1
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Garcia-Castrillo L, Cadamuro J, Dodt C, Lauwaert D, Hachimi-Idrissi S, Van Der Linden C, Bergs J, Costelloe S, Grossmann F, Koca A, Palomäki A, Ruiz JL, Stonys R, Thorsteinsdottir TK, von Meyer A, Vermeersch P, Abellas Alvarez MC, Eker P, Golea A, Kurland L, Lippi G, Zhilenkova Y, Sehmi K. Recommendations for blood sampling in emergency departments from the European Society for Emergency Medicine (EUSEM), European Society for Emergency Nursing (EuSEN), and European Federation of Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for the Preanalytical Phase. Executive summary. Clin Chem Lab Med 2024; 62:1538-1547. [PMID: 38581294 DOI: 10.1515/cclm-2024-0059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Accepted: 01/26/2024] [Indexed: 04/08/2024]
Abstract
AIM Blood Sampling Guidelines have been developed to target European emergency medicine-related professionals involved in the blood sampling process (e.g. physicians, nurses, phlebotomists working in the ED), as well as laboratory physicians and other related professionals. The guidelines population focus on adult patients. The development of these blood sampling guidelines for the ED setting is based on the collaboration of three European scientific societies that have a role to play in the preanalytical phase process: EuSEN, EFLM, and EUSEM. The elaboration of the questions was done using the PICO procedure, literature search and appraisal was based on the GRADE methodology. The final recommendations were reviewed by an international multidisciplinary external review group. RESULTS The document includes the elaborated recommendations for the selected sixteen questions. Three in pre-sampling, eight regarding sampling, three post-sampling, and two focus on quality assurance. In general, the quality of the evidence is very low, and the strength of the recommendation in all the questions has been rated as weak. The working group in four questions elaborate the recommendations, based mainly on group experience, rating as good practice. CONCLUSIONS The multidisciplinary working group was considered one of the major contributors to this guideline. The lack of quality information highlights the need for research in this area of the patient care process. The peculiarities of the emergency medical areas need specific considerations to minimise the possibility of errors in the preanalytical phase.
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Affiliation(s)
- Luis Garcia-Castrillo
- Emergency Department, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Janne Cadamuro
- Department of Laboratory Medicine, Paracelsus Medical University Salzburg, Salzburg, Austria
| | - Christoph Dodt
- Emergency Department, Universitair Ziekenhuis Brussels, Brussels, Belgium
| | - Door Lauwaert
- München Klinik gGmbH, Clinic for Acute and Emergency Care, Munich, Germany
| | - Said Hachimi-Idrissi
- Universiteit Gent Faculteit Geneeskunde en Gezondheidswetenschappen, Emergency Medicine, Gent, Belgium
- Universitair Ziekenhuis Gent, Emergency Medicine, Gent, Belgium
| | | | - Jochen Bergs
- Faculty of Medicine and Life Sciences, Research Group Healthcare & Ethics, Hasselt University, Limburg, Belgium
- Department of Healthcare, PXL University of Applied Sciences and Arts, Hasselt, Netherlands
| | - Sean Costelloe
- Department of Clinical Biochemistry, Cork University Hospital Group, Cork, Ireland
| | | | - Ayca Koca
- Department of Emergency Medicine, Ankara University School of Medicine, Ankara, Türkiye
| | - Ari Palomäki
- Kanta-Häme Central Hospital, Tampere Universities, Hämeenlinna, Finland
| | - Jose Luis Ruiz
- Emergency Department, Hospital Universitario de La Ribera, Valenciana, Spain
| | - Ricardas Stonys
- Center of Laboratory Medicine, Vilnius University Hospital Santaros Klinikos, Vilnius, Lithuania
| | | | | | - Pieter Vermeersch
- KU Leuven University Hospitals Leuven, Laboratory Medicine, Leuven, Belgium
| | | | - Pinar Eker
- Biochemistry and Clinical Biochemistry, Maltepe Universitesi Tip Fakultesi, Istanbul, Türkiye
| | - Adela Golea
- Emergency Department, Cluj-Napoca County Emergency Hospital, Cluj-Napoca, Romania
| | - Lisa Kurland
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Giuseppe Lippi
- Section of Clinical Biochemistry, Universita degli Studi di Verona, Verona, Italy
| | - Yulia Zhilenkova
- Department of Laboratory Medicine and Genetics, Almazov National Medical Research Centre, Sankt-Peterburg, Russia
| | - Kawaldip Sehmi
- International Alliance of Patients' Organizations, London, UK
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2
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Yu J, Zhu G, Cui K, Yu D, Bayartaikishigtai D, Chen Z, Zhou Z. Comparison of the speed and quality of innovative and traditional pneumatic tube system transport outside of an emergency laboratory. Heliyon 2024; 10:e31511. [PMID: 38826741 PMCID: PMC11141344 DOI: 10.1016/j.heliyon.2024.e31511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Revised: 05/13/2024] [Accepted: 05/16/2024] [Indexed: 06/04/2024] Open
Abstract
Background Ensuring the rapidity and accuracy of emergency laboratory test results is especially important to save the lives of patients with acute and critical conditions. To better meet the needs of clinicians and patients, detection efficiency can be improved by reducing extra-laboratory sample turnaround times (TATs) through the use of innovative pneumatic tube system (PTS) transport for sample transport. However, concerns remain regarding the potential compromise of sample quality during PTS transit relative to that occurring with manual transportation. This study was performed to evaluate the efficacy of an innovative PTS (Tempus600 PTS) relative to a traditional PTS in terms of sample transit time, sample quality, and the concordance of analytical results with those obtained from manually transported samples. Methods In total, 30 healthy volunteers aged >18 years were recruited for this study, conducted for five consecutive days. Venous blood samples were collected from six volunteers per day at fixed timepoints. From each volunteer, nine blood samples were collected into tubes with tripotassium ethylene diamine tetraacetic acid anticoagulant, tubes with 3.2 % sodium citrate, and serum tubes with separation gel (n = 3 each) and subjected to all tests conducted in the emergency laboratory in our hospital. 270 blood samples from 30 healthy volunteers were transported and analyzed, yielding 6300 test results. The blood samples were divided randomly into three groups (each containing one tube of each type) and transported to the emergency laboratory manually and with Tempus600 PTS and conventional Swisslog PTS, respectively. The extra-laboratory TATs, sample quality, and test results of the transported blood samples were compared. Results The sample quality and test results did not differ according to the delivery method. The TAT was much shorter with the Tempus600 than with the other two transport modes (58.40 ± 1.52 s vs. 1711.20 ± 77.56 s for manual delivery and 146.60 ± 1.82 s for the Swisslog PTS; P = 0.002). Conclusion Blood sample transport with the Tempus600 PTS significantly reduced the extra-laboratory TAT without compromising sample quality or test result accuracy, thereby improving the efficiency of sample analysis and the services provided to clinicians and patients.
