静脉血标本不合格的原因分析及改进措施

Cause analysis of unqualified venous blood specimens and improvement measures

目的分析不合格静脉血标本产生的原因,提出相应的改进措施,确保分析前环节的标本质量。方法回顾性分析2019年6—11月中山大学附属第三医院岭南院区检验科送检的静脉血标本,统计不同月份和不同科室产生的不合格标本数,计算标本不合格率并进行比较,分析出现不合格静脉血标本的原因并提出解决对策。结果2019年6—11月本院检验科共采集静脉血标本69290份,其中不合格标本227份,总不合格率为0.33%。2019年7—10月静脉血标本不合格率逐月升高,经分析原因,并加强对新入职护士的培训和讲座,11月的标本不合格率有所降低。静脉血标本不合格数最多的科室为新生儿科(26份)、重症监护病房(ICU;15份)和风湿内科(15份);不合格率最高的科室为风湿内科〔0.50%(15/2987)〕、泌尿外科〔0.44%(5/1149)〕以及神经外科〔0.41%(13/3159)〕。静脉血标本不合格的主要原因依次为标本凝固、标本量不足、容器类型错误、项目重复和溶血。针对不合格标本产生的具体原因,采取相应的改进措施,对护理人员进行强化培训和定期考核。结论检验科应加强与护理部和临床科室的联系,及时沟通和反馈不合格标本的情况,严格执行标本采集规范,确保标本检测的准确性,降低静脉血标本不合格率,为临床提供及时准确的诊断依据。

Objective To analyze the causes of unqualified venous blood specimens,put forward the corresponding improvement measures,and ensure the sample quality before analysis.Methods The venous blood specimens from Lingnan Hospital,the Third Affiliated Hospital of Sun Yat-sen University from June to November in 2019 were retrospectively analyzed.The number of unqualified samples venous blood in different months and different clinical departments were counted,the unqualified rates of specimens were statistically analyzed and compared,the causes of unqualified venous blood specimens were analyzed and countermeasures were put forward.Results A total of 69290 specimens of venous blood were collected in clinical laboratory from June to November in 2019,of which 227 specimens were unqualified,and the total unqualified rate was 0.33%.The unqualified rate of venous blood specimens increased month by month from July to October in 2019.After analyzing the causes and strengthening the training and lectures for new nurses,the unqualified rate decreased in November.The departments with the most unqualified venous blood samples were department of neonatology(26 samples),intensive care unit(ICU;15 samples)and department of rheumatology(15 samples);the top 3 departments with the highest unqualified rate of venous blood were department of rheumatology[0.50%(15/2987)],department of urology surgery[0.44%(5/1149)]and department of neurosurgery[0.41%(13/3159)].The major causes of venous blood samples were clotted blood specimen,insufficient blood volume,incorrect container type,item duplication and hemolysis.According to the causes of unqualified specimens,corresponding improvement measures were taken to strengthen the training and regular assessment of nursing staff.Conclusion The clinical laboratories should strengthen the contact with the nursing and clinical departments,timely communicate and feedback the situation of unqualified specimens,strictly implement the sample collection specification,ensure the accuracy of collected specimens,and reduce the unqualified rate of venous blood specimens,so as to provide timely and accurate diagnosis basis for clinic.