The relationship between vacuum and hemolysis during catheter blood collection: a retrospective analysis of six large cohorts

Abstract Background: Blood collection through intravenous (IV) catheters is a common practice at emergency departments (EDs). This technique is associated with higher in vitro hemolysis rates and may even be amplified by the use of vacuum collection tubes. Our aim was to investigate the association of five different vacuum tubes with hemolysis rates in comparison to an aspiration system under real-life conditions and to propose an equation to estimate the amount of hemolysis, depending on the vacuum collection tube type. Methods: We retrospectively evaluated hemolysis data of plasma samples from our ED, where blood is drawn through IV catheters. Over the past 5 years, we compared 19,001 hemolysis index values amongst each other and against the respective vacuum pressure (Pv) of the collection tubes, which were used within the six observational periods. Results: The highest hemolysis rates were associated with full-draw evacuated tubes. Significantly reduced hemolysis was observed for two kinds of partial-draw tubes. The hemolysis rate of one partial-draw blood collection tube was comparable to those of the aspiration system. Regression analysis of Pv and mean free hemoglobin (fHb) values yielded the formula fHb (g/L)=0.0082*Pv2–0.1143*Pv+ 0.5314 with an R2 of 0.99. Conclusions: If IV catheters are used for blood collection, hemolysis rates directly correlate with the vacuum within the tubes and can be estimated by the proposed formula. By the use of partial-draw vacuum blood collection tubes, hemolysis rates in IV catheter collections can be reduced to levels comparable with collections performed by aspiration systems.

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Residual Negative Pressure in Vacuum Blood-Collection Tube and Hemolysis in Pediatric Blood Specimens

Laboratory Medicine ◽

10.1093/labmed/lmz026 ◽

2019 ◽

Vol 51 (1) ◽

pp. 41-46

Author(s):

Jing Hu ◽

Qiao-Xin Zhang ◽

Tong-Tong Xiao ◽

Mei-Chen Pan ◽

Ying-Mu Cai

Keyword(s):

Negative Pressure ◽

Blood Collection ◽

Free Hemoglobin ◽

Significant Difference ◽

Collection Tube ◽

Biochemical Analyzer ◽

Blood Specimens ◽

Adult Volunteers ◽

Blood Collection Tubes ◽

Blood Collection Tube

ABSTRACT Objective To determine a method to reduce specimen hemolysis rates in pediatric blood specimens. Methods A total of 290 blood specimens from pediatric patients were classiﬁed into the capped group or uncapped group. The hemolysis index and levels of lactate dehydrogenase (LDH) were measured using an automated biochemical analyzer. Also, we performed a paired test to measure the concentration of free hemoglobin in specimens from 25 randomly selected healthy adult volunteers, using a direct spectrophotometric technique. Results The hemolytic rate of capped specimens was 2-fold higher than that of uncapped specimens. We found significant differences for LDH. Also, there was a significant difference in the concentration of free hemoglobin in the random-volunteers test. Conclusions Eliminating the residual negative pressure of vacuum blood-collection tubes was effective at reducing the macrohemolysis and/or microhemolysis rate.

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In-vitro hemolysis and its financial impact using different blood collection systems

LaboratoriumsMedizin ◽

10.1515/labmed-2015-0078 ◽

2015 ◽

Vol 0 (0) ◽

Author(s):

Janne Cadamuro ◽

Georg Martin Fiedler ◽

Cornelia Mrazek ◽

Thomas Klaus Felder ◽

Hannes Oberkofler ◽

...

Keyword(s):

Financial Impact ◽

Blood Collection ◽

Laboratory Diagnostics ◽

Time Interval ◽

Time Intervals ◽

Mean Values ◽

The Past ◽

Collection Tube ◽

Blood Collection Tube

AbstractHemolytic specimens are among the most challenging preanalytical issues in laboratory diagnostics. The type of blood collection tube in use is claimed to influence in vitro hemolysis. We aimed to examine this hypothesis and estimate the respective financial impact, evaluating routine blood samples from the past 4 years.A total of 47,820 hemolysis index (HI) values from five different time intervals (IV1–IV5) were compared against each other, representing the following tubes: IV1-Sarstedt Monovette; IV2-8 mL/16×100 mm Greiner BioOne (GBO) Vacuette; IV3/IV4-5 mL/16×100 mm GBO Vacuette; IV5-4.5 mL/13×75 mm GBO Vacuette. For estimation of the economic impact, material, personnel and analytical costs were calculated.HI mean values in time interval IV2 were significantly higher than in all other intervals, while mean values amongst all other intervals were comparable. The number of moderately and severely hemolyzed samples increased with incrementing vacuum. Overall comparable costs between intervals IV1 and IV5 were €11,370, €14,045, €12,710, €11,213 and €8138 per 10,000 samples, respectively.Aspiration tubes and low vacuum tubes show comparable hemolysis rates. Increasing vacuum levels are associated with higher hemolysis rates. By decreasing in vitro hemolysis, financial savings up to €5907 per 10,000 samples could be gained.