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Affiliation(s)
| | | | - Kai Cui
- Diagnostic Laboratory Service, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Dongze Yu
- Diagnostic Laboratory Service, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Dabuxilite Bayartaikishigtai
- Diagnostic Laboratory Service, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Zixin Chen
- Diagnostic Laboratory Service, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
| | - Zhou Zhou
- Diagnostic Laboratory Service, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
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Chen S, Zang Y, Wang L, Zheng J, Deng H, Li M, Li Y, Qian B, Lu Y. Evaluation of a rail logistics transmission system for the transportation of blood components within a medical centre. Vox Sang 2023; 118:955-965. [PMID: 37673798 DOI: 10.1111/vox.13527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/14/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
BACKGROUND AND OBJECTIVES Rail logistics transmission systems (RLTSs) are commonly used for the transportation of blood samples, pathological specimens and other medical materials in many hospitals, as they are rapid, secure, cost-effective and intelligent. However, few studies have evaluated blood component transportation from blood banks to the patient care areas of hospitals using RLTS. In this study, we evaluate the RLTS used for the transportation of blood components within a medical centre. MATERIALS AND METHODS The dispatch of blood components, including packed red blood cells (pRBCs), fresh frozen plasma (FFP), cryoprecipitate and platelet units, from a blood bank to critical care areas or general wards was done using RLTS. Parameters such as the delivery time, temperature, physical integrity and blood component quality were evaluated via analytical testing using specimens obtained before and after transportation by RLTS. RESULTS The turnaround time and temperature of all tested blood units via RLTS transportation were able to meet the clinical demands of blood component delivery (median time: 323 s [118-668 s]; temperature variation: 4.5-8.9°C for pRBCs and FFP and 21.5-23.5°C for cryoprecipitate and platelet units). Furthermore, parameters of pRBC quality, including the haemolysis index and potassium and lactate dehydrogenase levels in plasma, were not significantly different before and after transportation through RLTS. Similarly, RLTS transportation affected neither the basic coagulation test results in FFP and cryoprecipitate specimens nor platelet aggregation and activation markers in apheresis platelet specimens. CONCLUSION Hospital-wide delivery of blood components via RLTS seems to be safe, reliable and cost-effective and does not have any negative impact on blood quality. Therefore, the establishment of standard criteria, protocols and guidelines based on further studies is needed.
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Affiliation(s)
- Shaoheng Chen
- Department of Blood Transfusion, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yan Zang
- Department of Blood Transfusion, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Lili Wang
- Department of Blood Transfusion, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jun Zheng
- Department of Blood Transfusion, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Huimin Deng
- Department of Blood Transfusion, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Meiting Li
- Department of Blood Transfusion, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yaohua Li
- Department of Blood Transfusion, The First Affiliated Hospital of Naval Medical University, Shanghai, China
| | - Baohua Qian
- Department of Laboratory Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuanshan Lu
- Department of Blood Transfusion, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Bowen RAR, Esguerra V, Arboleda E, Cheng P, Hu B. Impact of blood collection devices and mode of transportation on peripheral venous blood gas parameters. Clin Chim Acta 2023; 548:117464. [PMID: 37399883 DOI: 10.1016/j.cca.2023.117464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 06/05/2023] [Accepted: 06/28/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Peripheral venous blood (PVB) gas analysis has become an alternative to arterial blood gas (BG) analysis in assessing acid-base balance. This study aimed to compare the effects of blood collection devices and modes of transportation on peripheral venous BG parameters. METHODS PVB-paired specimens were collected from 40 healthy volunteers into blood gas syringes (BGS) and blood collection tubes (BCT), transported by either a pneumatic tube system (PTS) or human courier (HC) to the clinical laboratory, and compared using a two-way ANOVA or Wilcoxon signed-rank test. To determine clinical significance, the PTS and HC-transported BGS and BCT biases were compared to the total allowable error (TEA). RESULTS PVB partial pressure of oxygen (pO2), fractional oxyhemoglobin (FO2Hb), fractional deoxyhemoglobin (FHHb), and oxygen saturation (sO2) showed statistically significant differences between BGS and BCT (p < 0.0001). Compared to HC-transported BGS and BCT, statistically significant increases in pO2, FO2Hb, sO2, oxygen content (only in BCT) (all p < 0.0001), and base excess extracellular (only in BCT; p < 0.0014) concentrations and a statistically significant decrease in FHHb concentration (p < 0.0001) were found in BGS and BCT delivered by PTS. The biases between PTS- and HC-transported BGS and BCT exceeded the TEA for many BG parameters. CONCLUSIONS Collecting PVB in BCT is unsuitable for pO2, sO2, FO2Hb, FHHb, and oxygen content determinations.
