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Ninnemann J, Zylla S, Streichert T, Otto B, Haenel M, Nauck M, Petersmann A. Diagnostic sample transport via pneumatic tube systems: data logger and their algorithms are sensitive to transport effects. Clin Chem Lab Med 2024; 62:657-663. [PMID: 37833063 DOI: 10.1515/cclm-2023-0632] [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: 06/16/2023] [Accepted: 10/04/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVES Many hospitals use pneumatic tube systems (PTS) for transport of diagnostic samples. Continuous monitoring of PTS and evaluation prior to clinical use is recommended. Data loggers with specifically developed algorithms have been suggested as an additional tool in PTS evaluation. We compared two different data loggers. METHODS Transport types - courier, conventional (cPTS) and innovative PTS (iPTS) - were monitored using two data loggers (MSR145® logger, CiK Solutions GmbH, Karlsruhe, Germany, and a prototype developed at the University Medicine Greifswald). Data loggers differ in algorithm, recording frequencies and limit of acceleration detection. Samples from apparently healthy volunteers were split among the transport types and results for 37 laboratory measurands were compared. RESULTS For each logger specific arbitrary units were calculated. Area-under-the-curve (AUC)-values (MSR145®) were lowest for courier and highest for iPTS and increased with increasing recording frequencies. Stress (St)-values (prototype logger) were obtained in kmsu (1,000*mechanical stress unit) and were highest for iPTS as well. Statistical differences between laboratory measurement results of transport types were observed for three measurands sensitive for hemolysis. CONCLUSIONS The statistical, but not clinical, differences in the results for hemolysis sensitive measurands may be regarded as an early sign of preanalytical impairment. Both data loggers record this important interval of beginning mechanical stress with a high resolution indicating their potential to facilitate early detection of preanalytical impairment. Further studies should identify suitable recording frequencies. Currently, evaluation and monitoring of diagnostic sample transport should not only rely on data loggers but also include diagnostic samples.
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Affiliation(s)
- Jana Ninnemann
- Institute of Clinical Chemistry and Laboratory Medicine, 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
| | - Thomas Streichert
- Institute of Clinical Chemistry, Faculty of Medicine and University Hospital, University Hospital Cologne, Cologne, Germany
| | - Benjamin Otto
- Department of Internal Medicine, University Medical Center, Hamburg-Eppendorf, Hamburg, Germany
| | - Mattis Haenel
- Max Planck Institute of Plasma Physics, Sub-institute 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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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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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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Mwogi T, Mercer T, Tran DN(T, Tonui R, Tylleskar T, Were MC. Therapeutic turnaround times for common laboratory tests in a tertiary hospital in Kenya. PLoS One 2020; 15:e0230858. [PMID: 32267844 PMCID: PMC7141613 DOI: 10.1371/journal.pone.0230858] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Accepted: 03/10/2020] [Indexed: 11/18/2022] Open
Abstract
METHODS We evaluated therapeutic TAT for a tertiary hospital in Western Kenya, using a time-motion study focusing specifically on common hematology and biochemistry orders. The aim was to determine significant bottlenecks in diagnostic testing processes at the institution. RESULTS A total of 356 (155 hematology and 201 biochemistry) laboratory tests were fully tracked from the time of ordering to availability of results to care providers. The total therapeutic TAT for all tests was 21.5 ± 0.249 hours (95% CI). The therapeutic TAT for hematology was 20.3 ± 0.331 hours (95% CI) while that for biochemistry tests was 22.2 ± 0.346 hours (95% CI). Printing, sorting and dispatch of the printed results emerged as the most significant bottlenecks, accounting for up to 8 hours of delay (Hematology-8.3 ± 1.29 hours (95% CI), Biochemistry-8.5 ± 1.18 hours (95% CI)). Time of test orders affected TAT, with orders made early in the morning and those in the afternoon experiencing the most delays in TAT. CONCLUSION Significant inefficiencies exist at multiple steps in the turnaround times for routine laboratory tests at a large referral hospital within an LMIC setting. Multiple opportunities exist to improve TAT and streamline processes around diagnostic testing in this and other similar settings.
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Affiliation(s)
- Thomas Mwogi
- Centre for International Health, University of Bergen, Bergen, Norway
- Directorate of Medicine, Moi Teaching and Referral Hospital, Eldoret, Uasin Gishu, Kenya
- Institute of Biomedical Informatics, Moi University, Eldoret, Uasin Gishu, Kenya
| | - Tim Mercer
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, Texas, United States of America
| | - Dan N. (Tina) Tran
- Department of Pharmacy Practice, College of Pharmacy, Purdue University, West Lafeyette, IN, United States of America
| | - Ronald Tonui
- Department of Immunology, Moi University, Eldoret, Uasin Gishu, Kenya
- Laboratory Services Division, Moi Teaching and Referral Hospital, Eldoret, Kenya
| | | | - Martin C. Were
- Department of Biomedical Informatics and Medicine, Vanderbilt University Medical Center, Nashville, TN, United States of America
- Vanderbilt Institute for Global Health, Nashville, TN, United States of America
- Institute of Biomedical Informatics, Moi University, Eldoret, Uasin Gishu, Kenya
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Kapoula GV, Kontou PI, Bagos PG. The impact of pneumatic tube system on routine laboratory parameters: a systematic review and meta-analysis. ACTA ACUST UNITED AC 2017; 55:1834-1844. [DOI: 10.1515/cclm-2017-0008] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 03/27/2017] [Indexed: 11/15/2022]
Abstract
AbstractBackground:Pneumatic tube system (PTS) is a widely used method of transporting blood samples in hospitals. The aim of this study was to evaluate the effects of the PTS transport in certain routine laboratory parameters as it has been implicated with hemolysis.Methods:A systematic review and a meta-analysis were conducted. PubMed and Scopus databases were searched (up until November 2016) to identify prospective studies evaluating the impact of PTS transport in hematological, biochemical and coagulation measurements. The random-effects model was used in the meta-analysis utilizing the mean difference (MD). Heterogeneity was quantitatively assessed using the Cohran’sResults:From a total of 282 studies identified by the searching procedure, 24 were finally included in the meta-analysis. The meta-analysis yielded statistically significant results for potassium (K) [MD=0.04 mmol/L; 95% confidence interval (CI)=0.015–0.065; p=0.002], lactate dehydrogenase (LDH) (MD=10.343 U/L; 95% CI=6.132–14.554; p<10Conclusions:This meta-analysis suggests that PTS may be associated with alterations in K, LDH and AST measurements. Although these findings may not have any significant clinical effect on laboratory results, it is wise that each hospital validates their PTS.
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