Impact of blood collection devices and mode of transportation on peripheral venous blood gas parameters.
Author(s): Bowen RAR, Esguerra V, Arboleda E, Cheng P, Hu B
Publication: Clin Chim Acta, 2023, Vol. 548, Page 117464
PubMed ID: 37399883 PubMed Review Paper? No
Purpose of Paper
This paper compared twenty blood gas parameters among case-matched specimens collected in lithium heparin syringes and tubes that were transported by courier and pneumatic tube system (PTS).
Conclusion of Paper
Blood specimens collected in plastic spray-coated lithium heparin evacuated tubes had significantly higher levels of partial pressure of oxygen (pO2), fractional oxyhemoglobin (FO2Hb, and oxygen saturation (sO2) and lower fractional deoxyhemoglobin (FHHb) than blood specimens that were collected in plastic electrolyte-balanced lithium heparin blood gas syringes, and the percent bias exceeded the total allowable error (TEA) in ≥86.3% of specimen pairs. The method of transport significantly affected pO2 levels based on a two-way ANOVA, with significantly higher pO2 in blood collected in syringes and tubes that were transported by PTS than matched blood transported by courier. While not significant by two-way ANOVA, blood in PTS-transported syringes and tubes had a significantly higher FO2Hb, calculated oxygen content (tube only), and sO2 and lower FHHb and base excess (tube only) than the matched specimen transported by courier in Wilcoxon signed-rank analysis. Importantly, the percent bias for pO2, FO2Hb, FHHb, and sO2 exceeded the TEA (calculated oxygen content and base excess TEA were unknown), with bias exceeding the TEA observed in 30-87.5% of specimen pairs.
Studies
-
Study Purpose
This study compared twenty blood gas parameters among case-matched specimens collected in lithium heparin syringes and tubes that were transported by courier and PTS. Blood from 40 healthy volunteers was collected using 21-gauge butterfly needles, through 30 cm of tubing, into two 3-mL plastic electrolyte-balanced lithium heparin blood gas syringes and two 4-mL plastic spray-coated lithium heparin evacuated tubes. During collection, tourniquets were released within 1 min of application. Any air bubbles in the tubes or syringes were immediately removed and tubes were capped to maintain anaerobic conditions. Syringes were mixed by rolling them in the collector’s hands, followed by inversion eight times; tubes were mixed by inversion ten times. Immediately after mixing, one tube and one syringe were sent to the laboratory by courier (mean duration=5 min) while the other was sent by pneumatic tube system (426.7 m with 8 bends, 6 accelerations/decelerations, speed 6.1 m/s; and average duration=5 min). After arrival, tubes and syringes were thoroughly mixed. pH and levels of sodium, potassium, chloride, ionized calcium, glucose, and lactate and the partial pressure of carbon dioxide (pCO2) and oxygen (pO2) were analyzed at 37°C on one of six ABL 825 BG instruments; matched specimens were analyzed together. Total hemoglobin, oxyhemoglobin, deoxyhemoglobin, carboxyhemoglobin, and methemoglobin were measured by co-oximetry and bicarbonate; total CO2, sO2, FO2Hb, base excess extracellular fluid, oxygen content, and hematocrit were calculated by the BG instrument.
Summary of Findings:
Blood specimens collected in tubes had higher levels of pO2, FO2Hb, and sO2 and lower FHHb than blood specimens that were collected in syringes (P<0.0001, all), with 79.1%, 65.1%, -39.8%, and 64.7% percent bias in pO2, FO2Hb, FHHb, and sO2, respectively. Importantly, the percent bias in pO2, FO2Hb, FHHb, and sO2 exceeded the total allowable error (TEA) in 93.0%, 86.3%, 93.0%, and 90.0% of pairs, respectively. The method of specimen transport significantly affected pO2 when analyzed by 2-way ANOVA, with significantly higher pO2 in specimens collected in syringes and tubes that were transported by PTS than the matched blood transported by courier (P<0.0001, both). Blood in PTS-transported syringes and tubes had higher FO2Hb (P=0.0002 and P<0.0001, respectively), calculated oxygen content (tube only P<0.0001), and sO2 (P=0.0002 and P<0.0001, respectively) and lower FHHb (P=0.0002 and P<0.0001, respectively) and base excess extracellular fluid (tube only, P=0.0014) than the matched specimen transported by courier after Wilcoxon signed-rank analysis, although differences were not significant by two-way ANOVA. Importantly, the percent bias in pO2, FO2Hb, FHHb, and sO2 exceeded the TEA (calculated oxygen content and base excess TEA were unknown). Importantly, the bias in pO2, FO2Hb, FHHb, and sO2 between PTS and courier-delivered syringes exceeded the TEA for 30%, 85%, 80%, and 87.5% of specimens, respectively. Similarly, the bias in pO2, FO2Hb, FHHb, and sO2, between PTS- and courier-delivered tubes exceeded the TEA for 62.5%, 72.5%, 77.5%, and 77.5% of specimens, respectively. pH, hematocrit, and levels of sodium, potassium, chloride, ionized calcium, glucose, lactate, total hemoglobin, fractional carboxyhemoglobin, fractional methemoglobin, and total carbon dioxide were not significantly affected by collection container or transport method.
Biospecimens
Preservative Types
- None (Fresh)
Diagnoses:
- Normal
Platform:
Analyte Technology Platform Carbohydrate Clinical chemistry/auto analyzer Electrolyte/Metal Clinical chemistry/auto analyzer Small molecule Clinical chemistry/auto analyzer Protein 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
Biospecimen Acquisition Type of collection container/solution Syringe
Evacuated tube