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Affiliation(s)
- Raffick A R Bowen
- Department of Pathology, Stanford Health Care, Stanford, CA 94305, United States.
| | - Vanessa Esguerra
- Stanford Hospital and Clinics, Stanford, CA 94305, United States
| | | | - Phil Cheng
- Stanford Hospital and Clinics, Stanford, CA 94305, United States
| | - Bing Hu
- Stanford Hospital and Clinics, Stanford, CA 94305, United States
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5
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Yang RX, Qiu SJ, Song WJ, Zhang H, Zhang BF, Xu HG. Effects of centrifugation prior to pneumatic tube system transport on routine biochemical and immunological tests of susceptibility to hemolysis. Clin Chim Acta 2023; 541:117242. [PMID: 36739074 DOI: 10.1016/j.cca.2023.117242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Revised: 01/09/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pneumatic tube system (PTS) may be associated with preanalytical hemolysis. The objective of this study was to evaluate the effects of PTS on biochemical and immunological tests susceptible to hemolysis and try to find ways to reduce the result bias caused by PTS. METHODS Laboratory parameters were compared between PTS without centrifuging group, PTS after centrifuging group, PTS with serum group, and hand-delivered (HD) group. Studies were performed to access the influence of different PTS transport frequencies on laboratory assays. RESULTS PTS transportation resulted in obviously increase in LDH (lactate dehydrogenase) and NSE (neuron-specific enolase) results (LDH: Bias = 17.95%, 95% confidence interval (CI) = -3.13-39.02; p < 0.001; NSE: Bias = 64.26%, 95% CI = -21.29-149.82; p < 0.001; respectively). After pre-centrifugation, no statistical difference was observed in LDH results (Bias = 2.83%, 95% CI = -13.00-18.65; p = 0.737). However, the bias of NSE still reach 19.16% (95% CI = -41.78-80.11), which exceeded the clinical acceptable range (p = 0.017). Both LDH(p = 0.931) and NSE(p > 0.999) show no statistical difference between PTS with serum group and HD group (LDH: Bias = -1.60%, 95% CI = -6.00-2.81; NSE: Bias = -3.68%, 95% CI = -11.35-3.99). CONCLUSION PTS can lead to falsely increased LDH and NSE test results. Only loading the centrifuged upper serum in new tubes during PTS transport can eliminate the results bias of NSE.
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Affiliation(s)
- Rui-Xia Yang
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, Jiangsu, China
| | - Si-Jie Qiu
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, Jiangsu, China
| | - Wei-Juan Song
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, Jiangsu, China
| | - Hui Zhang
- Department of Laboratory Medicine, Liyang People's Hospital, Liyang, Jiangsu, China
| | - Bing-Feng Zhang
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, Jiangsu, China.
| | - Hua-Guo Xu
- Department of Laboratory Medicine, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China; Branch of National Clinical Research Center for Laboratory Medicine, Nanjing, Jiangsu, China.
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6
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Kumari S, Kumar S, Bharti N, Shekhar R. Impact of Pneumatic Transport System on Preanalytical Phase Affecting Clinical Biochemistry Results. J Lab Physicians 2022; 15:48-55. [PMID: 37064988 PMCID: PMC10104724 DOI: 10.1055/s-0042-1750077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022] Open
Abstract
Abstract
Introduction PTS (pneumatic transport system) is extensively being used in modern hospitals for rapid transportation of blood samples and other specimens. However, it has a potential impact on blood components, which should be investigated and nullified accordingly. This study was part of a correction program aimed at reducing hemolysis. It was done by comparing paired samples transported manually and by PTS.
Materials and Methods This study was initiated to monitor the impact of PTS on hemolysis of clinical biochemistry blood samples. It was performed in two phases—before and after the corrective action taken. Phase I: done after PTS installation but before the corrective action was taken. Duplicate samples from 100 healthy individuals were collected, one set transported by PTS and the other by human carriers. Both sets were assessed for 25 biochemistry analytes, hemolysis index (HI), and acceleration profiles using a data logger. Corrective measures were then taken, followed by phase II of the study. In phase II, the sample size and study design remained the same as phase I. All the test results of PTS and hand-carried samples were statistically analyzed for any significant difference.
Result In phase I, all the hemolysis-manifesting parameters, LDH (lactate dehydrogenase), potassium, AST (aspartate transaminase), and phosphorus, were raised in PTS samples as compared with the manual samples. Their differences were significant as the p-values were 0.001, 0.000, 0.025, and 0.047, respectively. The differences for LDH and potassium were clinically significant as well. HI (9%) and peak acceleration (15.7 g) were high in PTS samples.In phase II, no statistically significant difference between paired samples was found for all biochemistry parameters except for a few which were clinically nonsignificant. For PTS samples, HI was 2.5% and the peak acceleration was 11.2 g, whereas for manual samples, HI was 2%.
Conclusion Evidence of hemolysis was found in PTS samples as compared with handheld samples, which was resolved after several corrective actions were taken. Thereafter, PTS became reliable for sample delivery in a routine biochemistry laboratory. Hence, each hospital should scrutinize their PTS for its effects on sample integrity to get rid of PTS-induced preanalytical errors.
