Re: one study done on tube system and k

May 24, 2012

nice study thanks.Can you add this to our files on Potassium that has the cautions about blood being handled correctly?CE Grim MDOn May 24, 2012, at 7:45 AM, Francis Bill SUSPECTED PA wrote: Skip to main page content HOME CURRENT ISSUE ARCHIVE CONTACT US SUBSCRIBE HELP Keywords Search Advanced » User Name Password Sign In Lab Medicinelabmed.ascpjournals.org doi: 10.1309/LMZNZ2Y1P3KRDQYL (2009) LabMedicine, 40, 728-731. Changes of Serum Lactate Dehydrogenase and Potassium Levels Produced by a Pneumatic Tube System Ming Cui, PhD1, Rongrong Jing, PhD1 and Huimin Wang, PhD1,2+ Author Affiliations 1Center of Laboratory Medicine, Affiliated Hospital of Nantong University 2Public Health Institute of Nantong University, Nantong, Jiangsu Province, People's Republic of China Next Section AbstractObjective: Errors in laboratory measurements could be derived from many pre-analytical factors. The aim of this study was to assess the influence of the hospital's pneumatic tube system (PTS) on serum lactate dehydrogenase (LDH) and potassium. Methods: Forty-five healthy blood donors were involved. We studied LDH and potassium delivered to the laboratory by a PTS with different carrier inserts and transport times. In addition, influences of the PTS sending different types of specimens on LDH and potassium were determined. Results: Blood specimens sent via PTS several times or without carrier inserts had statistical changes in LDH; the potassium had a slightly rising trend. Of the under-filled blood draw tubes or lithium heparin tube specimens, changes were caused by the PTS, but there were no effects on pure serum specimens. Conclusions: Many minor shakings derived from the transportation of the PTS inevitably influenced LDH and potassium. Rapid sample delivery systems, usually pneumatic tube systems (PTSs), have been installed in hospitals to transport blood specimens from the phlebotomy site to the core laboratory and deliver patient reports to clinicians. The use of such rapid sample delivery systems can significantly reduce the turnaround times (TATs) of results, which account for approximately 40% in the laboratory median TATs.1 However, the forces applied on a blood specimen transported by a PTS include sudden accelerations/decelerations, changes in air pressures, movement of blood in the test tube, and vibrations. It should be noted that the strong forces from the PTS can potentially affect some clinical laboratory measurements, such as blood gas measurements,2 spectrophotometric analysis of cerebrospinal fluid,3 routine and novel hematology, and coagulation analyzations.4 In some cases it will induce blood cell deterioration caused by rapid a ccelerations and decelerations along its trajectory.5 Thus, considering the blood specimen's quality, Sodi and colleagues stressed that all laboratories should investigate their blood specimen's susceptibility to hemolysis when transported through the PTS.6The aim of this study was to evaluate the possible changes to the levels of 2 sensitive indicators, lactate dehydrogenase (LDH) and potassium. Both easily leak out of the blood cells in blood specimens when transported through the PTS in our hospital. Previous SectionNext Section Materials and Methods Description of the PTSThe PTS (Sumetzberger, Vienna, Austria) installed in our hospital had 2 subsystems, 52 stations, a constant speed of 6 m/s, and the longest route of 600 m. In our present study, the test specimens were transported by the PTS from the phlebotomy site to the clinical chemistry laboratory, which is approximately 90 m including 17 vertical and horizontal bends (800 mm radius) and 2 switches. The carriers have a diameter of 160 mm and a length of 440 mm. Two kinds of carrier inserts (sponge-rubber and plastic-bag) were used for protection during the transportation in the PTS. Specimens and Experimental DesignThe study subjects consisted of 45 healthy blood donors (21 males and 24 females, mean age 29 years, range 22–35 years). All subjects gave informed consent to participate in the study. The collection of venous blood specimens was performed by a single venipuncture from the antecubital vein by trained phlebotomists. Two kinds of Vacuette blood collection tubes, 5 mL clot activator tubes and 4 mL lithium heparin tubes, were used in this study. Part 1: Effects of r Inserts and