Neonatal Intensive Care Unit Quality Initiative: Identifying Preanalytical Variables Contributing to Specimen Hemolysis and Measuring the Impact of Evidence-Based Practice Interventions

Abstract

Objectives: Blood specimen hemolysis is a major cause of sample recollection in the neonatal intensive care unit. We aimed to reduce the hemolysis rate from 6.3% at baseline to less than 4% within the 9 months' duration of the study.

Methods: Intravenous infusion of lipid emulsion during sample collection, sample collection site, and blood sample transportation methods were investigated as possible contributors to hemolysis. Subsequently, two practice improvements were implemented: pausing lipid emulsion infusion prior to collection and slowing withdrawal rates through arterial catheters.

Results: Samples were more likely to be hemolyzed if they were collected during lipid infusion and subsequently transported by pneumatic tube or collected through an arterial catheter. Retrospective analysis demonstrated a decreased number of tests cancelled due to specimen hemolysis (3.5%) after our interventions.

Conclusions: We identified three variables contributing to hemolysis and instituted two clinical practice interventions to significantly reduce test cancellations due to hemolysis.

Keywords: Arterial catheter draws; Clinical chemistry; Clinical practice intervention; Lipid emulsion infusion; Neonatal ICU; Quality improvement; Sample transport; Specimen hemolysis.