Influence of pneumatic tube delivery system on laboratory results.
Author(s): Makhlouf R, Fendri S, Jallouli D, Labiadh Z, Fritis L, Chaabouni K, Elleuch A, Ayadi FM
Publication: Ann Clin Biochem, 2023, Vol. , Page 45632231213743
PubMed ID: 37921518 PubMed Review Paper? No
Purpose of Paper
This paper compared levels of eight biochemistry analytes in venous blood specimens that were transported by pneumatic tube system (PTS) along a short/fast or a long/slow path and those that were transported by courier. Levels of arterial blood gas and pH were compared in case-matched arterial blood specimens that were transported by PTS and courier.
Conclusion of Paper
Compared to the matched venous blood specimens that were delivered by a courier, venous blood transported by the short/fast PTS path (80 m at 11.4 m/sec) had significantly higher levels of aspartate aminotransferase (AST) and potassium, and venous blood specimens that were transported by the long/slow path (385 m at 6.4 m/sec) had higher levels of AST. Potassium levels were significantly higher in venous blood specimens that were transported on the short/fast PTS path compared to levels in specimens transported on the long/slow path. However, the bias in all analytes was considered clinically insignificant. A slight but statistically and clinically insignificant increase in hemolysis index was found in venous blood specimens that were transported by PTS using either path compared to those transported by a courier. Among the specimens with a hemolysis index that exceeded the limit for lactate dehydrogenase (LDH), only one specimen displayed a significant change after PTS.
The partial pressure oxygen (pO2) was significantly higher in arterial blood specimens that were transported by PTS than by a courier, and the bias in pO2 exceeded the acceptable limit in 30% of PTS transported arterial specimens. pH and partial pressure carbon dioxide (pCO2) were not significantly affected by transport method.
Studies
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Study Purpose
This study compared levels of sodium, potassium, chloride, LDH, AST, alanine aminotransferase (ALT), and glucose as well as the hemolysis index between case-matched blood transported by a courier with levels in blood transported by a pneumatic tube system using short/fast and long/slow paths. Blood was collected from 30 patients into three lithium heparin tubes per patient by the same phlebotomist in the sampling room. Matched specimens were hand delivered or sent by PTS either from the sampling room to the laboratory along a short/fast path (80 m at 11.4 m/sec) or from cardiovascular surgery to the laboratory along a long/slow path (385 m at 6.4 m/sec). Matched samples were held until the arrival of the courier-delivered specimen and then both specimens were analyzed together. Levels of sodium, potassium, chloride, LDH, AST, ALT, and blood glucose as well as the hemolysis index were quantified using a Roche Cobas C501 chemistry analyzer. The total acceptable limit variation (TALV) was calculated based on the analytical coefficient of variance (CV) and the intra-individual CV; changes that exceeded the TALV were considered clinically significant.
Summary of Findings:
The temperature variation during specimen transport was <0.5°C for all specimens. As expected, PTS transport time was significantly shorter than transport time by courier (54 s ± 18 s versus 8 min 28 s ± 4 min 15 s; P<0.001). Compared to matched venous blood specimens delivered by a courier, venous blood specimens transported by PTS along a short/fast path (80 m at 11.4 m/sec) had higher levels of AST and potassium (P=0.037 and P=0.029, respectively), and specimens transported by PTS along ae long/slow path (385 m at 6.4 m/sec) had higher levels of AST (P=0.048). Potassium levels were higher in specimens transported on the short/fast PTS path compared to the long/slow path (P=0.048). However, the bias in all analytes was lower than the calculated TALV and thus differences were considered clinically insignificant. While a slight increase in the hemolysis index was found in specimens transported by PTS using the short/fast path or long/slow path compared to those transported by a courier (2.5 and 2.0, respectively versus 1.0), it was statistically insignificant and the percentage of specimens with a hemolysis index that exceeded the limit for LDH analysis was low (4.93% for courier, 3.7% for fast/short PTS and 6.66% for long/slow PTS). Finally, among the specimens with a hemolysis index that exceeded the limit for LDH, only one specimen displayed a significant change (22%) after PTS.
Biospecimens
Preservative Types
- Frozen
Diagnoses:
- Not specified
Platform:
Analyte Technology Platform Carbohydrate Clinical chemistry/auto analyzer Protein Clinical chemistry/auto analyzer Electrolyte/Metal Clinical chemistry/auto analyzer Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Storage Within hospital transportation method Hand-delivered
Pneumatic tube system
Storage Specimen transport duration/condition PTS 80 m at 11.4 m/sec
PTS 385 m at 6.4 m/sec
Courier
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Study Purpose
This study compared levels of arterial blood gas and pH between case-matched blood specimens that were transported by courier with those that were transported by pneumatic tube system (PTS). Arterial blood was collected from the femoral artery of 40 patients in the intensive care unit into two heparin sodium syringes. Matched specimens were hand delivered or sent by PTS from the ICU to the laboratory (306 m at 4.4 m/sec). Matched samples were held until the arrival of the courier-delivered specimen and then both were analyzed together. Arterial blood gas, including oxygen and carbon dioxide partial pressures, were analyzed using an ABL800 Flex Radiometer analyzer. The total acceptable limit variation (TALV) was calculated based on the analytical coefficient of variance (CV) and the intra-individual CV; changes in pCO2 and pH that exceeded TALV were considered clinically significant. For pO2, changes were compared to the French Society of Clinical Biology (SFBC) acceptability standard.
Summary of Findings:
The pO2 was significantly higher in arterial blood specimens that were transported by PTS compared to those that were transported by courier (P=0.001), and the bias in pO2 exceeded the acceptable limit specified by SFBC in 30% of specimens. However, pH and pCO2 were not significantly affected by the method of specimen transport and were lower than the TALV.
Biospecimens
Preservative Types
- Frozen
Diagnoses:
- Not specified
Platform:
Analyte Technology Platform Small molecule Clinical chemistry/auto analyzer Gas Clinical chemistry/auto analyzer Pre-analytical Factors:
Classification Pre-analytical Factor Value(s) Storage Within hospital transportation method Hand-delivered
Pneumatic tube system