Transport TimesA total of 50 mL of blood from each donor was collected into 10 Vacuette clot activator tubes. Of the 10 specimens, No. 1 was hand carried from the phlebotomy site to the clinical chemistry laboratory (mode H). Numbers 2, 3, and 4 were protected with sponge-rubber inserts (mode S) and transported by the PTS 1 time, 5 times, or 9 times, respectively. Numbers 5, 6, and 7 were protected with plastic-bag inserts (mode P) and sent via the PTS for the above times respectively. Numbers 8, 9, and 10 were transported with no inserts (mode N) by the PTS for the same times respectively. Part 2: Effects of Transportation of Under-filled Blood Specimens and Anticoagulated SpecimensWe obtained 10 mL of blood from each donor. The first 1 mL of blood was drawn into a 5 mL Vacuette clot activator tube, and only 20% of the tube capacity was filled. Another 5 mL Vacuette clot activator tube was filled with 5 mL of blood, and a 4 mL Vacuette lithium-heparin tube was simultaneously filled with 4 mL of blood. Then all 3 specimens were transported by the PTS 5 times with sponge-rubber inserts. Part 3: Effects of Transportation of SerumThe amount of 7 mL of blood from each donor was drawn into 2 Vacuette clot activator tubes and allowed to clot for 30 minutes. Pooled sera from the 2 tubes were aliquotted into 3 Vacuette tubes after centrifugation. One of them was hand carried for 1 time; the others were transported by the PTS for 1 time or 9 times, respectively. In each part of the study, a standardized procedure was followed to eliminate certain variables: all measurements of each part were tested in the same run; all blood specimens were routinely centrifuged for 10 minutes at 2,500 × g; hand carrying was always done by the same person. Sample AnalysisLactate dehydrogenase activity was measured on the Hitachi 7600 instrument (Hitachi, Tokyo, Japan) with an IFCC-recommended method. An ISE method was used for measuring potassium levels. The calibration was processed with Randox calibrators (Randox Laboratories, Crumlin, United Kingdom) in accordance with the manufacturer's instructions, and internal quality controls were performed in the same batch with these analytical specimens. Statistical AnalysisAll statistical analyses were used by SPSS 15.0 or Med-Calc 9.6 software. The paired t-test or one-way ANOVA and LSD analyses were used to evaluate the statistical differences among groups. P<0.05 was regarded as statistically significant. Previous SectionNext Section Results Part 1: Effects of r Inserts and Transportation TimesTo determine the effects of the PTS with different carrier inserts on the results of serum LDH and potassium, we compared specimens sent to the laboratory via a PTS with hand-carried specimens drawn from the same donors at the same time. Table 1 shows the statistically significant changes in LDH between specimens that were hand carried and those sent through the PTS with no carrier insert (mode N). Among the 3 modes (S, P, N), significant differences were found between mode N and modes S and P (P<0.001). For potassium, there were rising trends during the PTS transportation (Figure 1). View this table: In this window In a new window Table 1Summary of Statistical Data on Specimens Sent via PTS for Different Times in 4 Sending Modes View larger version: In this page In a new window Figure 1Effect of transportation modes and times on the values of LDH and potassium. Mean LDH and potassium (±SD) are represented by the box; medians are plotted as a line inside the box; error bars represent the 10th and 90th percentiles. Means of each group are linked by a line. hc1, sent by hand 1 time; sr1, sr5, or sr9, sent via PTS with sponge-rubber inserts 1 time, 5 times, or 9 times respectively; pb1, pb5, or pb9, sent via PTS with plastic bag inserts 1 time, 5 times, or 9 times respectively; ni1, ni5, or ni9, sent via PTS without carrier inserts (no inserts) 1 time, 5 times, or 9 times respectively. Table 1 also demonstrates the effects of transport times on results of serum LDH and potassium under modes S, P, and N. When the transport time increased, the levels of LDH were higher, and statistical changes were found (P<0.001). For potassium, there were rising trends between only 1 time and many times (Figure 1). The PTS with no carrier insert and increased transportation affected the serum LDH and potassium, but the extent of changes was