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Affiliation(s)
- Sweta Kumari
- Biochemistry Department, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India
| | - Santosh Kumar
- Biochemistry Department, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India
| | - Neha Bharti
- Biochemistry Department, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India
| | - Ravi Shekhar
- Biochemistry Department, Indira Gandhi Institute of Medical Sciences, Sheikhpura, Patna, Bihar, India
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7
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Märtens CM, Schöpfel J, Bollmann S, Hannemann A, Zylla S, Dahl MB, Gauß F, Schedl J, Nauck M, Petersmann A. Evaluation of a pneumatic tube system carrier prototype with fixing mechanism allowing for automated unloading. Clin Chem Lab Med 2022; 60:1202-1210. [PMID: 35635785 DOI: 10.1515/cclm-2022-0193] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 05/20/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES A carrier prototype by Aerocom® (Schwäbisch Gmünd, Germany) for pneumatic tube systems (PTS) is able to transport 9 blood tubes which are automatically fixed by closing the lid. In this study, we examined the influence of the transport on blood sample quality using the carrier prototype comparing to courier transport and a conventional carrier (AD160, Aerocom®). METHODS Triplicate blood samples sets (1 lithium heparin, 1 EDTA, 1 sodium citrate) of 35 probands were split among the transportation methods: 1. courier, 2. conventional carrier, and 3. carrier prototype. After transport 51 measurands from clinical chemistry, hematology and coagulation were measured and compared. RESULTS Overall, 49 of the investigated 51 measurands showed a good concordance among the three transport types, especially between the conventional carrier and the carrier prototype. Focusing on well-known hemolysis sensitive measurands, potassium showed no statistically significant differences. However, between courier and both carrier types lactate dehydrogenase (LDH) and free hemoglobin (fHb) showed statistically significant shifts, whereas the clinical impact of the identified differences was neglectable. The median concentration of fHb, for example, was 0.29 g/L (18 µmol/L), 0.31 g/L (19 µmol/L) and 0.32 g/L (20 µmol/L) for courier transport, conventional carrier and carrier prototype, respectively. These differences cannot be resolved analytically since the minimal difference (MD) for fHb is 0.052 g/L (3.23 µmol/L), at this concentration. CONCLUSIONS The carrier prototype by Aerocom® is suitable for transportation of diagnostic blood samples. The overall workflow is improved by decreasing hands-on-time on the ward and laboratory while minimizing the risk of incorrectly packed carriers.
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Affiliation(s)
- Cora M Märtens
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Juliane Schöpfel
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Stefan Bollmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Anke Hannemann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Stephanie Zylla
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Mathilde Borg Dahl
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Friederike Gauß
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany
| | - Josef Schedl
- Technical Department, University Medicine Greifswald, Greifswald, Germany
| | - Matthias Nauck
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald, University Medicine Greifswald, Greifswald, Germany
| | - Astrid Petersmann
- Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Greifswald, Greifswald, Germany.,Institute of Clinical Chemistry and Laboratory Medicine, University Medicine Oldenburg, Oldenburg, Germany
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8
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Yurt EF, Akbiyik F, Bicer C. Investigation of the effects of pneumatic tube transport system on routine biochemistry, hematology, and coagulation tests in Ankara City Hospital. Clin Chem Lab Med 2022; 60:707-713. [PMID: 35167733 DOI: 10.1515/cclm-2021-1235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Accepted: 02/02/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Academics are far from a consensus regarding the effects of pneumatic tube system (PTS) delivery on sample integrity and laboratory test results. As for the reasons for conflicting opinions, each PTS is uniquely designed, sample tubes and patient characteristics differ among studies. This study aims to validate the PTS utilized in Ankara City Hospital for routine chemistry, coagulation, and hematology tests by comparing samples delivered via PTS and porter. METHODS The study comprises 50 healthy volunteers. Blood samples were drawn into three biochemistry, two coagulation, and two hemogram tubes from each participant. Each of the duplicate samples was transferred to the emergency laboratory via Swiss log PTS (aka PTS-immediately) or by a porter. The last of the biochemistry tubes were delivered via the PTS, upon completion of coagulation of the blood (aka PTS-after). The results of the analysis in these groups were compared with multiple statistical analyses. RESULTS The study did not reveal any correlation between the PTS and serum hemolysis index. There were statistically significant differences in several biochemistry tests. However, none of them reached the clinical significance threshold. Basophil and large unidentified cell (LUC) tests had poor correlations (r=0.47 and r=0.60; respectively) and reached clinical significance threshold (the average percentages of bias, 10.2%, and 15.4%, respectively). The remainder of the hematology and coagulation parameters did not reach clinical significance level either. CONCLUSIONS The modern PTS validated in this study is safe for sample transportation for routine chemistry, coagulation, and hematology tests frequently requested in healthy individuals except for basophil and LUC.
