Low vacuum (3mL) rapid serum tubes offer better protection from hemolysis than plasma separator tubes collected in the emergency department.

Evaluation of the BD vacutainer rapid serum tube on haemolysis markers in the emergency department

Background The Oncology Department at our institution requested faster turn-around times (TAT) for chemistry testing. Prior to their request, serum separator tubes (SST) were collected and tested in our core laboratory. To accommodate the request, we added plasma total bilirubin and aspartate aminotransferase (AST) to our stat laboratory test menu with collection in plasma separator tubes (PST). Upon implementation of this testing change, we observed an increase in specimen recollection rates due to hemolysis. We systematically evaluated laboratory testing variables that could have contributed to the increase: pneumatic tube transport path, differences in hemolysis measurements between chemistry analyzer models, and specimen types. Previous studies have demonstrated that lithium heparin plasma specimens are more susceptible to hemolysis than serum. Likewise, patients undergoing chemotherapy or radiation therapy may have fragile red blood cell (RBC) membranes, further complicating the issue. Our study*s objective was to assess the impact of changing from SST to PST collections. We conducted a 3-month pilot study to determine if we could reduce our recollection rates by collecting/testing Rapid Serum Tube (RST), while maintaining plasma TAT. Methods We compared recollection rates for specimens collected from the oncology patients and tested in our core laboratory (SST, May-June 2021), stat laboratory (PST, September-November 2022), pilot period in stat lab (RST, January-March 2023), and post-pilot period in stat lab (PST, May-July 2023). Data were extracted from our laboratory information system and recollection rates were calculated using Tableau (Salesforce, Inc, San Francisco, CA). Analysis was performed in Excel (Microsoft, Redmond, WA) using Student’s t-test, with p < 0.05 defined as statistically significant. Results SST specimens collected from oncology patients and tested in the core lab (May-June 2021) resulted in a recollection rate of 0.17% (4/2341). PST specimens sent to the stat lab (Sept-Nov 2022) had an increased recollection rate of 0.90% (55/6129, p-value < 0.001). During the pilot period when RST tubes were used (Jan-Mar 2023), our recollection rate decreased to 0.19% (11/5801, p-value 0.014). After the pilot period ended and PST tubes were again utilized for testing (May-July 2023), the recollection rate again increased to 0.34% (22/6500, p-value 0.019). Conclusion Rapid TAT of laboratory results within specialized-care settings, such as a cancer treatment clinic, is necessary to provide patients with the most effective and personalized treatment regimens. Hemolysis presents a challenge as it generates an analytical issue with the release of contents from RBCs that may spuriously affect the concentration of the analyte being measured, delaying result reporting due to the need for specimen recollection. The data from our study highlight the utility of rapid serum tubes. Not only did they achieve stat TAT that was observed with the use of PST, but they also decreased specimen recollection rates that mirror the low rates observed with the use of SST. Thus, this technology may be an excellent replacement for standard SST when specimen integrity is critical to rapidly reporting accurate test results.

Pneumatic Tube Delivery System for Blood Samples Reduces Turnaround Times Without Affecting Sample Quality

Rapid serum tubes reduce transport hemolysis and false positive rates for high-sensitivity troponin T

Head injury is a potentially lethal and frequently occurring condition in the emergency department (ED). Reliable and fast diagnosis is important both for patients and flow in the ED. Circulating S100B is used to rule out the need for head computer tomography in low-risk patients with mild head injury. The flow of these patients through the ED would benefit from shorter turn-around time. Standard serum clotting tubes require 30-60 min clotting time, followed by an analysis time of 45 min. Here, we evaluated the performance of two alternative blood collection tubes; a rapid serum tube (RST) with a recommend clotting time of 5 min and a hirudin tube (HIR) for instant anticoagulation. S100B measurement was performed on paired blood samples from 221 subjects using a Roche Cobas 602 analyser. The performances of the alternative tubes were evaluated by method comparison to the standard serum clotting tube, repeatability and agreement of results obtained from alternative tubes compared with the standard clotting tube. Both alternative tubes had a minor positive bias (RST = 0.011 µg/L, HIR = 0.008 µg/L). The repeatability was 2% for RST and 10% for HIR, while being 4% for the standard clotting tube. In the agreement analysis, the positive and negative predictive values for RST were 62% and 100% while being 73% and 99% for HIR respectively. Our study suggests that RST is a feasible alternative to reduce laboratory turn-around time in S100b analysis.

