American Journal of Laboratory Medicine

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Evaluation of Phlebotomy Services in Clinical Laboratory Setting in Addis Ababa Public Hospitals, Addis Ababa, Ethiopia

Received: 18 April 2017    Accepted: 28 April 2017    Published: 23 June 2017
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Abstract

Background: Phlebotomy is the system of drawing a blood sample for the use of laboratory testing and for blood transfusion. Professionals who are performing phlebotomy services called phlebotomists. It is a critical part of the pre analytical phase of laboratory testing and is the most neglected procedures in health care. About 70% of the quality of the test are affected during phlebotomy and other pre analytical services. However, little is known about the practice of phlebotomy services in developing countries like Ethiopia. Objectives: To assess the practice of phlebotomists and to identify the major sources of errors during venous blood collection in public hospitals in Addis Ababa. Methodology: Hospital based, cross sectional observational and follow-up study was conducted from March to May 30, 2014. The study followed 40 phlebotomists while each of them was collecting 5 different venous blood collections (giving a total of 200 phlebotomies). Well structured questionnaires and checklists were used to collect data. Data was entered on EPI-Data version 3.1 and statistical analysis was performed with SPSS version 20. Descriptive statistics were employed and the Chi square test was used for comparing major errors observed. Result: Almost all laboratory phlebotomy sites had no Standard Oprating Procedures (SOPs) available in collection sites and most of collection sites were not well ventilated. The major errors identified were use of single glove for more than one client 139 of 200 (69.5%), inappropriate cleaning practice of vein puncture sites 180 of 200 (90%), collecting blood before the disinfectant alcohol dried 139 of 200 (69.5%), incorrect tube collection sequences 107 of 200 (53.5%), unnecessarily applying of tourniquets after blood started flowing in to the collection tubes and syringes 170 of 200 (85.0%) and applying tourniquets before locating and selecting appropriate site for venous blood collection 175 of 200 (87.5%). Conclusion and Recommendation: -Many errors were identified in the phlebotomy practice during the observational study. As the quality of blood specimen influences patient result: emphasis should be given on phlebotomy training to improve the practices for phlebotomists and ensure safety as well as quality during blood collections for laboratory analysis.

DOI 10.11648/j.ajlm.20170203.11
Published in American Journal of Laboratory Medicine (Volume 2, Issue 3, May 2017)
Page(s) 24-33
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Phlebotomy, Venous Blood Collection, Quality, Tourniquet, Preanalytical Errors

References
[1] WHO Guidelines on Drawing Blood: Best Practices in Phlebotomy. Geneva; 2010.
[2] Lippi G, Salvagno GL, Montagnana M, Franchini M, Guidi GC. Phlebotomy issues and quality improvement in results of laboratory testing. Clinical laboratory. 2006; 52 (5-6): 217-230.
[3] Hawkins R. Managing the pre-and post-analytical phases of the total testing process. Ann Lab Med. 2012; 32 (1): 5-16.
[4] Lima-Oliveira G, Guidi GC, Salvagno GL, Montagnana M, Rego FG, Lippi G, et al. Is Phlebotomy Part of the Dark Side in the Clinical Laboratory Struggle for Quality? Lab Med. 2012; 43 (5): 172-176.
[5] Lai X, Yang P, Zhang Y, Cao J, Zhang L. Analysis of Factors Influencing the Generation of Unqualified Clinical Samples and Measures to Prevent this Generation. Ann Lab Med. 2012; 32 (3): 216-219.
[6] Mäkitalo O, Liikanen E. Improving Quality at the Preanalytical Phase of Blood Sampling: Literature Review. International Journal of Biomedical Laboratory Science (JIBS). 2013; 2 (1): 7-16.
[7] Bolenius K, Brulin C, Grankvist K, Lindkvist M, Soderberg J. A content validated questionnaire for assessment of self reported venous blood sampling practices. BMC Res Notes. 2012; 5: 39. 1
[8] Saurav Patra M, Mukherjee B, Das AK. Pre-analytical errors in the clinical laboratory and how to minimize them. Int. J. Bioassays. 2013; 2 (3): 551-553.
[9] Söderberg J, Wallin O, Grankvist K, Brulin C. Is the test result correct? A questionnaire study of blood collection practices in primary health care. J Eval Clin Pract. 2010; 16 (4): 707-711.
[10] Bowen RA, Hortin GL, Csako G, Otanez OH, Remaley AT. Impact of blood collection devices on clinical chemistry assays. Clin Biochem. 2010; 43 (1-2): 4-25.
[11] Lippi G, Becan-McBride K, Behúlová D, Bowen RA, Church S, Delanghe J, et al. Preanalytical quality improvement: in quality we trust. Clin Chem Lab Med. 2013; 51 (1): 229–241.
[12] Serdar MA, Kenar L, Hasimi A, Kocu L, Turkmen YH, Kurt I, et al. Tourniquet application time during phlebotomy and the influence on clinical chemistry testing; is it negligible. Turk J Biochem. 2008; 33: 85-88.
[13] Abay Sisay, Tedla Mindaye, Abrham Tesfaye, Eyob Abera, Adino Desale, Assessing the outcome of Strengthening Laboratory Management Towards Accreditation (SLMTA) on laboratory quality management system in city government of Addis Ababa, Ethiopia. The pan African Medical Journal. 2015; 20: 314.
[14] Program for Appropriate Technology in Health (PATH). RBP-EIA: Collecting, Processing, and Handling Venous, Capillary, and Blood Spot Samples. PATH Publications. 2005. [http://www.path.org (accsessed date 16 september 2013)].
[15] Bush V, Mangan L. The Hemolyzed Specimen: Causes, Effects, and Reduction. BD Lab Notes. 003; 13 (1). [http://www.bd.com/vacutainer (accessed date 12 september 2013)].
[16] Sultan J, Afzal T, Jabeen K. Identification of the Types of Pre-analytical Errors in the Clinical Chemistry Laboratory from Jan-2012 to Dec-2012 at Jinnah Hospital, Pathology Department. A. P. M. C. 2013; 7:1 (accsessed date 1 september 2013)].
[17] Clinical and Laboratory Standards Institute (CLSI). Procedures for the collection of diagnostic blood specimens by venipuncture. Document H3-A5. 2003; 23 (32): 17.
[18] Lippi G, Salvagno GL, Montagnana M, Brocco G, Guidi GC. Influence of short-term venous stasis on clinical chemistry testing. Clin Chem Lab Med. 2005; 43 (8): 869-75.
Author Information
  • ALERT Center, Addis Ababa, Ethiopia