different. Part 2: Effects of Transportation of Under-filled Blood Specimens and Anticoagulated SpecimensTable 2 and Figure 2 show the data of paired specimens when sending them via the PTS 5 times with sponge-rubber protection. For LDH and potassium, there were statistically significant changes in under-filled specimens compared to filled specimens (Pâ‰¤0.0001). In addition, under complete tube-filling circumstances, statistical differences were also found between clotted specimens and lithium-heparin anticoagulated ones (Pâ‰¤0.0001). However, LDH values were higher in anticoagulated tubes than in serum tubes while potassium was lower. The underfilled or the unclotted specimens sent via PTS have an effect on the results of LDH and potassium. The levels of serum LDH were more altered by the PTS than potassium. View this table: In this window In a new window Table 2Analytical Results of 3 Kinds of Specimens When Sent via the PTS for 5 Times and Their Significance View larger version: In this page In a new window Figure 2Effect of transportation specimen types on the values of LDH and potassium. When 1 mL of blood was drawn into a 5 mL vacuum tube and 4 mL remained, the levels of LDH and potassium were higher than the values of fully-filled specimens. However, in complete fully-filled circumstances, there was a higher value of LDH and a lower value of potassium in plasma than in serum. Part 3: Effects of Transportation of SerumWhen sera were sent by the PTS many times and by hand 1 time, no statistical changes of LDH and potassium were found (Table 3). View this table: In this window In a new window Table 3Summary of Statistical Data of Serum LDH and Potassium with 2 Sent Means for Different Times Previous SectionNext Section DiscussionPneumatic tube systems allow rapid and convenient transport of blood specimens to clinical laboratories and are widely used in modern medical centers. However, there is growing attention to blood specimen quality affected by the PTS. To the best of our knowledge, few studies have investigated the effect of PTS on hemolysis. In a study by Stair and colleagues,7 of the 291 specimens they studied, 47 of those carried by hand were visibly hemolyzed on arrival, compared with 40 specimens transported by a PTS. The hemolysis was determined by a technologist who was blinded to how the pair of specimens had been reported. There was no significant difference in hemolysis frequency between sent specimens by hand and via PTS. Fernandes and colleagues also reported there was no significant difference in the hemolysis rate between specimens delivered by a PTS and those delivered by a human courier. In their essays, hemolysis was measured by visual inspection of the specimens using a 4-point validated Likert scale based on the plasma hemoglobin concentration.8 However, in the Steige and colleagues study, hemoglobin, LDH, and potassium of the blood specimens would alter when sent through their PTS, which had some different characteristics when compared to our PTS, such as number of bends, carriers, inserts, and transport speeds.9From the published studies, it is apparent that differences exist in different PTSs. Therefore, PTSs should be evaluated prior to use for transport of whole blood specimens. The aim of this study was to assess the influence of the PTS in our hospital on the levels of serum LDH and potassium that easily leak out of the blood cells. The first part of the study showed protection played an important role in the specimens' transportation. Statistical differences existed between hand-carried blood speciments and those transported via the PTS without sponge-rubber or plastic-bag inserts for 1 time, statistical differences occurred compared to hand-carried ones. In addition, we found there were statistical changes between modes S, P, and N despite the number of times sent. These indicate blood specimens should be protected with carrier inserts during transportation by the PTS. Furthermore, with increased transportation, the rising LDH values showed the statistical difference under modes S, P, and N. All of these demonstrated that during the transportation of blood specimens, too many slight shakings had inevitably influenced the stability of some blood constituents. In addition, blood specimens transported in incompletely filled tubes appeared to have been shaken more than those transported in