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Makhlouf R, Fendri S, Jallouli D, Labiadh Z, Fritis L, Chaabouni K, Elleuch A, Ayadi FM. Influence of pneumatic tube delivery system on laboratory results. Ann Clin Biochem 2023:45632231213743. [PMID: 37921518 DOI: 10.1177/00045632231213743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
INTRODUCTION The pneumatic tube system (PTS) is an automated and fast modality of transportation of biological samples, but it has been reported to induce preanalytical errors. AIM To study the influence of transportation by PTS on biochemistry tests which are particularly sensitive to haemolysis and atmospheric pressure variation. MATERIALS AND METHODS We compared laboratory results of arterial blood gas, sodium, potassium, chloride, lactate dehydrogenase, aspartate aminotransferase, alanine aminotransferase, glucose and haemolysis index of samples conveyed simultaneously by PTS and by courier. RESULTS We recruited 30 patients from the sampling room and 40 patients from the intensive care unit. Transport through PTS resulted in a significant increase in aspartate aminotransferase and potassium without exceeding the limits of acceptability. Potassium was significantly more increased for samples transported in a higher speed line (p = .048) but without exceeding the limits of acceptability. No significant impact was noted on haemolysis indices. The pO2 variations due to PTS transportation exceeded the limit of acceptability with significant intra-individual variations. CONCLUSION Our PTS is validated for biochemistry tests results. It reduces turnaround times without affecting sample quality. However, the interpretation of arterial blood gas results should be careful for samples transported by PTS.
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Affiliation(s)
- Rihab Makhlouf
- Clinical Chemistry Laboratory, Habib Bourguiba Hospital, Sfax, Tunisia
- Research Laboratory LR19ES13 Medicine school of Sfax, University of Sfax, Tunisia
| | - Sana Fendri
- Clinical Chemistry Laboratory, Habib Bourguiba Hospital, Sfax, Tunisia
- Research Laboratory LR19ES13 Medicine school of Sfax, University of Sfax, Tunisia
| | - Dana Jallouli
- Clinical Chemistry Laboratory, Habib Bourguiba Hospital, Sfax, Tunisia
- Research Laboratory LR19ES13 Medicine school of Sfax, University of Sfax, Tunisia
| | - Zeinab Labiadh
- Higher School of Health Sciences and Techniques of Sfax, University of Sfax, Tunisia
| | - Lotfi Fritis
- Biomedical Department, Habib Bourguiba Hospital, Sfax, Tunisia
| | - Khansa Chaabouni
- Clinical Chemistry Laboratory, Habib Bourguiba Hospital, Sfax, Tunisia
- Research Laboratory LR19ES13 Medicine school of Sfax, University of Sfax, Tunisia
| | - Aida Elleuch
- Clinical Chemistry Laboratory, Habib Bourguiba Hospital, Sfax, Tunisia
- Research Laboratory LR19ES13 Medicine school of Sfax, University of Sfax, Tunisia
| | - Fatma Makni Ayadi
- Clinical Chemistry Laboratory, Habib Bourguiba Hospital, Sfax, Tunisia
- Research Laboratory LR19ES13 Medicine school of Sfax, University of Sfax, Tunisia
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Kadwa AR, Grace JF, Zeiler GE. Sources of error in acid-base analysis from a blood gas analyser result: a narrative review. J S Afr Vet Assoc 2022; 93:89-98. [DOI: 10.36303/jsava.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023] Open
Affiliation(s)
- AR Kadwa
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria,
South Africa
- Section of Anaesthesia and Critical Care, Valley Farm Animal Hospital,
South Africa
| | - JF Grace
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria,
South Africa
- Section of Anaesthesia and Critical Care, Valley Farm Animal Hospital,
South Africa
| | - GE Zeiler
- Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria,
South Africa
- Section of Anaesthesia and Critical Care, Valley Farm Animal Hospital,
South Africa
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Çuhadar S, Özkanay-Yörük H, Köseoğlu M, Katırcıoğlu K. Detection of preanalytical errors in arterial blood gas analysis. Biochem Med (Zagreb) 2022; 32:020708. [PMID: 35799987 PMCID: PMC9195608 DOI: 10.11613/bm.2022.020708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 03/15/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Blood gas analysis (BGA) is an essential test used for years to provide vital information in critically ill patients. However, the instability of the blood gases is a problem. We aimed to evaluate time and temperature effects on blood gas stability. Materials and methods Arterial blood was collected from 20 patients into syringes. Following BGA for baseline, syringes were divided into groups to stand at 4°C and 22°C for 30, 60, 90, 120 minutes. All were tested for pH, partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), oxygen saturation (sO2), oxyhemoglobin (O2Hb), sodium, potassium, glucose, lactate, oxygen tension at 50% hemoglobin saturation (p50), and bicarbonate. A subgroup analysis was performed to detect the effect of air on results during storage. Percentage deviations were calculated and compared against the preset quality specifications for allowable total error. Results At 4°C, pO2 was the least stable parameter. At 22°C, pO2 remained stable for 120 min, pH and glucose for 90 min, lactate and pCO2 for 60 min. Glucose and lactate were stable when chilled. Air bubbles interfered pO2 regardless of temperatures, whereas pCO2 increased significantly at 22°C after 30 min, and pH decreased after 90 min. Bicarbonate, sO2, O2Hb, sodium, and potassium were the unaffected parameters. Conclusions Correct BGA results are essential, and arterial sample is precious. Therefore, if immediate analysis cannot be performed, up to one hour, syringes stored at room temperature will give reliable results when care is taken to minimize air within the blood gas specimen.