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Inferences and Legal Considerations Following a Blood Collection Tube Recall

Journal of Analytical Toxicology ◽

10.1093/jat/bkaa056 ◽

2020 ◽

Author(s):

Luke N Rodda ◽

Sue Pearring ◽

Curt E Harper ◽

Nicholas B Tiscione ◽

Alan Wayne Jones

Keyword(s):

Sodium Fluoride ◽

Enzyme Inhibitor ◽

Blood Collection ◽

Blood Alcohol ◽

Potassium Oxalate ◽

Collection Tube ◽

Evacuated Tubes ◽

The Stability ◽

Stored Blood ◽

Blood Collection Tube

Abstract In mid-2019, medical, forensic and legal communities were notified that a certain shipment of evacuated blood sampling tubes were recalled by the manufacturer. This recall order described that the preservative sodium fluoride (100 mg) and anticoagulant potassium oxalate (20 mg) were missing from a small batch of 10-mL evacuated tubes. This gave cause for concern for possible implications in criminal justice (e.g., in drink-driving offenses) when blood–alcohol concentrations are interpreted. In reality, the lack of an anticoagulant would have been immediately obvious during sample preparation, owing to the formation of a large clot in the tube when received. Certain impairing drugs (e.g., cocaine and 6-acetylmorphine) are unstable in blood and tend to degrade without an enzyme inhibitor, such as sodium fluoride, present. In reviewing available literature related to current practices and the stability of ethanol in stored blood samples, there does not appear to be a clear consensus regarding the amount of sodium fluoride preservative necessary, if any at all, when blood is taken from living subjects under sterile conditions for typical forensic ethanol analysis.

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Immunoassay Interference by a Commonly Used Blood Collection Tube Additive, the Organosilicone Surfactant Silwet L-720

Clinical Chemistry ◽

10.1373/clinchem.2005.055400 ◽

2005 ◽

Vol 51 (10) ◽

pp. 1874-1882 ◽

Cited By ~ 36

Author(s):

Raffick AR Bowen ◽

Yung Chan ◽

Mark E Ruddel ◽

Glen L Hortin ◽

Gyorgy Csako ◽

...

Keyword(s):

Solid Phase ◽

Blood Collection ◽

Becton Dickinson ◽

Total Triiodothyronine ◽

Collection Tube ◽

Capture Antibody ◽

Blood Collection Tubes ◽

Blood Collection Tube ◽

Selection Of ◽

Serum Components

Abstract Background: A small number of immunoassays on several different types of analyzers were recently adversely affected by tube additives in Becton Dickinson (BD) Vacutainer® SST™, SST II, and Microtainer™ blood collection tubes. We examined the effect of a commonly used tube surfactant, Silwet™ L-720, on immunoassays and the mechanism for the interference. Methods: Immunoassays were performed on serum supplemented with Silwet L-720 on the IMMULITE™ 2500 and AxSYM™ analyzers. Direct effects of the surfactant on the chemiluminescent detection step of immunoassays and on antibody immobilization on the solid phase were examined. Results: Increasing the final surfactant concentration from 0 to 400 mg/L in serum significantly increased (∼51%) the apparent total triiodothyronine (TT3) concentrations measured on the IMMULITE 2500 but not the AxSYM analyzer. Several other competitive, but not noncompetitive, assays were also significantly affected by the surfactant on the IMMULITE 2500 analyzer. The effect was independent of serum components, and the surfactant had no direct effect on chemiluminescence reactions. The capture antibody, however, was displaced from the solid phase by incubation with solutions containing surfactant under conditions similar to the IMMULITE TT3 assay. Conclusions: The Silwet L-720 surfactant, which is used to coat the inner surfaces of tubes, appears to account for previously reported immunoassay interference by BD Vacutainer SST blood collection tubes. One of the mechanisms for the interference is the desorption of antibodies from the solid phase by the surfactant. The results identify an important factor in the selection of suitable blood collection tube surfactants and provide an approach for solving similar tube-assay interference problems in the future.