completely filled tubes, which was consistent with findings by Harold and colleagues.9 Additionally, we found the PTS had more influence on anticoagulated blood specimens than completely clotted specimens. The anticoagulated blood specimens induced more increased LDH values than clotted specimens transported by the PTS. It has been well known the values of LDH are higher in serum tubes than in heparin ones when these tubes were transported by hand (the routine way). However, the extent of influence was different between LDH and potassium. The probable explanation of our results was that the concentration of red cell LDH was 160-fold greater than that present in the plasma10 or 150 times greater than that of normal serum. However, the distribution of intracellular and extracellular potassium is not as obvious as LDH (ie, the concentration of potassium inside the RBC was only 23 times as much as that found in plasma).10 The shakings induced by a PTS were so slight the changes of potassium were not similar to LDH, which was higher in heparin tubes than in serum ones after being transported by the PTS. No slight influence of PTS is more easily ignored than high value variables. Although a World Health Organization document recommended plasma specimens for the test of LDH and potassium, our results showed the changes of LDH and potassium in lithium-heparin tubes after sending via the PTS could not be ignored.11In addition, we found there were no statistical changes when sera were transported several times through the PTS. This reminds us the transportation of serum is available. The whole blood specimen should be centrifuged after completed clotting, and the sera were aliquoted into another tube to be sent via the PTS. In conclusion, although the use of a PTS increased work efficiency and decreased TATs, all clinical laboratory staff should recognize the negative side of PTS with regards to the stability of blood constituents. Previous SectionNext Section AcknowledgmentsWe gratefully acknowledge Jianyou Su, Lianying Chen, and Jianhui Xu of the Clinical Chemistry Laboratory Section and Yinchun Chen of the Blood Sampling Center for their skillful work. Copyright© by the American Society for Clinical Pathology (ASCP) Previous Section References 1.â†µ Guss DA, Chan TC, Killeen JP. The impact of a pneumatic tube and computerized physician order management on laboratory turnaround time. Ann Emerg Med. 2008;51:181–185. CrossRefMedline 2.â†µ on PO, CM, Gaze DC, et al.Changes in blood gas samples produced by a pneumatic tube system. J Clin Pathol. 2002;55:105–107. Abstract/FREE Full Text 3.â†µ Wenham PR, Hanson T, Ashby JP. Interference in spectrophotometric analysis of cerebrospinal fluid by hemolysis induced by transport through a pneumatic tube system. Ann Clin Biochem. 2001;38:371–375. Abstract/FREE Full Text 4.â†µ Kratz A, Salem RO, Van Cott EM. Effects of a pneumatic tube system on routine and novel hematology and coagulation parameters in healthy volunteers. Arch Pathol Lab Med. 2007;131:293–296. Medline 5.â†µ Health Technical Memorandum (HTM)2009. Pneumatic air tube transport systems: Management policy. Available at http://195.92.246.148/knowledge_network/documents/HTM2009%20Pneumatic%20air%20tube%20transport%20systems%20Management%20policy%202003123133017281.pdf. Accessed November 26, 2008. 6.â†µ Sodi R, Darn SM, Stott A. Pneumatic tube system induced hemolysis: Assessing sample type susceptibility to hemolysis. Ann Clin Biochem. 2004;41:237–240. Abstract/FREE Full Text 7.â†µ Stair TO, Howell JM, Fitzgerald DJ, et al.Hemolysis of blood specimens transported from ED to laboratory by pneumatic tube. Am J Emerg Med. 1995;13:484. Medline 8.â†µ Fernandes CM, Worster A, Eva K, et al.Pneumatic tube delivery system for blood samples reduces turnaround times without affecting sample quality. J Emerg Nurs. 2006;32:139–143. CrossRefMedline 9.â†µ Steige H, JD. Evaluation of pneumatic-tube system for delivery of blood specimens. Clin Chem. 1971;17:1160–1164. Abstract/FREE Full Text 10.â†µ Narayanan S. The preanalytic phase. An important component of laboratory medicine. Am J Clin Pathol. 2000;113:429–452. Abstract/FREE Full Text 11.