Preanalytical management: serum vacuum tubes validation for routine clinical chemistry

Lima-Oliveira, Gabriel; Lippi, Giuseppe; Salvagno, Gian Luca; Montagnana, Martina; Picheth, Geraldo; Guidi, Gian Cesare

doi:10.11613/bm.2012.021

Cited by 33 publications

(13 citation statements)

References 26 publications

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“…No clinically significant differences were observed with use of the reformulated tube types; it thus appeared that the reformulated BD tubes had been successfully adjusted to reduce assay interference and yield results that were similar to those of glass and Vacuette tubes for the total triiodothyronine (TT 3 ), total thyroxine (TT 4 ), and cortisol assays tested [2,5]. However, further studies by Wang et al [6] and Lima-Oliveira et al [7], as well as recent TT 3 , TT 4 , and cortisol results from patients’ specimens in the author’s clinical laboratory have indicated that BD blood collection tube related interference in some clinical assays may not be fully resolved.…”

Section: Introductionmentioning

confidence: 99%

Blood collection tube-related alterations in analyte concentrations in quality control material and serum specimens

Bowen

Sattayapiwat

Gounden

et al. 2014

Clinical Biochemistry

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Objectives Several previous studies have described the effects of interfering substances on clinical assay results; however, the effects of exogenous substances, particularly additives from blood collection tubes on quality control (QC) specimens and serum specimens have not been well examined. This study examines the effects of blood-collection tube additives on total triiodothyronine (TT3), and thyroxine (TT4), cortisol, and routine clinical chemistry tests in QC and serum specimens from apparently healthy volunteers. Methods QC and serum specimens were poured or collected into different blood collection tubes. TT3 and TT4, cortisol, and routine chemistry tests were analyzed from the different blood-collection tube types. Results The findings of this study demonstrate clinically and/or statistically significant blood collection tube-related alterations in the TT3, TT4, and cortisol concentrations of QC specimens and TT4 concentrations from serum specimens. Conclusions These findings have important implications for clinical laboratories, demonstrating that QC specimens should ideally, like patients’ specimens, be poured into blood collection tubes. This strategy would reveal any adverse effects caused by blood collection tubes, which otherwise would not likely be detected by most routine QC practices. The results of this study also show the importance of producing blood collection tubes that contain additives that are truly inert and do not adversely affect clinical laboratory testing.

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Section: Introductionmentioning

confidence: 99%

Blood collection tube-related alterations in analyte concentrations in quality control material and serum specimens

Bowen

Sattayapiwat

Gounden

et al. 2014

Clinical Biochemistry

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“…17-hydroxyprogesterone, and aldosterone) ( 22 ). Furthermore, both serum- and lithium heparin-vacuum tubes with gel separator produced by different companies showed different laboratory results for clinical chemistry tests ( 23 , 24 ). Before adopting and standardizing every kind of in vitro devices (i.e.…”

Section: Discussionmentioning

confidence: 99%

Abnormal gel flotation caused by contrast media during adrenal vein sampling

Lima-Oliveira

Lippi²,

Salvagno

et al. 2016

Biochem Med

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IntroductionDuring adrenal venous sampling (AVS) procedure, radiologists administer a contrast agent via the catheter to visualize the proper catheter position.Materials and methodsA patient with primary aldosteronism diagnostic-hypothesis was admitted for AVS. A venogram was performed to confirm the catheter’s position with 2mL of Iopamidol 300 mg/mL. Samples were collected with syringe connected to a hydrophilic coated catheter by low-pressure aspiration from each of the four collection sites: inferior vena cava in the suprarenal portion, inferior vena cava in the infrarenal portion, left adrenal vein, and right adrenal vein; then immediately transferred from syringe to tubes with gel separator. All tubes were centrifuged at 1200 x g for 10 minutes.ResultsAt the end of centrifugation process, primary blood tubes containing blood from inferior vena cava and left adrenal vein exhibited the standard gel separator barrier, while tubes from right adrenal vein showed abnormal flotation of gel separator. The radiologist confirmed the usage of 2.6 mL instead of 2.0 mL of Iopamidol 300 mg/mL. This iodinated contrast media, with 1.33 g/cm3 of density, was used close to the right adrenal vein due to some difficulty to access it.ConclusionThe abnormal flotation of gel separator in samples taken from right adrenal vein can be explained by the usage of the iodinated contrast media. We suggest using plain-tubes (without gel separator) for AVS in order to avoid preanalytical nonconformities. Moreover, a blood volume equivalent to twice the catheter extension should be discarded to eliminate residual contrast media before collection of samples for laboratory assays.

