Annals of Clinical Biochemistry > Volume 45, Number 3 > Pp. 266-269

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Original Articles

Is suboptimal phlebotomy technique impacting on potassium results for primary care?

Ian R Bailey and Vanessa R Thurlow

Department of Chemical Pathology, Princess Royal University Hospital, Farnborough, Kent BR6 8ND, UK

Corresponding author: Ms Vanessa R Thurlow. Email: vanessa.thurlow{at}bromleyhospitals.nhs.uk

Background: Pre-analytical problems causing pseudohyperkalaemia have been highlighted previously. These include transit time and temperature effects when sample collection points are geographically widely spread. Similarly, inappropriate phlebotomy technique (in particular, requesting patients to fist clench to facilitate venesection) is a documented cause of pseudohyperkalaemia, but its incidence may be impossible to establish. This study illustrates how primary care population serum potassium data altered when local phlebotomy clinics optimized their technique.

Methods: The effect of improving phlebotomy was studied by plotting average monthly primary care population serum potassium data and average percentage of samples with hyperkalaemia (5.2 mmol/L or higher) against mean monthly temperature before and after changes in phlebotomy practice. Only samples from primary care were included between 2002 and 2005 inclusive.

Results: Primary care population serum potassium was inversely related to ambient temperature. Following the change in phlebotomy practice, the annual percentage of results above reference range (5.2 mmol/L or higher) was reduced from 9% to 6% and the number of results breaching the upper telephoning threshold (5.8 mmol/L or higher) fell from 0.9% to 0.5%.

Conclusions: Ensuring that phlebotomists were trained to avoid facilitating venesection by requesting patients to hand grip (fist clench), was associated with lower mean serum potassium results for the primary care patient population and a reduced incidence of hyperkalaemia. It is likely that the contribution of patient fist clenching during phlebotomy to pseudohyperkalaemia has been underestimated.

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This article has been cited by other articles:

				R. Gambino, M. Sanfilippo, and L. Lazcano Pseudohyperkalaemia from finger flexion during venepuncture masks true hypokalaemia Ann Clin Biochem, March 1, 2009; 46(2): 177 - 177. [Full Text] [PDF]