1. VERIFICATION OF BLOOD COLLECTION SYSTEM GIAN LUCA SALVAGNO, MD, PhD University of Verona, Italy

2. HUB Spoke START

5. Laboratory’ s errors Lundberg’s loop.

6. Laboratory testing

8. Errors and patient’s outcome

11. Pre- analytica l errors

12. Preanalytical:56% Analytical:21% Postanalytical:18% Multiple: 5% Preanalytical:56% Analytical:21% Postanalytical:18% Multiple: 5% ……….and in laboratory?

14. Pre-analytical phase: Where? Patient identification Critical s point Blood specimen collection Specimen identification Specimen transport Time of specimen arrival Check-in Centrifugation decaping Aliquoting and labeling of the secondary specimen Outside LaboratoryLaboratoryLaboratoryLaboratory Within

15. Phlebotomist?

16. Blood collection device

18. Blood drawing technique

19. VENOUS STASIS

20. Venous Stasis:Tourniquet time

23. 1)Tourniquet time: Clinical Chemistry

24. GLS 2) Tourniquet time: Coagulation testing

25. 3) Tourniquet time: Hematological testing

26. BLOOD CONTAINER

31. GLS Anticoagulants

35. VENOUS ACCESS

37. Hemolysis: Clinical Chemistry

38. GLS Hemolysis: Coaguation testing

39. GLS VisuallyundetectablehemolysisVisuallyundetectablehemolysis Percentage RBC lysate on the total RBC mass. 0 0.1 0.2 0.4 0.8 1.6 3.3 6.8 14.7 Hemolysis :clinical chemistry testing

40. NEEDLE SIZE

42. Recommendations for Collection of a Quality Specimen for Coagulation Testing

44. Influence of under-filling of 3.2% buffered sodium citrate blood tubes on results of activated partial thromboplastin time (APTT), prothrombin time (PT), fibrinogen, activated protein C resistance (APCR), and coagulation factor VIII. The dotted lines designate the desirable bias for each parameter.

46. GLS The JCAHO has recently given priority within the 2007 National Patient Safety Goals to the improvement of the accuracy of patient identification and it applies to all JCAHO-accredited healthcare organizations and those seeking JCAHO accreditation. Failure to comply can result in a special Type I recommendation and jeopardize a facility’s accreditation status.

47. GLS The International Organization for Standardization 15189:2003 clause 5.4 “Pre-examination procedures'” includes requirements for traceability of primary samples to an identified individual.

48. GLS

51. What’s next?

55. “Which is the best choice?” Or……

57. …and I am ready to start!

58. The End Take a home message