  • School of Clinical Laboratory Science, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia

  • GIZ-Ethiopia, Addis Ababa, Ethiopia

  • School of Clinical Laboratory Science, College of Health Science, Addis Ababa University, Addis Ababa, Ethiopia

Cite This Article
  • APA Style

    Wondimeneh Liknaw Mekonon, Aster Tsegaye Abebe, Eshetu Lemma Haile, Abay Sisay Misganaw. (2017). Evaluation of Phlebotomy Services in Clinical Laboratory Setting in Addis Ababa Public Hospitals, Addis Ababa, Ethiopia. American Journal of Laboratory Medicine, 2(3), 24-33. https://doi.org/10.11648/j.ajlm.20170203.11

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    ACS Style

    Wondimeneh Liknaw Mekonon; Aster Tsegaye Abebe; Eshetu Lemma Haile; Abay Sisay Misganaw. Evaluation of Phlebotomy Services in Clinical Laboratory Setting in Addis Ababa Public Hospitals, Addis Ababa, Ethiopia. Am. J. Lab. Med. 2017, 2(3), 24-33. doi: 10.11648/j.ajlm.20170203.11

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    AMA Style

    Wondimeneh Liknaw Mekonon, Aster Tsegaye Abebe, Eshetu Lemma Haile, Abay Sisay Misganaw. Evaluation of Phlebotomy Services in Clinical Laboratory Setting in Addis Ababa Public Hospitals, Addis Ababa, Ethiopia. Am J Lab Med. 2017;2(3):24-33. doi: 10.11648/j.ajlm.20170203.11

