影響病患血液檢體溶血之收集流程因素探討

Affecting Factors Related to the Collecting Procedure of the Hemolyzed Blood Specimens

病患血液檢體之採取對住院病患而言，是一項普遍的治療項目，但卻常遇檢體溶血問題，為檢驗科退件而必須再度採血之狀況；雖檢驗結果之品管，分為分析上及非分析上之品管，但本文主針對分析前之檢體收集流程面作探討。因再度採血可能導致成本及治療之延誤之影響，且回顧文獻，目前國內所發表文獻中，未見學者直接針對影響病患血液檢體溶血之收集流程因素作探討，故筆者試圖經由了解病患血液檢體溶血之收集流程因素，以提供日後降低檢體溶血比率，提高品質之參考。文中，除整合相關文獻及筆者之臨床經驗，指出抽血使用材料、針頭（導針及鋼針）型號、抽血部位、止血帶使用、執行抽血人員及病患本身之個別差異、運送方式、檢體輕柔搖晃的次數、血液被抽入針筒內時，過於用力、檢體排送至試管之方式、檢體離心時機、檢體成份不同及酒精未蒸發，即進行靜脈穿刺等因素，皆為溶血之可能因素，並更進一步論及相關研究之限制及針對護理臨床、護理教育及護理研究之運用，提出具體建議。

The collection of the blood specimen of the hospitalized patients is a common procedure. Hemolysis is the major reason for recollecting. This article focused on the affecting factors related to the collecting procedure of the hemolyzed specimens. There has been no relevant article directly related to the affecting factors related to the collecting procedure of the hemolyzed specimen published in Taiwan. We reviewed international articles to explore the affecting factors related to the collecting procedure of the hemolyzed specimens. The affecting factors included the materials of the aspiration, the size of the catheter or straight needle, the anatomic location, the ways to use tourniquet, the differences of the skills of the performers and patients themselves, transportation, the frequencies of the specimen being gently inverted, the ways of drawing blood into tubes, the timing of centrifuging blood specimens, different specimens, and whether venipuncture before alcohol vaporized or not. Limitations of related researches and suggestions on nursing practices, nursing education and nursing research were also discussed.