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Affiliation(s)
- Serap Çuhadar
- Department of Biochemistry, Atatürk Training and Research Hospital, Izmir, Turkey
| | - Hayat Özkanay-Yörük
- Department of Biochemistry, Atatürk Training and Research Hospital, Izmir, Turkey
| | - Mehmet Köseoğlu
- Department of Biochemistry, Tınaztepe University, Izmir, Turkey
| | - Kaan Katırcıoğlu
- Department of Anesthesiology and Reanimation, Tınaztepe University, Izmir, Turkey
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van Wijk XMR, Leanse JH, Poinier A, Uriel N, O'Connor MF, Weber SG, Tesic V, Staneva I. A root cause analysis of 'falsely elevated' oxygen saturation: investigation of pneumatic tube transport and differences between estimated and measured saturation in a critical patient population. Clin Chem Lab Med 2021; 58:e72-e74. [PMID: 31525163 DOI: 10.1515/cclm-2019-0776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Accepted: 08/26/2019] [Indexed: 11/15/2022]
Affiliation(s)
- Xander M R van Wijk
- Department of Pathology, The University of Chicago Medicine and Biological Sciences, 5841 S. Maryland Ave., Rm. TW 010-B, MC 0004, Chicago, IL 60637, USA, Phone: +773-702-2806, Fax: 773-702-6268
| | - Julie H Leanse
- Department of Clinical Laboratories, UChicago Medicine, Chicago, IL, USA
| | - Abby Poinier
- Department of Cardiovascular Service Line, UChicago Medicine, Chicago, IL, USA
| | - Nir Uriel
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Michael F O'Connor
- Department of Medicine, The University of Chicago, Chicago, IL, USA.,Department of Anesthesia and Critical Care, The University of Chicago, Chicago, IL, USA
| | - Stephen G Weber
- Department of Medicine, The University of Chicago, Chicago, IL, USA
| | - Vera Tesic
- Department of Pathology, The University of Chicago, Chicago, IL, USA
| | - Iliana Staneva
- Department of Cardiovascular Service Line, UChicago Medicine, Chicago, IL, USA
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Nybo M, Lund ME, Titlestad K, Maegaard CU. Blood Sample Transportation by Pneumatic Transportation Systems: A Systematic Literature Review. Clin Chem 2018; 64:782-790. [DOI: 10.1373/clinchem.2017.280479] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/05/2017] [Indexed: 11/06/2022]
Abstract
Abstract
BACKGROUND
Pneumatic transportation systems (PTSs) are increasingly used for transportation of blood samples to the core laboratory. Many studies have investigated the impact of these systems on different types of analyses, but to elucidate whether PTSs in general are safe for transportation of blood samples, existing literature on the subject was systematically assessed.
METHODS
A systematic literature review was conducted following the preferred reporting items for systematic reviews and metaanalyses (PRISMA) Statement guidelines to gather studies investigating the impact of PTS on analyses in blood samples. Studies were extracted from PubMed and Embase. The search period ended November 2016.