Effect of blood collection tubes on the incidence of artifactual hyperkalemia on patient samples from an outreach clinic

We evaluated the effects of pneumatic tube system (PTS) transport rates and distances on routine hematology and coagulation analysis. PTS effects on centrifuged blood samples were also examined. The study was completed at Dicle University Hospital, which has the longest pneumatic tube system in Turkey. Blood samples were collected at three different locations within the hospital and an emergency department, and delivered to the central laboratory by the PTS or a human carrier. Samples were transported at different rates and over varying distances. Each specimen's potassium (K) and lactic dehydrogenase (LDH) levels, in both the serum and plasma, were tracked to monitor hemolysis. Measurements of LDH and K were obtained using heparin or citrate. A positive correlation was observed between distance and hemolysis in serum samples transported at 4.2 m/sec, and at 3.1 m/sec for more than 2200 m (r = 0.774 and r = 0.766, respectively). Distance and hemolysis were also correlated in non-centrifuged samples (r = 0.871). The alterations in plasma LDH and K levels at different rates and PTS lengths were not statistically significant. The rate of hemolysis in PTS transported samples, dependent on PTS length and rate, may seriously affect routine tests of non-centrifuged samples.

In recent years, a rapid-clotting serum tube, BD Vacutainer® Rapid Serum Tube (RST™), was introduced to improve turn-around times for serum samples. Previous studies reported reduced concentrations of some markers of haemolysis in RST specimens compared to other serum or plasma samples. We aimed to compare RST to plasma tubes for haemolysis markers in an emergency department (ED) setting, where increased rates of haemolysis are commonly seen. Patients presenting to ED over an eight-day period had an RST, BD Vacutainer® PST™ II (plasma) Tube and BD Vacutainer® Heparin (non-gel, plasma) Tube collected. Blood was drawn from an intravenous cannula, and samples were promptly analysed for haemolysis index, potassium, phosphate, aspartate aminotrasferase (AST), magnesium and lactate dehydrogenase (LD). A total of 347 patient samples were included, and 9.2% of the PST samples were haemolysed. The RST tubes had small increases in all of the haemolysis markers compared to both plasma tubes (P ≤ 0.005), except LD which was lower in the RST group. There were no significant differences in the proportion of results above the upper reference limit between the tubes, except for LD which had a lower proportion in RST samples (P ≤ 0.002). Compared to plasma, RST specimens show small increases in several haemolysis markers, consistent with known differences between serum and plasma, but the proportion of elevated haemolysis markers is similar to plasma. In a setting with a high haemolysis rate such as ED, RST specimens provide a non-inferior sample type for markers of haemolysis.