â†µ Banfi G, Bauer K, Brand W, et al.Use of anticoagulants in diagnostic laboratory investigations. Geneva, Switzerland: World Health Organization; 2002 WHO document WHO/DIL/LAB/99.1 Rev 2. « Previous | Next Article » Table of Contents This Article doi: 10.1309/LMZNZ2Y1P3KRDQYL (2009) LabMedicine, 40, 728-731. Abstract Figures Only » Full Text Full Text (PDF) - TOC Category Science - Services E-mail this article to a friend Alert me when this article is cited Alert me if a correction is posted Similar articles in this journal No Web of Science related articles Download to citation manager + Citing Articles No citing articles Citing Articles via Web of Science (1) Articles citing this article + Google Scholar Articles by Cui, M. Articles by Wang, H. Search for related content + PubMed Articles by Cui, M. Articles by Wang, H. Navigate This Article Top Abstract Materials and Methods Results Discussion Acknowledgments References Current Issue May 2012, 43 (4) Alert me to new issues of LabMedicine SUBMISSIONS PERMISSIONS ADVERTISE CE UPDATES EDITORIAL BOARD E-MAIL ALERTS (FREE) RSS FEEDS (FREE) CONTACT US ASCP.ORG AJCP CAREER CENTER Copyright © 2012 by The American Society for Clinical Pathology Print ISSN: 0007-5027 Online ISSN: 1943-7730

May 24, 2012

This appears to be a good study of one Pneumatic Tube System and shows me there may be + .1 variance by using the system. If doctors ignore numbers in the 2.5 - 3.0 range for years I'm sure they won't notice 0.1! (It may explain why some at the low end of the range have Sxs.) What it doesn't address is the consistency of a courier system. I'm sure this one was very controlled since they were doing a study but if someone was doing thousands a day like at the VA would they be consistent and timely and how would we know and control? (I prefer a .1 variance to wondering if the courier was on time, didn't stop at the CU or potty room or find someone to chat with, etc., especially since the doctor will not notice a difference between 3.4 and 3.5!)

Now the good point that your study does make is the quality of the Pneumatic Tube System and how often is it checked. That might be a good discussion for you to have with Deborah Cutts, the Quality Manager at the VA. In fact maybe you can convince her to look at the whole process from the draw through the Pneumatic Tube System.

>> [Publisher Logo] > <http://www.ascpjournals.org/tslogin?url=http%3A%2F%2Fwww.ascp.org%2F> > [LabMedicine] <http://labmed.ascpjournals.org/>> Skip to main page content> <http://labmed.ascpjournals.org/content/40/12/728.full#content-block>> > * HOME <http://labmed.ascpjournals.org/>> * CURRENT ISSUE <http://labmed.ascpjournals.org/content/current>> * ARCHIVE <http://labmed.ascpjournals.org/content>> * CONTACT US <http://labmed.ascpjournals.org/feedback>> * SUBSCRIBE> <http://labmed.ascpjournals.org/site/subscriptions/index.xhtml>> * HELP <http://labmed.ascpjournals.org/help>> Keywords Search <http://labmed.ascpjournals.org/content/40/12/728.full#>> Advanced » <http://labmed.ascpjournals.org/search> User Name > Password Sign In > <http://labmed.ascpjournals.org/content/40/12/728.full#>> *> Lab Medicinelabmed.ascpjournals.org> 1. doi: 10.1309/LMZNZ2Y1P3KRDQYL (2009) LabMedicine, 40, 728-731.> Changes of Serum Lactate Dehydrogenase and Potassium Levels Produced by> a Pneumatic Tube System> 1. Ming Cui> <http://labmed.ascpjournals.org/search?author1=Ming+Cui & sortspec=date & su\> bmit=Submit> , PhD1> <http://labmed.ascpjournals.org/content/40/12/728.full#aff-1> ,> 2. Rongrong Jing> <http://labmed.ascpjournals.org/search?author1=Rongrong+Jing & sortspec=da\> te & submit=Submit> , PhD1> <http://labmed.ascpjournals.org/content/40/12/728.full#aff-1> and> 3. Huimin Wang> <http://labmed.ascpjournals.org/search?author1=Huimin+Wang & sortspec=date\> & submit=Submit> , PhD1> <http://labmed.ascpjournals.org/content/40/12/728.full#aff-1> ,2> <http://labmed.ascpjournals.org/content/40/12/728.full#aff-2>> > + <http://labmed.ascpjournals.org/content/40/12/728.full#> Author> Affiliations> > 1. 1Center of Laboratory Medicine, Affiliated Hospital of Nantong> University> 2. 2Public Health Institute of Nantong University, Nantong, Jiangsu> Province, People's Republic of China> > Next Section> <http://labmed.ascpjournals.org/content/40/12/728.full#sec-5> Abstract> Objective: Errors in laboratory measurements could be derived from many> pre-analytical factors. The aim of this study was to assess the> influence of the hospital's pneumatic tube system (PTS) on serum> lactate dehydrogenase (LDH) and potassium.