RESULTS
A total of 39 studies were retrieved. Of these, only 12 studies were conducted on inpatients, mainly intensive care unit patients. Blood gases, hematology, and clinical chemistry were well investigated, whereas coagulation, rotational thromboelastometry, and platelet function in acutely ill patients were addressed by only 1 study each. Only a few parameters were affected in a clinically significant way (clotting time parameter in extrinsic system thromboelastometry, pO2 in blood gas, multiplate analysis, and the hemolysis index).
CONCLUSIONS
Owing to their high degree of heterogeneity, the retrieved studies were unable to supply evidence for the safety of using PTSs for blood sample transportation. In consequence, laboratories need to measure and document the actual acceleration forces in their existing PTS, instituting quality target thresholds for these measurements such as acceleration vector sums. Computer modeling might be applied to the evaluation of future PTS installations. With the increasing use of PTS, a harmonized, international recommendation on this topic is warranted.
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Affiliation(s)
- Mads Nybo
- Department of Clinical Biochemistry and Pharmacology, Odense University Hospital, Odense, Denmark
| | - Merete E Lund
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Kjell Titlestad
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
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Pupek A, Matthewson B, Whitman E, Fullarton R, Chen Y. Comparison of pneumatic tube system with manual transport for routine chemistry, hematology, coagulation and blood gas tests. Clin Chem Lab Med 2017; 55:1537-1544. [PMID: 28432841 DOI: 10.1515/cclm-2016-1157] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/06/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND The pneumatic tube system (PTS) is commonly used in modern clinical laboratories to provide quick specimen delivery. However, its impact on sample integrity and laboratory testing results are still debatable. In addition, each PTS installation and configuration is unique to its institution. We sought to validate our Swisslog PTS by comparing routine chemistry, hematology, coagulation and blood gas test results and sample integrity indices between duplicate samples transported either manually or by PTS. METHODS Duplicate samples were delivered to the core laboratory manually by human courier or via the Swisslog PTS. Head-to-head comparisons of 48 routine chemistry, hematology, coagulation and blood gas laboratory tests, and three sample integrity indices were conducted on 41 healthy volunteers and 61 adult patients. RESULTS The PTS showed no impact on sample hemolysis, lipemia, or icterus indices (all p<0.05). Although alkaline phosphatase, total bilirubin and hemoglobin reached statistical significance (p=0.009, 0.027 and 0.012, respectively), all had very low average bias which ranged from 0.01% to 2%. Potassium, total hemoglobin and percent deoxyhemoglobin were statistically significant for the neonatal capillary tube study (p=0.011, 0.033 and 0.041, respectively) but no biases greater than ±4% were identified for these parameters. All observed differences of these 48 laboratory tests were not clinically significant. CONCLUSIONS The modern PTS investigated in this study is acceptable for reliable sample delivery for routine chemistry, hematology, coagulation and blood gas (in syringe and capillary tube) laboratory tests.
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Affiliation(s)
- Alex Pupek
- .Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network Fredericton, NB, Canada; and Dalhousie Medical Program in New Brunswick, Saint John, NB, Canada
| | - Beverly Matthewson
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, NB, Canada
| | - Erin Whitman
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, NB, Canada
| | - Rachel Fullarton
- Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, NB, Canada
| | - Yu Chen
- Chief of Department of Laboratory Medicine, Dr. Everett Chalmers Regional Hospital, Horizon Health Network, Fredericton, New Brunswick, Canada E3B 5N5; Associate Professor, Department of Pathology, Dalhousie University, Halifax, NS, Canada.
