Does cleaning of venipuncture site with alcohol affect blood ethanol concentration?

TL;DR

This study finds that using alcohol to clean a blood draw site does not falsely increase blood ethanol levels in patients.

Contribution

The study empirically demonstrates that ethanol-based antiseptics do not affect measured blood ethanol concentrations below legal driving limits.

Findings

No significant difference in blood ethanol concentration was found between alcohol-based and iodine-based site cleaning methods.

Bland-Altman analysis showed a small negative bias with narrow agreement limits between the two techniques.

Ethanol-based antiseptic use does not lead to falsely elevated blood ethanol levels below legal driving limits.

Abstract

It is important to accurately determine the blood ethanol concentration (BEC) to ensure appropriate diagnosis and treatment of patients in the emergency department (ED) and protect their legal rights. This study aimed to determine whether sterilization of venipuncture site with ethanol, which is frequently used in practice in the ED would affect BEC.

Venous blood samples were collected by two consecutive techniques from 94 individuals who were admitted to the ED, had an indication for BEC measurement, and volunteered to participate in the study. The reference technique involved applying 3 cc of 10 % povidone-iodine solution to a gauze pad, cleaning the right arm antecubital region, and performing phlebotomy. The index technique used 3 cc of alcohol-based antiseptic (89 % ethanol) on another gauze for cleaning the left arm antecubital region. Both techniques allowed the antiseptic to air-dry for 30 s before phlebotomy. Two blood sample tubes per patient were sent to the laboratory, and BEC were measured using the alcohol dehydrogenase enzymatic method.

94 patients were included in the study. The mean age was 37.8 years (±15.7), with 77 % (n = 72) of them were male. The median BEC levels measured by both the reference and index techniques were 2 mg/dL (IQR: 0.97–16.25) and 2 mg/dL (IQR: 0.90–15.22), respectively, with no significant statistical difference (p = 0.536). 72 (77 %) of the patients had a BEC level below the legal driving limit of 20 mg/dL. Bland-Altman analysis, performed on these patients, revealed a small negative bias, −0.116 mg/dL with a standard deviation of 1.13 mg/dL. The upper and lower limit of the agreement was 2.092 and −2.323 respectively.

In patients with a BEC level of less than 20 mg/dL, using ethanol-containing antiseptics before blood sampling does not lead to erroneously elevated BEC levels.

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