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  • @article{10.11648/j.ajlm.20170203.11,
      author = {Wondimeneh Liknaw Mekonon and Aster Tsegaye Abebe and Eshetu Lemma Haile and Abay Sisay Misganaw},
      title = {Evaluation of Phlebotomy Services in Clinical Laboratory Setting in Addis Ababa Public Hospitals, Addis Ababa, Ethiopia},
      journal = {American Journal of Laboratory Medicine},
      volume = {2},
      number = {3},
      pages = {24-33},
      doi = {10.11648/j.ajlm.20170203.11},
      url = {https://doi.org/10.11648/j.ajlm.20170203.11},
      eprint = {https://download.sciencepg.com/pdf/10.11648.j.ajlm.20170203.11},
      abstract = {Background: Phlebotomy is the system of drawing a blood sample for the use of laboratory testing and for blood transfusion. Professionals who are performing phlebotomy services called phlebotomists. It is a critical part of the pre analytical phase of laboratory testing and is the most neglected procedures in health care. About 70% of the quality of the test are affected during phlebotomy and other pre analytical services. However, little is known about the practice of phlebotomy services in developing countries like Ethiopia. Objectives: To assess the practice of phlebotomists and to identify the major sources of errors during venous blood collection in public hospitals in Addis Ababa. Methodology: Hospital based, cross sectional observational and follow-up study was conducted from March to May 30, 2014. The study followed 40 phlebotomists while each of them was collecting 5 different venous blood collections (giving a total of 200 phlebotomies). Well structured questionnaires and checklists were used to collect data. Data was entered on EPI-Data version 3.1 and statistical analysis was performed with SPSS version 20. Descriptive statistics were employed and the Chi square test was used for comparing major errors observed. Result: Almost all laboratory phlebotomy sites had no Standard Oprating Procedures (SOPs) available in collection sites and most of collection sites were not well ventilated. The major errors identified were use of single glove for more than one client 139 of 200 (69.5%), inappropriate cleaning practice of vein puncture sites 180 of 200 (90%), collecting blood before the disinfectant alcohol dried 139 of 200 (69.5%), incorrect tube collection sequences 107 of 200 (53.5%), unnecessarily applying of tourniquets after blood started flowing in to the collection tubes and syringes 170 of 200 (85.0%) and applying tourniquets before locating and selecting appropriate site for venous blood collection 175 of 200 (87.5%). Conclusion and Recommendation: -Many errors were identified in the phlebotomy practice during the observational study. As the quality of blood specimen influences patient result: emphasis should be given on phlebotomy training to improve the practices for phlebotomists and ensure safety as well as quality during blood collections for laboratory analysis.},
     year = {2017}
    }
    

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  • TY  - JOUR
    T1  - Evaluation of Phlebotomy Services in Clinical Laboratory Setting in Addis Ababa Public Hospitals, Addis Ababa, Ethiopia
    AU  - Wondimeneh Liknaw Mekonon
    AU  - Aster Tsegaye Abebe
    AU  - Eshetu Lemma Haile
    AU  - Abay Sisay Misganaw
    Y1  - 2017/06/23
    PY  - 2017
    N1  - https://doi.org/10.11648/j.ajlm.20170203.11
    DO  - 10.11648/j.ajlm.20170203.11
    T2  - American Journal of Laboratory Medicine
    JF  - American Journal of Laboratory Medicine
    JO  - American Journal of Laboratory Medicine
    SP  - 24
    EP  - 33
    PB  - Science Publishing Group
    SN  - 2575-386X
    UR  - https://doi.org/10.11648/j.ajlm.20170203.11
    AB  - Background: Phlebotomy is the system of drawing a blood sample for the use of laboratory testing and for blood transfusion. Professionals who are performing phlebotomy services called phlebotomists. It is a critical part of the pre analytical phase of laboratory testing and is the most neglected procedures in health care. About 70% of the quality of the test are affected during phlebotomy and other pre analytical services. However, little is known about the practice of phlebotomy services in developing countries like Ethiopia. Objectives: To assess the practice of phlebotomists and to identify the major sources of errors during venous blood collection in public hospitals in Addis Ababa. Methodology: Hospital based, cross sectional observational and follow-up study was conducted from March to May 30, 2014. The study followed 40 phlebotomists while each of them was collecting 5 different venous blood collections (giving a total of 200 phlebotomies). Well structured questionnaires and checklists were used to collect data. Data was entered on EPI-Data version 3.1 and statistical analysis was performed with SPSS version 20. Descriptive statistics were employed and the Chi square test was used for comparing major errors observed. Result: Almost all laboratory phlebotomy sites had no Standard Oprating Procedures (SOPs) available in collection sites and most of collection sites were not well ventilated. The major errors identified were use of single glove for more than one client 139 of 200 (69.5%), inappropriate cleaning practice of vein puncture sites 180 of 200 (90%), collecting blood before the disinfectant alcohol dried 139 of 200 (69.5%), incorrect tube collection sequences 107 of 200 (53.5%), unnecessarily applying of tourniquets after blood started flowing in to the collection tubes and syringes 170 of 200 (85.0%) and applying tourniquets before locating and selecting appropriate site for venous blood collection 175 of 200 (87.5%). Conclusion and Recommendation: -Many errors were identified in the phlebotomy practice during the observational study. As the quality of blood specimen influences patient result: emphasis should be given on phlebotomy training to improve the practices for phlebotomists and ensure safety as well as quality during blood collections for laboratory analysis.
    VL  - 2
    IS  - 3
    ER  - 

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