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

Ann Clin Biochem 2008;45:266-269
© 2008 Association for Clinical Biochemistry


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Original Articles

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}

Background: Pre-analytical problems causing pseudohyperkalaemia have beenhighlighted previously. These include transit time and temperatureeffects when sample collection points are geographically widelyspread. Similarly, inappropriate phlebotomy technique (in particular,requesting patients to fist clench to facilitate venesection)is a documented cause of pseudohyperkalaemia, but its incidencemay be impossible to establish. This study illustrates how primarycare population serum potassium data altered when local phlebotomyclinics optimized their technique.

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

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

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

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