Labortory sampling (COVID,blood,urine,etc) at home.

Sampling

The same grade, 1C, is accorded to the wearing of gloves during the actual sampling procedure. Applying a tourniquet is a strong recommendation with high quality evidence (1A). Selection of the adequate venepuncture site requires precise anatomical knowledge on the course of the arm veins. The authors consider this a strong recommendation with moderate quality evidence (1B). Equally important, according to the authors, is thorough cleansing of the venepuncture site with 70 percent ethyl alcohol or any other appropriate disinfectant prior to sampling. 

Alcohol drying times and handling of the disinfected site are described in detail. The next steps, puncturing the vein either with the needle or a butterfly, drawing the blood into the first tube and releasing the tourniquet are strong recommendations with high quality evidence (1A). The authors, moreover, consider the order of draw of utmost importance: blood culture tube, citrate tube, plain tube or tube with clot activator, heparin tube, EDTA tube, glycolysis inhibitor tube (NaF or comparable) and other tubes. Another strong recommendation is inversion, 5 to 10 times, of the correctly filled sample tubes. Gentle removal of the needle and correct disposal in adequate containers is a strong recommendation with high quality evidence (1A).

Subsequent treatment of the wound and asking the patient to apply pressure on the puncture site are strong recommendations with low quality evidence (1C).The tubes are inverted four more times, the gloves are removed and discarded. Correct removal of the gloves is considered a strong recommendation with high quality evidence.

Post sampling

After sampling, the patient should be advised to rest for about five minutes or he/she should be monitored by the person who took the sample until the bleeding has stopped. Communication with the patient that concludes the procedure is, according to the authors, a strong recommendation with moderate quality evidence. In a final section the authors discuss the implementation of the guidelines. Here, national laws and regulations which might pose an implementation barrier or challenge have to be considered. In order to successfully implement these guidelines on correct and error-free venous blood sampling a number of measures need to be taken. Staff has to be trained and refresher training has to be offered in regular intervals. Certification and regular recertification of the training as well as the actual performance of the procedure is useful. In the meantime audits are a suitable instrument to ensure long-term quality.

For hospitals, the authors recommend an implementation team with a team leader who is familiar with all national laws, regulations and recommendations and applies them resp. complies with them in the course of the implementation of the „Recommendations on venous blood sampling“.