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“…Presently in order to start a ''light-side'' period in the preanalytical phase and in patient safety, the attention of the laboratory professionals has been focused on some procedures previously regarded as consolidated, such as: (i) furniture changes among different manufacturers of syringes for blood gas analyses, which can represent new sources of laboratory variability; similar considerations apply to not validated vacuum tubes [28][29][30][31]; (ii) transport boxes unable to guarantee the maintenance of the temperature during blood specimens transportation [32]; (iii) traditionally accepted although incorrect paradigms ranging from the filling of vacuum tubes to the mixing procedures which appear unsupported by accurate experimental verification; e.g., recently it has been observed that there is no apparent need to mix all blood specimens after collection into vacuum tube systems by venipuncture [33,34]. On the other hand, apparently incorrect vigorous mixing of the primary blood vacuum tubes immediately after collection does not promote laboratory variability [35]; more so, no clinical impact has been observed in routine and specialized coagulation laboratory testing when the vacuum tubes are incompletely filled (when filled more than 90 % but \100 %) [36].…”

Section: Discussionmentioning

confidence: 99%

Quality Impact on Diagnostic Blood Specimen Collection Using a New Device to Relieve Venipuncture Pain

et al. 2013

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A new device called Buzzy Ò has been recently presented that combines a cooling ice pack and a vibrating motor in order to relieve the venipuncture pain. The aim of this study was to evaluate the impact of Buzzy Ò use during diagnostic blood specimen collection by venipuncture for routine immunochemistry tests. Blood was collected from 100 volunteers by a single, expert phlebotomist. A vein was located on the left forearm without applying tourniquet, in order to prevent any interference from venous stasis, and blood samples were collected using a 20-G straight needle directly into 5 mL vacuum tubes with clot activator and gel separator. In sequence, external cold and vibration by Buzzy Ò was applied on the right forearm-5 cm above the chosen puncture site-for 1 min before venipuncture and continued until the end of the same procedure already done in the left forearm. The panel of tests included the following: glucose, total cholesterol, HDL-cholesterol, triglycerides, total protein, albumin, c-reactive protein, urea, creatinine, uric acid, alkaline phosphatase, amylase, AST, ALT, g-glutamyltransferase, lactate dehydrogenase, creatine kinase, total bilirubin, phosphorus, calcium, magnesium, iron, sodium, potassium, chloride, lipase, cortisol, insulin, thyroid-stimulating hormone, total triiodothyronine, free triiodothyronine, total thyroxine, free thyroxine and haemolysis index. Clinically significant differences between samples were found only for: total protein, albumin and transferrin. The Buzzy Ò can be used during diagnostic blood specimens collection by venipuncture for the majority of the routine immunochemistry tests. We only suggest avoiding this device during blood collection when protein, albumin and transferrin determinations should be performed.

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Preanalytical management: serum vacuum tubes validation for routine clinical chemistry

Cited by 33 publications

References 26 publications

Blood collection tube-related alterations in analyte concentrations in quality control material and serum specimens

Blood collection tube-related alterations in analyte concentrations in quality control material and serum specimens

Abnormal gel flotation caused by contrast media during adrenal vein sampling

Quality Impact on Diagnostic Blood Specimen Collection Using a New Device to Relieve Venipuncture Pain

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