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Broz P, Rajdl D, Racek J, Zenkova J, Petrikova V. Influence of pneumatic tube system transport on routinely assessed and spectrophotometric cerebrospinal fluid parameters. Clin Chem Lab Med 2017; 55:47-52. [PMID: 27362961 DOI: 10.1515/cclm-2016-0143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 05/27/2016] [Indexed: 11/15/2022]
Abstract
BACKGROUND Pneumatic tube systems (PTS) are widely used in many hospitals. Using PTS reduces turnaround time (TAT) and can improve patients' outcome. METHODS We investigated whether clinically significant differences could be observed in CSF samples transported by pneumatic tube in comparison with samples transported by hand. Two aliquots from one sample were sent by PTS and by hand from the department of neurology or neurosurgery and compared. RESULTS Routine cytological and biochemical assessment was compared in 27 cases. There were no statistically significant changes (transport by hand vs. PTS) in glucose levels [data are expressed as median (minimum-maximum)] at 3.7 (2.5-8.6) mmol/L vs. 3.6 (2.7-8.6) mmol/L, p=0.96 or lactate levels at 1.8 mmol/L (1.1-5.5) vs. 1.8 mmol/L (1.1-5.4). We observed a statistically significant decline in total protein levels in samples transported by PTS at 0.56 g/L (0.19-4.29) vs. 0.49 g/L (0.18-4.3), p=0.008. We observed no changes in erythrocyte count at 5/μL (0-40,000) vs. 5/μL (0-40,106), mononuclear cells at 2/μL (1-145) vs. 3/μL (1-152), or polynuclear cells at 0/μL (0-235) vs. 0/μL (0-352). Spectrophotometric examination was performed in 20 cases. There were no statistically significant differences (transport by hand vs. transport by PTS) in NOA at 0.002 (0.001-1.537) vs. 0.001 (0.001-1.528), p=0.95 or NBA at 0.001 (0.001-0.231) vs. 0.001 (0.001-0.276), p=0.675. Samples transported by PTS were delivered faster than samples transported by courier (transport by hand vs. PTS) at 25 min (10-153) vs. 15 min (4-110), p=0.002. CONCLUSIONS We found no significant changes in glucose, lactate levels and in any of the cytological parameters assessed, nor were statistically significant changes observed in the spectrophotometric parameters. We found a statistically significant decrease in total protein levels in samples transported by PTS. Transport by PTS can be faster than transport by hand.
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Koçak FE, Yöntem M, Yücel O, Cilo M, Genç O, Meral A. The effects of transport by pneumatic tube system on blood cell count, erythrocyte sedimentation and coagulation tests. Biochem Med (Zagreb) 2013; 23:206-10. [PMID: 23894866 PMCID: PMC3900063 DOI: 10.11613/bm.2013.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Introduction: Today, the pneumatic tube transport system (PTS) is used frequently because of its advantages related to timing and speed. However, the impact of various types of PTS on blood components is unknown. The aim of this study was to examine the influence of PTS on the quality of routine blood cell counts, erythrocyte sedimentation, and certain blood coagulation tests. Materials and methods: Paired blood samples were obtained from each of 45 human volunteers and evaluated by blood cell count, erythrocyte sedimentation, and several coagulation tests, including prothrombin time (PT) and activated partial thromboplastin time (aPTT). Blood samples were divided into 2 groups: Samples from group 1 were transported to the laboratory via the PTS, and samples from group 2 were transported to the laboratory manually. Both groups were evaluated immediately by the tests listed above. Results: The blood sample test results from groups 1 and 2 were evaluated and compared. No statistically significant differences were observed (P = 0.069–0.977). Conclusion: The PTS yielded no observable effects on blood cell counts, erythrocyte sedimentation, or PT and aPTT test results. We concluded that the PTS can be used to transport blood samples and yield reliable results for blood cell counts, erythrocyte sedimentation, and several coagulation tests.
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Affiliation(s)
- Fatma Emel Koçak
- Kütahya Evliya Celebi Training and Research Hospital of Faculty of Medicine of Dumlupinar University, Department of Biochemistry and Clinical Biochemistry, Kütahya,Turkey.
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Abstract
Blood gas testing is a commonly ordered test in hospital settings, where the results almost always have the potential to dictate an immediate or urgent response. The preanalytical steps in testing, from choosing the correct tests to ensuring the specimen is introduced into the instrument correctly, must be perfectly coordinated to ensure that the patient receives appropriate and timely therapy in response to the analytical results. While many of the preanalytical steps in blood gas testing are common to all laboratory tests, such as accurate specimen labeling, some are unique to this testing because of the physicochemical properties of the analytes being measured. The common sources of preanalytical variation in blood gas testing are reviewed here.
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Affiliation(s)
- Geoffrey Baird
- Department of Laboratory Medicine, University of Washington, Seattle, WA, USA.
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Felder RA. Preanalytical Errors Introduced by Sample-Transportation Systems: A Means to Assess Them. Clin Chem 2011; 57:1349-50. [DOI: 10.1373/clinchem.2011.172452] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Robin A Felder
- University of Virginia Health System, Charlottesville, VA
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Pneumatic tube delivery systems for patient samples: evidence of quality and quality of evidence. Clin Chem Lab Med 2011; 49:1245-1246. [DOI: 10.1515/cclm.2011.216] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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