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Affiliation(s)
- Emine F Yurt
- Medical Biochemistry, Adilcevaz Oncology Hospital, Bitlis, Turkey
| | - Filiz Akbiyik
- Medical Biochemistry, Siemens Healthineers, Ankara City Hospital, Ankara, Turkey
| | - Cemile Bicer
- Medical Biochemistry, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
- Medical Biochemistry, Ankara City Hospital, Ankara, Turkey
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9
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Reichert L, Wallner S, Burkhardt R, Offner R, Ahrens N, Hähnel V. Triple apheresis platelet concentrate quality after pneumatic tube system, conveyor box, and courier transport: An observational study. Health Sci Rep 2022; 5:e596. [PMID: 35425867 PMCID: PMC8989271 DOI: 10.1002/hsr2.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/10/2022] Open
Affiliation(s)
- Lena Reichert
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| | - Stefan Wallner
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| | - Ralph Burkhardt
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| | - Robert Offner
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
| | - Norbert Ahrens
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
- MVZ for Laboratory Medicine Raubling, amedes Labor Raubling Germany
| | - Viola Hähnel
- Institute for Clinical Chemistry and Laboratory Medicine University Hospital Regensburg Regensburg Germany
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10
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Frater JL. Comments regarding "The accuracy of mean corpuscular volume guided anaemia classification in primary care" by Schop et al. (Family Practice, 2021, 1-5, doi:10.1093/fampra/cmab034) and the problem of laboratory error in red blood cell mean corpuscular volume. Fam Pract 2021; 38:852-854. [PMID: 34617119 DOI: 10.1093/fampra/cmab132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- John L Frater
- Department of Pathology and Immunology, Washington University School of Medicine, St. Louis, MO, United States
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11
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Buntsma NC, Gąsecka A, Roos YBWEM, van Leeuwen TG, van der Pol E, Nieuwland R. EDTA stabilizes the concentration of platelet-derived extracellular vesicles during blood collection and handling. Platelets 2021; 33:764-771. [PMID: 34697987 DOI: 10.1080/09537104.2021.1991569] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Citrate is the recommended anticoagulant for studies on plasma extracellular vesicles (EVs). Because citrate incompletely blocks platelet activation and the release of platelet-derived EVs, we compared EDTA and citrate in that regard. Blood from healthy individuals (n = 7) was collected and incubated with thrombin receptor-activating peptide-6 (TRAP-6) to activate platelets, subjected to pneumatic tube transportation (n = 6), a freeze-thaw cycle (n = 10), and stored before plasma preparation (n = 6). Concentrations of EVs from platelets (CD61+), activated platelets (P-selectin+), erythrocytes (CD235a+), and leukocytes (CD45+) were measured by flow cytometry. Concentrations of EVs from platelets and activated platelets increased 1.4-fold and 1.9-fold in EDTA blood upon platelet activation, and 4.2-fold and 9.6-fold in citrate blood. Platelet EV concentrations were unaffected by pneumatic tube transport in EDTA blood but increased in citrate blood, and EV concentrations of erythrocytes and leukocytes were comparable. The stability of EVs during a freeze-thaw cycle was comparable for both anticoagulants. Finally, the concentration of platelet EVs was stable during storage of EDTA blood for six hours, whereas this concentration increased 1.5-fold for citrate blood. Thus, EDTA improves the robustness of studies on plasma EVs.
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Affiliation(s)
- Naomi C Buntsma
- Department of Neurology, Amsterdam UMC, University of Amsterdam, The Netherlands.,Biomedical Engineering & Physics, Amsterdam UMC, University of Amsterdam, The Netherlands.,Vesicle Observation Centre, and Laboratory of Experimental Clinical Chemistry, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Aleksandra Gąsecka
- Vesicle Observation Centre, and Laboratory of Experimental Clinical Chemistry, Amsterdam UMC, University of Amsterdam, The Netherlands.,1st Chair and Department of Cardiology, Medical University of Warsaw, Warsaw Poland
| | - Yvo B W E M Roos
- Department of Neurology, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Ton G van Leeuwen
- Biomedical Engineering & Physics, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Edwin van der Pol
- Biomedical Engineering & Physics, Amsterdam UMC, University of Amsterdam, The Netherlands.,Vesicle Observation Centre, and Laboratory of Experimental Clinical Chemistry, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Rienk Nieuwland
- Biomedical Engineering & Physics, Amsterdam UMC, University of Amsterdam, The Netherlands.,Vesicle Observation Centre, and Laboratory of Experimental Clinical Chemistry, Amsterdam UMC, University of Amsterdam, The Netherlands
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12
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Roginski E, Nissen PH, Hojbjerg JA, Grove EL, Hvas AM. Impact of centrifugation time and pneumatic tube transport on plasma concentrations of direct oral anticoagulants. Int J Lab Hematol 2021; 44:216-222. [PMID: 34638165 DOI: 10.1111/ijlh.13729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 08/09/2021] [Accepted: 09/23/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Rapid results are needed when plasma concentrations of direct oral anticoagulants (DOACs) are required in acute clinical settings. We evaluated the impact of centrifugation time and pneumatic tube transport on DOAC plasma concentrations with the overall aim of reducing turnaround time. METHODS Blood samples were spiked with rivaroxaban, apixaban or dabigatran in a low and a high concentration prior to centrifugation for 25 minutes (3163 g) or 5 minutes (3000 g) (n = 20 for each DOAC). Both samples spiked with DOACs (n = 20 for each DOAC) and patient samples (n = 25 in total) were transported manually or by pneumatic tube system samples. RESULTS For samples spiked with DOAC, statistically significant differences in DOAC plasma concentrations were found between centrifugation times for rivaroxaban in low (P < .05) and high (P < .05) concentrations. Relative bias was below 9% for all DOACs. Statistically significant differences were found between modes of transportation for rivaroxaban (P < .01) and dabigatran (P < .01) in high concentrations. Relative bias was 4%-23% for all DOACs. For patient samples, no statistically significant differences were found between modes of transportation, and relative bias was below 12% for all DOACs. CONCLUSION Minor, clinically insignificant, differences regarding centrifugation times were found in DOAC plasma concentrations. Importantly, no significant differences were found according to transportation modes for samples collected from patients. Although statistically significant differences were found depending on mode of transportation of spiked samples, relative bias was clinically acceptable. Thus, reduced centrifugation time and pneumatic tube transport should be considered to reduce turnaround time for rapid measurement of DOAC plasma concentrations.