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A Comparison of Serum and Plasma Blood Collection Tubes for the Integration of Epidemiological and Metabolomics Data

Frontiers in Molecular Biosciences ◽

10.3389/fmolb.2021.682134 ◽

2021 ◽

Vol 8 ◽

Author(s):

Jennie Sotelo-Orozco ◽

Shin-Yu Chen ◽

Irva Hertz-Picciotto ◽

Carolyn M. Slupsky

Keyword(s):

Epidemiological Studies ◽

Blood Collection ◽

Metabolomics Data ◽

Heparin Plasma ◽

Collection Tube ◽

Edta Plasma ◽

The Impact ◽

Blood Collection Tubes ◽

Blood Collection Tube ◽

Citrate Plasma

Blood is a rich biological sample routinely collected in clinical and epidemiological studies. With advancements in high throughput -omics technology, such as metabolomics, epidemiology can now delve more deeply and comprehensively into biological mechanisms involved in the etiology of diseases. However, the impact of the blood collection tube matrix of samples collected needs to be carefully considered to obtain meaningful biological interpretations and understand how the metabolite signatures are affected by different tube types. In the present study, we investigated whether the metabolic profile of blood collected as serum differed from samples collected as ACD plasma, citrate plasma, EDTA plasma, fluoride plasma, or heparin plasma. We identified and quantified 50 metabolites present in all samples utilizing nuclear magnetic resonance (NMR) spectroscopy. The heparin plasma tubes performed the closest to serum, with only three metabolites showing significant differences, followed by EDTA which significantly differed for five metabolites, and fluoride tubes which differed in eleven of the fifty metabolites. Most of these metabolite differences were due to higher levels of amino acids in serum compared to heparin plasma, EDTA plasma, and fluoride plasma. In contrast, metabolite measurements from ACD and citrate plasma differed significantly for approximately half of the metabolites assessed. These metabolite differences in ACD and citrate plasma were largely due to significant interfering peaks from the anticoagulants themselves. Blood is one of the most banked samples and thus mining and comparing samples between studies requires understanding how the metabolite signature is affected by the different media and different tube types.

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Importance of blood-collection tubes in plasma lidocaine determinations.

Clinical Chemistry ◽

10.1093/clinchem/25.4.617 ◽

1979 ◽

Vol 25 (4) ◽

pp. 617-619 ◽

Cited By ~ 20

Author(s):

W W Stargel ◽

C R Roe ◽

P A Routledge ◽

D G Shand

Keyword(s):

Binding Sites ◽

Clinical Samples ◽

Therapeutic Drug ◽

Blood Collection ◽

Plasma Binding ◽

Sample Concentration ◽

Plasma Lidocaine ◽

Collection Tube ◽

Blood Collection Tubes

Abstract In 25 clinical samples serum lidocaine concentrations fell from a mean of 6.5 +/- 2.1 mg/L (mean +/- SD) to 4.9 +/- 1.8 mg/L (p less than 0.001) when the blood sample was allowed to make contact with the stopper of the Vacutainer collection tube. In vitro experiments showed that this effect of the stopper occurred only with whole blood and was dependent on sample concentration. The plasma binding of lidocaine decreased from a normal value of 56% +/- 2.2 (mean +/- SD) to 28% +/- 2.2 (p less than 0.001) when exposed to the Vacutainer stopper. We conclude that a chemical leached from such stoppers displaces lidocaine from its plasma-binding sites and that the drug is then redistributed into the erythrocytes, producing spuriously low lidocaine concentrations in plasma or serum. Such artifacts are important in therapeutic drug monitoring and can lead to erroneous clinical decisions.

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Impact of Blood Collection Tubes and Sample Handling Time on Serum and Plasma Metabolome and Lipidome

Metabolites ◽

10.3390/metabo8040088 ◽

2018 ◽

Vol 8 (4) ◽

pp. 88 ◽

Cited By ~ 10

Author(s):

Charmion Cruickshank-Quinn ◽

Laura K. Zheng ◽

Kevin Quinn ◽

Russell Bowler ◽

Richard Reisdorph ◽

...

