Common Troubles and Handling on IMPROVACUTER® Blood Collection System in Clinical Practice

◆ Common Trouble One in Clinical Practice: Inaccurate Vacuum
Principle for vacuum setting :
Vacuum is pre-designed relatively, its standard test condition is 20℃ ambient temperature, 1 barometric pressure and 0 altitude.  Acceptable vacuum scope is ±10% of the indicated volume (such as,  for 4ml of 13×75 mm tubes, the acceptable vacuum scope is 4±0.4ml, that is 3.6-4.4ml); 
The blood drawn volume varies with altitude, ambient temperature, barometric pressure, tube storage time, individual differences (such as venous pressure, blood viscosity, blood vessel condition and so on), blood collection technique, needle types and so on.
1.Less blood volume or can not take the blood (After successful venipuncture, no blood flows into tube or blood volume is less than the indicated volume). Possible causes: 
1.1The patients are too nervous that the veins contract too much to block the needle point. 
----Smooth the patients and gently turn the winged needle. 
1.2The different physical conditions of the patients, for example,the patients with high blood viscosity. (such as old patients, hyperpyrexia patients, severe burn patients, ct.)
----Choose a needle which is 1# bigger than the transfusion needle if the wound surface can do with it. 
----Select the cardinal vein for venipuncture. 
1.3Improper venipuncture site.(such as thrombosis intensive areas or vascular malformations)
----Turn the venipuncture needle slightly or do the venipuncture again. 
1.4When transfusion blood collection needle is applied, the luer connector of the luer adaptor hasn’t been screwed firmly with the female luer connector of the blood collection set, which results in vacuum lost. (applicable for blood collection set) 
----Screw the luer connector of the luer adaptor with the female luer connector of the blood collection set firmly. 
1.5End-point judgment is not correct, or change succeeding tubes too early. 
----Master end-point judgment properly. 
1.6Needle size is too small, prolonging the time for changing succeeding tubes, thus results in external cruor. 
----Choose a needle which is 1# bigger than the transfusion needle if the wound surface can do with it.
1.7Unsuccessful penetration of tube stopper or incorrect position of the needle cannula into the stopper causing sidewall penetration. 
----Push the needle into the closure vertically. 
1.8Vacuum tube is damaged by external force, causing premature vacuum loss.
----Apply “Three Inspections”and“Seven Checks” before use. 
1.9limitations of system: 
----If the ambient temperature of blood collection is too high, the quantity of blood drawn decreases along with the rise of temperature. 
2. More blood volume.(after successful venipuncture, the blood volume is over indicated volume). Possible causes:
2.1Body position of patients changes during blood collection.
Remarks: different from regular blood collection ways.
----Instruct to adopt correct collection position. 
2.2Patient feels nervous, then vein pressure rises, which will cause over drawing. 
----Smooth the patients. 
2.3Limitation of System: 
---- If the ambient temperature of blood collection is too low, the quantity of blood drawn increases along with the decrease of temperature. 
◆Common Trouble Two in Clinical Practice: Backflow
Precaution: 
1.Place patient’s arms in a downward position. 
2.Hold tube with the stopper uppermost, stopper higher than the bottom. 
3.Release tourniquet as soon as blood starts to flow into tube. 
◆Common Trouble Three in Clinical Practice: Slow Collection:
1.Small needle size is applied for patients with high blood viscosity. (As the inner diameter of venipuncture needle is small.)
----Select appropriate blood collection needle. 
2.Cardinal vein is not chosen for venipuncture. 
----While doing multi-collection, the cardinal vein should be chosen for venipuncture. 
3.Limitation of System: 
----Tubes with smaller draw volume may fill slowly than tubes of the same size with greater draw volume. (such as 4/75 is faster than 1/75.) 
----Needles of smaller size may fill slowly than needles of greater size. (such as : 22G is slower than 21G)
◆Common Trouble Four in Clinical Practice: Blood Splatter:
1.Blood collection is not handled in a routine way.  Improper practice causes blood spraying out from the venipuncture needle after collection of last tube. 
--------Practice Standard Precautions to minimize exposure hazard.  While blood collection set is used, if the end-point judgment is too late, it is recommended to remove the tube stopper needle first, then the intravenous needle or to remove the intravenous needle after folding the upper part of the flexible tube connected with intravenous needle. 
While multi-sample needle is applied, remove tube stopper needle first and then the intravenous needle. 
◆Common Trouble Five in Clinical Practice: Blood Leakage:
1. The rubber sleeve is peeled off. 
-----Practice standard precautions. The rubber sleeve is forbidden to be peeled off during the whole collection. 
2.Tube stopper needle do not penetrate vertically into the closure, which causes no recovery or slow recovery of sleeve. 

----The tube stopper needle should be kept vertical to the closure transect to ensure penetrating from the top of the needle sleeve.