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Pre-analytic errors: Blood-Collection Errors and Their Impact on Patients

There are many details that are critical for every venipuncture. In this post, we connect the dots between pre-analytical errors and patient outcomes. Numerous errors can be committed during the collection, transport, and handling of blood samples. We also list the impact each error can have on the test result and patient.

• ERROR: Delay in transporting/testing coagulation specimens • POTENTIAL IMPACT: Stroke, thrombophlebitis, and pulmonary embolism caused by unwarranted modification to blood thinner dosage based on inaccurate aPTT result.

• ERROR: improper mixing • POTENTIAL IMPACT: Patient mismanagement due to delays when anticoagulated tubes contain clots and must be recollected.

• ERROR: patient misidentification • POTENTIAL IMPACT: Transfusion- or medication-related death. Misdiagnosis, medication error, and general patient mismanagement due to being treated according to the results of another patient.

• ERROR: filling tubes in the wrong order • POTENTIAL IMPACT: Seizure and death from potassium carrying over from EDTA into tube to be tested for K+. Medication errors when additives carry over into coag tubes, falsely lengthening coagulation times and leading to unwarranted and life-threatening medication adjustments. Unnecessary antibiotic administration and prolonged hospitalization due to contaminated blood cultures.

• ERROR: pouring blood from one tube into another • POTENTIAL IMPACT: Patient mismanagement/misdiagnosis & medication errors based on altered results, especially potassium. Stroke/hemorrhage due to unwarranted modification to blood thinner dosage.

• ERROR: underfilling heparin tubes • POTENTIAL IMPACT: Patient mismanagement and/or /misdiagnosis from altered potassium, sodium, ALT, AST, amylase, and lipase results.

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