Keyword(s):

Processing Time ◽

Handling Time ◽

Blood Collection ◽

Sample Collection ◽

Sample Processing ◽

Plasma Metabolome ◽

Collection Tube ◽

Hydrophobic Fraction ◽

Blood Collection Tubes ◽

Blood Collection Tube

Background: Metabolomics is emerging as a valuable tool in clinical science. However, one major challenge in clinical metabolomics is the limited use of standardized guidelines for sample collection and handling. In this study, we conducted a pilot analysis of serum and plasma to determine the effects of processing time and collection tube on the metabolome. Methods: Blood was collected in 3 tubes: Vacutainer serum separator tube (SST, serum), EDTA (plasma) and P100 (plasma) and stored at 4 degrees for 0, 0.5, 1, 2, 4 and 24 h prior to centrifugation. Compounds were extracted using liquid-liquid extraction to obtain a hydrophilic and a hydrophobic fraction and analyzed using liquid chromatography mass spectrometry. Differences among the blood collection tubes and sample processing time were evaluated (ANOVA, Bonferroni FWER ≤ 0.05 and ANOVA, Benjamini Hochberg FDR ≤ 0.1, respectively). Results: Among the serum and plasma tubes 93.5% of compounds overlapped, 382 compounds were unique to serum and one compound was unique to plasma. There were 46, 50 and 86 compounds affected by processing time in SST, EDTA and P100 tubes, respectively, including many lipids. In contrast, 496 hydrophilic and 242 hydrophobic compounds differed by collection tube. Forty-five different chemical classes including alcohols, sugars, amino acids and prenol lipids were affected by the choice of blood collection tube. Conclusion: Our results suggest that the choice of blood collection tube has a significant effect on detected metabolites and their overall abundances. Perhaps surprisingly, variation in sample processing time has less of an effect compared to collection tube; however, a larger sample size is needed to confirm this.

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Interlaboratory comparison of the TransFix®/EDTA Vacuum Blood Collection tube with the 5 mL Cyto‐Chex® BCT

Cytometry Part B Clinical Cytometry ◽

10.1002/cyto.b.21731 ◽

2018 ◽

Vol 96 (6) ◽

pp. 496-507 ◽

Cited By ~ 2

Author(s):

Daniel Harrison ◽

Rosalie Ward ◽

Sarah Bastow ◽

Andrew Parr ◽

Susan Macro ◽

...

Keyword(s):

Interlaboratory Comparison ◽

Blood Collection ◽

Collection Tube ◽

Blood Collection Tube

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A Multicenter Evaluation of a Nongel Mechanical Separator Plasma Blood Collection Tube for Testing of Selected Therapeutic Drugs

The Journal of Applied Laboratory Medicine ◽

10.1093/jalm/jfaa033 ◽

2020 ◽

Vol 5 (4) ◽

pp. 671-685

Author(s):

Svetlana Morosyuk ◽

Julie Berube ◽

Robert Christenson ◽

Alan H B Wu ◽

Denise Uettwiller-Geiger ◽

...

Keyword(s):

The Other ◽

Initial Time ◽

Therapeutic Drug ◽

Blood Collection ◽

Test Results ◽

Sample Storage ◽

Therapeutic Drugs ◽

Collection Tube ◽

And Storage ◽

Blood Collection Tube

Abstract Background Some therapeutic drugs are unstable during sample storage in gel tubes. BD Vacutainer® Barricor™ Plasma Blood Collection Tube with nongel separator was compared with plasma gel tubes, BD Vacutainer PST™, PST II, and BD Vacutainer Serum Tube for acetaminophen, salicylate, digoxin, carbamazepine, phenytoin, valproic acid, and vancomycin during sample storage for up to 7 days. Methods Seven hospital sites enrolled 705 participants who were taking at least one selected drug. The study tubes were collected and tested at initial time (0 h), after 48 h of storage at room temperature and on day 7 (after additional 5 days of refrigerated storage). The performance of BD Barricor tube was evaluated for each drug by comparing BD Barricor samples with samples from the other tubes at 0 h from the same participant; stability was evaluated by comparing test results from the same tube at 0 h, 48 h, and 7 days. Results At 0 h, BD Barricor showed clinically equivalent results for selected therapeutic drugs compared with the other tubes, except phenytoin in BD PST. Phenytoin samples ≥20 µg/mL in BD PST had 10–12% lower values than samples in BD Barricor. During sample storage, all selected drugs remained stable for 7 days in BD Barricor and in serum aliquots. In BD PST, all drugs remained stable except phenytoin and carbamazepine and in BD PST II except for phenytoin. Conclusion The BD Barricor Tube is effective for the collection and storage of plasma blood samples for therapeutic drug monitoring without sample aliquoting.

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