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Affiliation(s)
- Emma Roginski
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Peter H Nissen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | | | - Erik Lerkevang Grove
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.,Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
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13
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Ding X, Wen X, Wang L, Chen T, Zhou G, He H, Xin X. Effects of a pneumatic tube system on the hemolysis of blood samples: a PRISMA-compliant meta-analysis. Scandinavian Journal of Clinical and Laboratory Investigation 2021; 81:343-352. [PMID: 34109899 DOI: 10.1080/00365513.2021.1930140] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Xuemei Ding
- Nursing Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.,Department of Nursing, Binzhou Medical College, Yantai, China
| | - Xiulin Wen
- Nursing Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Liying Wang
- Department of Nursing, Medical College of Yan'an University, Yan'an, China
| | - Ting Chen
- Department of Nursing, Medical College of Yan'an University, Yan'an, China
| | - Guangxia Zhou
- Nursing Department, Xi'an Fourth Hospital, Xi'an, Shanxi, China
| | - Hairong He
- Clinical Research Center, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Xia Xin
- Nursing Department, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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14
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Does the number of plasma separator tube inversions alter clinical chemistry and immunoassay test results on a Roche Cobas 8000 clinical chemistry platform? Clin Chim Acta 2020; 515:37-41. [PMID: 33388305 DOI: 10.1016/j.cca.2020.12.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/28/2020] [Indexed: 11/23/2022]
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15
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Piskunov DP, Danilova LA, Pushkin AS, Rukavishnikova SA. Influence of exogenous and endogenous factors on the quality of the preanalytical stage of laboratory tests (review of literature). Klin Lab Diagn 2020; 65:778-784. [PMID: 33373510 DOI: 10.18821/0869-2084-2020-65-12-778-784] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
A literature review in the article presents an analysis of the influence of endogenous and exogenous factors on quality of preanalytical phase of laboratory testing. The review shows significance of external and internal factors influencing blood samples at preanalytical phase of laboratory testing. Among the exogenous factors considered: phlebotomy, test tubes for samples, transportation and storage. A number of factors exist at this phase that significantly affect test results. We examined these aspects of phlebotomy process: staff training, disinfectant contamination, needle diameter, needle material contamination. The review considers possible contamination with tube components and the importance of choosing the right anticoagulants and excipients. Transportation and storage of biological samples can be a source of errors at the preanalytical phase of laboratory testing. We analyzed the problem of determining the stability of analytes during storage and aspects of transportation samples by modern means. Among the endogenous factors considered: hemolysis, lipemia, icterricity, cell metabolism.. Hemolysis is one of the most frequent consequences of errors at the preanalytical phase. We analyzed importance of choosing a method for identifying hemolized tubes and the heterogeneity of bias results on different analytical systems. The review shows contribution of various classes of lipoproteins to turbidity of sample, possible preanalytical errors and impact on analytical tests. We examined possible effects of high bilirubin concentrations on analyte measurements. In the review, we also examined metabolism of some cells and its effect on samples.
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Affiliation(s)
- D P Piskunov
- Saint-Petersburg State Pediatric Medical University.,«City Multiprofile Hospital № 2»
| | - L A Danilova
- Saint-Petersburg State Pediatric Medical University
| | - A S Pushkin
- Pavlov First Saint-Petersburg State Medical University.,«City Multiprofile Hospital № 2»
| | - S A Rukavishnikova
- Pavlov First Saint-Petersburg State Medical University.,«City Multiprofile Hospital № 2»
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16
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Wang H, Wang L, Liang H, Wei J, Wu Y, Wang X, Xu J. Falsely decreased FVIII activity following pneumatic tube transport. Int J Lab Hematol 2020; 43:305-310. [PMID: 33058454 DOI: 10.1111/ijlh.13363] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 09/04/2020] [Accepted: 09/23/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The pneumatic tube system (PTS) is widely used for sample delivery. We aimed to investigate the impacts of PTS on hemostasis assays. METHODS Triplicate samples from 30 healthy volunteers were delivered to the core laboratory manually by human courier or via the 500 m long-distance PTS or via the 1000 m long-distance PTS. Comparisons of 19 hemostasis tests were conducted. RESULTS Although PT, INR, APTT, FII, FV, FVII FIX, FX, FXII, DD, α2-PI, and PC had statistical significance (all P < .05), all had low average bias remaining within clinical acceptable limits. PTS transportation only resulted in a statistically significant and clinically relevant decrease in FVIII activity. In the 500 m-PTS group, 66.7% (20/30) of samples for FVIII testing had a bias greater than 8.3%. Moreover, in the 1000 m-PTS group, 96.7% (29/30) of samples had a bias of over 8.3%, and the maximal bias achieved 42.1%. CONCLUSIONS Pneumatic tube system in our institution could be used to deliver blood samples for hemostasis tests evaluated in this study except FVIII activity assay.
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Affiliation(s)
- Hong Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,National Key Clinical Department of Laboratory Medicine, Nanjing, China
| | - Lin Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,National Key Clinical Department of Laboratory Medicine, Nanjing, China
| | - Hanyu Liang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,National Key Clinical Department of Laboratory Medicine, Nanjing, China
| | - Jia Wei
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yining Wu
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xueying Wang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Jian Xu
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.,National Key Clinical Department of Laboratory Medicine, Nanjing, China
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17
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Singh A, Pradhan S, Ravi P, Dhale S. Application of six sigma and 5 S to improve medication turnaround time. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1757873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Ankit Singh
- Symbiosis Institute of Health Sciences, Symbiosis International (Deemed University), Pune, India
| | | | | | - Srikrishna Dhale
- Symbiosis Institute of Health Sciences, Symbiosis International (Deemed University), Pune, India
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18
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Gils C, Broell F, Vinholt PJ, Nielsen C, Nybo M. Use of clinical data and acceleration profiles to validate pneumatic transportation systems. ACTA ACUST UNITED AC 2019; 58:560-568. [PMID: 31804954 DOI: 10.1515/cclm-2019-0881] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Accepted: 11/03/2019] [Indexed: 11/15/2022]
Abstract
Abstract
Background
Modern pneumatic transportation systems (PTSs) are widely used in hospitals for rapid blood sample transportation. The use of PTS may affect sample integrity. Impact on sample integrity in relation to hemolysis and platelet assays was investigated and also, we wish to outline a process-based and outcome-based validation model for this preanalytical component.