Hemolysis is frequently reported in samples sent from emergency departments. In our study we aimed to compare the influence of invitro hemolysis on test results and hemolysis ratios of different blood drawing techniques (aspiration method and vacuum filling technique) used to draw blood from intravenous (IV) catheters in Emergency Department. Two techniques (aspiration vs. vacuum filling) used to draw blood into three different tubes (Sarstedt S-Monovette® 4.9 mL Serum Gel tube, BD 5 mL Vacutainer® Rapid Serum Tube (RST), and 5 mL Vacutainer® SST™II tube) and evaluated the effect of the hemolysis index of the sera on the tests analyzed. In the emergency department blood was drawn from 128 consecutive patients into Sarstedt S-Monovette® 4.9 mL Serum Gel tubes using aspiration technique and also into BD 5 mL Vacutainer® Rapid Serum Tubes (RST) and 5 mL Vacutainer® SST™II tubes using vacuum filling technique. All the tests requested from the patients were analyzed on all tubes and the hemolysis index of all the tubes were also evaluated. As a result, the percentage of hemolysis encountered in S-Monovette® vs. SST and S-Monovette® vs. RST was 4.41% vs. 14.71% and 0% vs. 18.97%, respectively (p < 0.001, p < 0.001). In addition to this, the mean values of the test results for each assay in S-Monovette® tubes showed a significant difference when compared to RST and SST (p < 0.01). CKMB and LDH test results found in the tubes filled using the aspiration techniques (S-Monovette®) were statistically significantly lower than the results gathered from the tubes filled using vacuum filling technique (Vacutainer® RST and Vacutainer® SST) (p < 0.001). The test results and HI taken from the aspiration method seemed to be more reliable despite the presence of hemolysis.

BD rapid serum tubes reduce false positive plasma troponin T results on the Roche Cobas e411 analyzer

Many studies have explored how using a pneumatic tube system (PTS) is related to the hemolysis of blood samples, but their conclusions have been inconsistent. This meta-analysis was to clarify whether using a PTS induces the hemolysis of blood samples. The PubMed, Embase, Scopus, CNKI, CqVip, SinoMed and WanFang databases were searched for studies published between January 1970 and August 2019. The primary outcomes were the hemolysis rate and hemolysis index of blood samples after applying a PTS and manual transportation. We estimated the pooled risk ratio (RR) and the standardized mean difference (SMD), using random-effects models. This meta-analysis included 29 studies covering 3121 blood samples. No significant differences were found between the PTS and manual-transportation groups in the hemolysis rate [RR: 0.99, 95% confidence interval (CI): 0.57 to 1.70], hemolysis index (SMD: 0.19, 95% CI: −0.00 to 0.38), or level of potassium (SMD: 0.05, 95% CI: −0.03 to 0.12), alanine aminotransferase (SMD: 0.00, 95% CI: −0.10 to 0.11), or aspartate aminotransferase (SMD: 0.04, 95% CI: −0.08 to 0.17). However, lactate dehydrogenase (LDH) level was significantly higher in the PTS group than in the manual-transportation group (SMD: 0.20, 95% CI: 0.06 to 0.34). Subgroup analysis revealed that the LDH level was clearly higher in the PTS group than in the manual-transportation group only when the PTS speed was ≥6 m/s or when the PTS distance was ≥250 m. According to this meta-analysis, PTSs were associated with alterations in LDH measurements, so it is sensible that each hospital validates and monitors their PTSs.

The most common way to validate a pneumatic tube system is to compare pneumatic tube system-transported blood samples to blood samples carried by hand. The importance of measuring the forces inside the pneumatic tube system has also been emphasized. The aim of this study was to define a validation protocol using a mini data logger (VitalVial, Motryx Inc., Canada) to reduce the need for donor samples in pneumatic tube system validation. As an indicator of the total vibration, the blood samples are exposed to under pneumatic tube system transportation; the area under the curve was determined by a VitalVial for all hospital Tempus600 lines using a five-day validation protocol. Only the three lines with the highest area under the curves were clinically validated by analysing potassium, lactate dehydrogenase and aspartate aminotransferase. A month after pneumatic tube system commissioning, a follow-up on laboratory data was performed. Mean area under the curve of the six lines ranged between 347 and 581. The variability of the area under the curve was between 1.51 and 11.55%. In the laboratory data follow-up, an increase in lactate dehydrogenase haemolysis was seen from the three lines with the highest area under the curve and the emergency department, which was not detected in the clinical validation. When the Tempus600 system was in commission, a higher mean area under the curve was measured. A three-day validation protocol using VitalVials is enough to determine the stability of a Tempus600 system and can greatly reduce the need for donor samples. When in commission, the stability of the pneumatic tube system should be verified and lactate dehydrogenase haemolysis should be routinely checked.

