due to contagion of the samples with atmospheric air post-collection.^6,vii

There were some limitations to this study. There was heterogeneity in study populations, protocols and equipment. Information technology is not clear whether our findings are generalisable to other sampling techniques, e.m. with narrower judge cannula.

In terms of haemolysis degrading the sample quality, we show that for most claret tests it does not pb to significant errors. Nonetheless, if the laboratory or analysers do not check for haemolysed samples it could lead to errors in results.⁸

Nosotros did not assess some unremarkably ordered blood tests. Our findings relate to specific assays and may non exist generalisable to other haematology and biochemistry investigations.

The clinical bear upon of these findings will be greatest in those situations in which patients require repeated blood tests where samples from peripheral intravenous cannula would be suitable. For example, if a patient were admitted with symptomatic anaemia and needed serial haemoglobin measurements samples from a cannula could be used. Peripheral intravenous cannula sampling can be an alternative for patients who find venepuncture intensely sorry. At that place are also patients in which venepuncture is technically difficult and peripheral intravenous cannula samples can provide easier admission to blood.

Our findings exercise not explain why some blood tests are not reliable when taken from a used peripheral intravenous cannula and this could be the subject area of further research. Further studies could also be considered to assess other assays which were not included in this newspaper.

Conclusions

Peripheral intravenous cannula samples are interchangeable with venepuncture for sodium, chloride, urea, creatinine and haematology tests. Peripheral intravenous cannula samples can be used for potassium measurement in situations where fault of ±0.47 mmol/L is acceptable. Claret gas analysis for pO₂ and pCO_two can testify clinically significant differences between peripheral intravenous cannula and venepuncture and then peripheral intravenous cannula samples should not be used. Overall, peripheral intravenous cannula sampling is a reasonable clinical practise for a range of common assays.

Declarations

Competing Interests

None alleged.

Funding

DD is supported by a Wellcome Trust Intermediate Clinical Fellowship (WT107467). DL is supported as a UCLH CEO clinical research fellow.

Ideals approving

Not applicable.

Contributorship

FL and DL both conceived the research. FL led the planning of the research. FL and DL contributed equally to the literature search, review of literature and data assay. All authors were involved in drafting and take approved the terminal version. FL is the guarantor and principal investigator, accepting responsibility for the written report.

Supplemental Material

sj-pdf-1-shr-ten.1177_2054270419894817 - Supplemental material for Claret sampled from existing peripheral 4 cannulae yields results equivalent to venepuncture: a systematic review:

Supplemental material, sj-pdf-one-shr-10.1177_2054270419894817 for Blood sampled from existing peripheral 4 cannulae yields results equivalent to venepuncture: a systematic review by Finnian D Lesser, David A Lanham and Daniel Davis in JRSM Open up

Appendix 1. PubMed search strategy

1. ((cannula) OR saline lock device) OR peripheral venous catheter OR (Catheterization, Peripheral*) OR Infusions, Intravenous/instrumentation*

2. ((blood sampling) OR Blood collection) OR phlebotomy

3. Humans[MeSH Terms]

4. #i AND #2 AND #3

Appendix 2. Excluded papers at full text review and reasons for exclusion

Provenance

Not commissioned. Peer-reviewed by Devaki Nair and Patrick Twomey.

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Source: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7236571/

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