Methods
The effect of PTS was evaluated by drawing duplicate blood samples from healthy volunteers, one sent by PTS and the other transported manually to the core laboratory. Markers of hemolysis (potassium, lactate dehydrogenase [LD] and hemolysis index [HI]) and platelet function and activation were assessed. Historic laboratory test results of hemolysis markers measured before and after implementation of PTS were compared. Furthermore, acceleration profiles during PTS and manual transportation were obtained from a mini g logger in a sample tube.
Results
Hand-carried samples experienced a maximum peak acceleration of 5 g, while peaks at almost 15 g were observed for PTS. No differences were detected in results of potassium, LD, platelet function and activation between PTS and manual transport. Using past laboratory data, differences in potassium and LD significantly differed before and after PTS installation for all three lines evaluated. However, these estimated differences were not clinically significant.
Conclusions
In this study, we found no evidence of PTS-induced hemolysis or impact on platelet function or activation assays. Further, we did not find any clinically significant changes indicating an acceleration-dependent impact on blood sample quality. Quality assurance of PTS can be performed by surveilling outcome markers such as HI, potassium and LD.
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Affiliation(s)
- Charlotte Gils
- Department of Clinical Biochemistry and Pharmacology , Odense University Hospital , Odense C , Denmark
- Clinical Institute , University of Southern Denmark , Odense , Denmark
| | | | - Pernille J. Vinholt
- Department of Clinical Biochemistry and Pharmacology , Odense University Hospital , Odense C , Denmark
- Clinical Institute , University of Southern Denmark , Odense , Denmark
| | - Christian Nielsen
- Department of Clinical Immunology , Odense University Hospital , Odense , Denmark
| | - Mads Nybo
- Clinical Institute , University of Southern Denmark , Odense , Denmark
- Department of Clinical Diagnostics , Hospital of South West Jutland , Esbjerg , Denmark
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19
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Chay JWM, Kim JH, B M Taha NS, Chiew SH, Chin KW, Lim SH, Ho LP. Urgent Delivery - Validation and Operational Implementation of Urgent Blood Delivery by Modern High Speed Hospital Pneumatic Tube System to Support Bleeding Emergencies Within a Hospital Massive Transfusion Protocol. Lab Med 2019; 50:e59-e69. [PMID: 31051501 DOI: 10.1093/labmed/lmz012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Timely blood delivery to patients with critical bleeding poses logistic challenges. A modern, high speed hospital pneumatic tube system (PTS) is one solution, but blood units may be subjected to high-speed torque and acceleration/deceleration forces. OBJECTIVE To validate a new PTS system for potential use at our 1,400-bed hospital in Singapore. METHOD Our validation included red blood cells, platelets, thawed plasma, and cryoprecipitate units transported from the blood bank for a distance of 820 meters (PTS track), at a velocity of 3-6 meters per second. Transit time, temperature, bag integrity, and blood quality were assessed visually and through analytical testing on pre- and post-PTS specimens. RESULTS Blood units arrived physically intact in less than 8 minutes. The temperature for each was within the acceptable range. Comparative testing of pre-PTS and post-PTS specimens showed no significant difference in physical quality and analyzed parameters (P> .05). CONCLUSIONS High speed PTS transportation of blood components has satisfactory fidelity and speed, without significant impact on quality. As a result, we incorporated PTS blood delivery into the hospital massive-transfusion protocol and successfully operationalized that new system.
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Affiliation(s)
- Jason Wai Mun Chay
- Department of Pathology and Laboratory Medicine, Sengkang General Hospital, Singapore
| | - Ji Hyun Kim
- Department of Pathology and Laboratory Medicine, Sengkang General Hospital, Singapore
| | - Nur Shahirah B M Taha
- Department of Pathology and Laboratory Medicine, Sengkang General Hospital, Singapore
| | - Siew Hong Chiew
- Department of Pathology and Laboratory Medicine, Sengkang General Hospital, Singapore
| | - Kwong Weng Chin
- Department of Pathology and Laboratory Medicine, Sengkang General Hospital, Singapore
| | - Shu Hong Lim
- Department of Pathology and Laboratory Medicine, Sengkang General Hospital, Singapore
| | - Liam Pock Ho
- Department of Pathology and Laboratory Medicine, Singapore General Hospital, Singapore.,Department of Pathology and Laboratory Medicine, Sengkang General Hospital, Singapore
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20
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Pai S, Frater JL. Quality management and accreditation in laboratory hematology: Perspectives from India. Int J Lab Hematol 2019; 41 Suppl 1:177-183. [PMID: 31069974 DOI: 10.1111/ijlh.13017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/04/2019] [Accepted: 03/06/2019] [Indexed: 11/29/2022]
Abstract
Quality management (QM), including quality assurance and quality control, was developed in clinical laboratories in North America and Western Europe, but must be implemented worldwide to ensure accurate, reproducible, and clinically useful results. India, a middle income country with a population of over 1.34 billion, has limited budget allotted to health care. As yet accreditation for clinical laboratories is not mandatory, which contributes to challenges in implementing good laboratory practice. This review provides a summary of internationally laid down QM principles and their application in a middle income country like India.