Plasma separator tubes (PSTs) are a variant of lithium heparin blood tube containing a polymer gel, which, when centrifuged, creates a physical barrier between plasma and blood cells. Their use is common in laboratory procedures of reptilian species. This study aimed to determine whether the use of plasma separator tubes impacts plasma biochemistry data in green sea turtles (Chelonia mydas) at time of collection and after 24 hr of contact time with the separator gel after centrifugation at refrigerator temperature. A single blood sample was collected from 42 rehabilitating green sea turtles at the Sea Turtle Healing Center, Brevard Zoo, Melbourne, Florida, USA and divided into one lithium heparin tube [LHT (0 hr)] and two PSTs. After immediate centrifugation of all three tubes, plasma was transferred from the LHT (0 hr) and one PST (0 hr) into tubes without additive. The plasma was left in contact with the separator gel in the second PST (24 hr). After 24 hr of refrigeration, all three plasma aliquots were analyzed for the following 23 analytes: sodium, potassium, chloride, carbon dioxide, calcium, phosphorus, magnesium, iron, total protein, albumin, globulin (calculated), aspartate aminotransferase, alanine aminotransferase, alkaline phosphatase, lactate dehydrogenase, gamma-glutamyltransferase, creatine kinase, glucose, urea nitrogen, creatinine, uric acid, triglyceride, and cholesterol. No statistically significant differences were found for any biochemical analytes between LHT (0 hr), PST (0 hr), and PST (24 hr). The use of PST does not appear to impact routine plasma biochemical analytes in green sea turtles and analytes appear stable in refrigerated plasma for up to 24 hr after centrifugation when using PSTs.

Technologic advances affecting analyzers used in clinical laboratories have changed the methods used to obtain many laboratory measurements, and many novel parameters are now available. The effects of specimen transport through a pneumatic tube system on laboratory results obtained with such modern instruments are unclear. To determine the effects of sample transport through a pneumatic tube system on routine and novel hematology and coagulation parameters obtained on state-of-the-art analyzers. Paired blood samples from 33 healthy volunteers were either hand delivered to the clinical laboratory or transported through a pneumatic tube system. No statistically significant differences were observed for routine complete blood cell count and white cell differential parameters or markers of platelet activation, such as the mean platelet component, or of red cell fragmentation. When 2 donors who reported aspirin intake were excluded from the analysis, there was a statistically, but not clinically, significant impact of transport through the pneumatic tube system on the mean platelet component. There were no statistically significant differences for prothrombin time, activated partial thromboplastin time, waveform slopes for prothrombin time or activated partial thromboplastin time, fibrinogen, or fibrin monomers. Although further study regarding the mean platelet component may be required, transport through a pneumatic tube system has no clinically significant effect on hematology and coagulation results obtained with certain modern instruments in blood samples from healthy volunteers.

The objective of the study was to find the incidence of hemolysis in samples transported through a pneumatic tube system (PTS) at different speeds. This prospective observational study was done in three phases: "short distance and high speed (115 m at 3 m/s)", "long distance and high speed (225 m at 3 m/s)" and "short distance and slow speed (115 at 2 m/s)". Fifty-two, 215 and 45 serum tube pairs, respectively, were evaluated in these three phases. A set of tubes was sent by PTS while the other was hand-carried. Samples were analyzed for supernatant hemoglobin (Hb), potassium (K+) and lactate dehydrogenase (LD). Mean transit time of samples through the PTS was much shorter as compared to human courier in all three phases. LD was elevated in PTS arm in the "short distance and high speed" phase and in the "long distance and high speed" phase, all three indices of hemolysis - Hb, K+ and LD - showed elevation in the PTS arm. However, at "short distance and slow speed" phase, there was no hemolysis in the PTS arm. Hospitals should validate their PTS before use and, by altering speed of sample transportation, hemolysis may be obliterated.