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Affiliation(s)
| | - John L Frater
- Department of Pathology and Immunology, Washington University, St. Louis, Missouri
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21
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Tang J, Fullarton R, Samson SL, Chen Y. Delayed cord clamping does not affect umbilical cord blood gas analysis. Arch Gynecol Obstet 2019; 299:719-724. [PMID: 30656440 DOI: 10.1007/s00404-019-05048-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 01/05/2019] [Indexed: 11/29/2022]
Abstract
BACKGROUND Although delayed umbilical cord clamping has been shown to have significant benefits for both term and preterm infants, currently, data on its impact on blood gas analysis have been scant and conflicting. METHODS In a retrospective review, we compared the demographic characteristics and blood gas parameters of 114 delayed cord clamping (DCC-births between 45 and 90 s in length; 109 being for 60 s) versus 407 early cord clamping births (ECC-immediately after delivery) collected over a 1-year period. Intrapartum care and timing of cord clamping for individual cases were performed at the discretion of obstetricians. The differences were assessed for statistical and clinical significance. RESULTS The DCC group was found to have significantly higher mean Apgar scores at both 1 and 5 min (p < 0.05), as well as lower percentages of nulliparous births, cesarean-section deliveries, epidural anesthesia usage, and major pregnancy-related complications. No significant differences in maternal age, gestational age, neonate birthweight, sex, or in the presence of meconium at birth were observed. A higher umbilical artery pO2 in the DCC group [21 (9) vs. 19 (10) mmHg, p < 0.05] was the only statistically significant difference found out of all the blood gas parameters analyzed. CONCLUSIONS In this study, infants selected for the DCC procedure were found to be overall lower risk than those delivered as per the standard ECC procedure. No clinically significant difference in any blood gas parameter was observed, and therefore, no adjustment to clinical reference intervals is needed for DCC blood gas samples taken after a 1-min delay period.
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Affiliation(s)
- Jiachen Tang
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, NB, E3B 5N5, Canada.,Faculty of Science, University of New Brunswick, Fredericton, NB, Canada
| | - Rachel Fullarton
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, NB, E3B 5N5, Canada
| | - Sheri-Lee Samson
- Department of Obstetrics and Gynecology, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, NB, Canada.,Department of Obstetrics and Gynecology, Dalhousie University, Halifax, NS, Canada
| | - Yu Chen
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, NB, E3B 5N5, Canada. .,Department of Pathology, Dalhousie University, Halifax, NS, Canada.
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22
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Guibourg B, Marcorelles P, Uguen A. Validation of a pneumatic tube system to transport surgical pathology biopsy samples. Clin Chem Lab Med 2018; 56:99-100. [PMID: 29095698 DOI: 10.1515/cclm-2017-0883] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2017] [Accepted: 10/04/2017] [Indexed: 11/15/2022]
Affiliation(s)
- Briac Guibourg
- Department of Pathology, University Hospital Morvan, Brest, France
| | - Pascale Marcorelles
- Department of Pathology, University Hospital Morvan, Brest, France.,European University of Brittany, Brest, France
| | - Arnaud Uguen
- Department of Pathology, University Hospital Morvan, Brest, France.,European University of Brittany, Brest, France.,Inserm, U1078, Brest, France
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23
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Nissen PH, Wulff DE, Tørring N, Hvas AM. The impact of pneumatic tube transport on whole blood coagulation and platelet function assays. Platelets 2018; 29:421-424. [DOI: 10.1080/09537104.2018.1430361] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Peter H. Nissen
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Dorte E. Wulff
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Niels Tørring
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
| | - Anne-Mette Hvas
- Department of Clinical Biochemistry, Aarhus University Hospital, Aarhus, Denmark
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24
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Agnihotri N, Agnihotri A. Turnaround Time for Red Blood Cell Transfusion in the Hospitalized Patient: A Single-Center "Blood Ordering, Requisitioning, Blood Bank, Issue (of Blood), and Transfusion Delay" Study. Indian J Crit Care Med 2018; 22:825-830. [PMID: 30662219 PMCID: PMC6311979 DOI: 10.4103/ijccm.ijccm_403_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background and Aim: The turnaround time (TAT) for blood transfusion (BT) is an important quality indicator for the health-care institutions undertaking this procedure. There is no established national or international benchmark for this TAT due to the dearth of a published literature. We thus studied the TAT and the contributory procedures leading to delay in commencing a red blood cell transfusion in the hospitalized patient. Materials and Methods: Delay was captured for the blood order transcription, requisitioning and sampling by the nurse, blood bank (BB) processing, blood issue, and the transfusion commencement in the hospitalized patients. The study was done prospectively over a 1-year period and involved all the patient locations spread over six floors in a tertiary care accredited hospital. Results: A total of 2022 blood requests were analyzed during the study period. Most (73%) of the blood requests were marked as urgent by the treating unit. The average time from ordering to initiation of BT was 135 min in our study. BB processes (compatibility testing and issue) comprised approximately 47% of this delay (63 min), while rest of the delay happened in the processes (ordering 13 min, sample transport 34 min, and BT commencement 25 min) outside the BB (72 min). Conclusion: Majority of the delay for blood transfusion happens due to the processes outside blood bank premises. Understanding the steps where delay happens has the potential to reduce the turnaround time for lifesaving procedures such as blood transfusion in the hospitalized patients.
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Affiliation(s)
- Naveen Agnihotri
- Department of Blood Transfusion Medicine, Nayati Medicity, Mathura, Uttar Pradesh, India
| | - Ajju Agnihotri
- Department of Blood Transfusion Medicine, Nayati Medicity, Mathura, Uttar Pradesh, India
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25
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Causes, consequences and management of sample hemolysis in the clinical laboratory. Clin Biochem 2017; 50:1317-1322. [DOI: 10.1016/j.clinbiochem.2017.09.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 09/13/2017] [Accepted: 09/18/2017] [Indexed: 12/15/2022]
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