> > Methods: Forty-five healthy blood donors were involved. We studied LDH> and potassium delivered to the laboratory by a PTS with different> carrier inserts and transport times. In addition, influences of the PTS> sending different types of specimens on LDH and potassium were> determined.> > Results: Blood specimens sent via PTS several times or without carrier> inserts had statistical changes in LDH; the potassium had a slightly> rising trend. Of the under-filled blood draw tubes or lithium heparin> tube specimens, changes were caused by the PTS, but there were no> effects on pure serum specimens.> > Conclusions: Many minor shakings derived from the transportation of the> PTS inevitably influenced LDH and potassium.> > Rapid sample delivery systems, usually pneumatic tube systems (PTSs),> have been installed in hospitals to transport blood specimens from the> phlebotomy site to the core laboratory and deliver patient reports to> clinicians. The use of such rapid sample delivery systems can> significantly reduce the turnaround times (TATs) of results, which> account for approximately 40% in the laboratory median TATs.1> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-1> However,> the forces applied on a blood specimen transported by a PTS include> sudden accelerations/decelerations, changes in air pressures, movement> of blood in the test tube, and vibrations. It should be noted that the> strong forces from the PTS can potentially affect some clinical> laboratory measurements, such as blood gas measurements,2> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-2> > spectrophotometric analysis of cerebrospinal fluid,3> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-3> routine> and novel hematology, and coagulation analyzations.4> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-4> In some> cases it will induce blood cell deterioration caused by rapid a> ccelerations and decelerations along its trajectory.5> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-5> Thus,> considering the blood specimen's quality, Sodi and colleagues> stressed that all laboratories should investigate their blood> specimen's susceptibility to hemolysis when transported through the> PTS.6 <http://labmed.ascpjournals.org/content/40/12/728.full#ref-6>> > The aim of this study was to evaluate the possible changes to the levels> of 2 sensitive indicators, lactate dehydrogenase (LDH) and potassium.> Both easily leak out of the blood cells in blood specimens when> transported through the PTS in our hospital.> Previous Section> <http://labmed.ascpjournals.org/content/40/12/728.full#abstract-1> Next> Section <http://labmed.ascpjournals.org/content/40/12/728.full#sec-13> > Materials and Methods Description of the PTS> The PTS (Sumetzberger, Vienna, Austria) installed in our hospital had 2> subsystems, 52 stations, a constant speed of 6 m/s, and the longest> route of 600 m. In our present study, the test specimens were> transported by the PTS from the phlebotomy site to the clinical> chemistry laboratory, which is approximately 90 m including 17 vertical> and horizontal bends (800 mm radius) and 2 switches. The carriers have a> diameter of 160 mm and a length of 440 mm. Two kinds of carrier inserts> (sponge-rubber and plastic-bag) were used for protection during the> transportation in the PTS.> Specimens and Experimental Design> The study subjects consisted of 45 healthy blood donors (21 males and 24> females, mean age 29 years, range 22–35 years). All subjects gave> informed consent to participate in the study. The collection of venous> blood specimens was performed by a single venipuncture from the> antecubital vein by trained phlebotomists. Two kinds of Vacuette blood> collection tubes, 5 mL clot activator tubes and 4 mL lithium heparin> tubes, were used in this study.> Part 1: Effects of r Inserts and Transport Times> A total of 50 mL of blood from each donor was collected into 10 Vacuette> clot activator tubes. Of the 10 specimens, No. 1 was hand carried from> the phlebotomy site to the clinical chemistry laboratory (mode H).> Numbers 2, 3, and 4 were protected with sponge-rubber inserts (mode S)> and transported by the PTS 1 time, 5 times, or 9 times, respectively.> Numbers 5, 6, and 7 were protected with plastic-bag inserts (mode P) and> sent via the PTS for the above times respectively. Numbers 8, 9, and 10> were transported with no inserts (mode N) by the PTS for the same times> respectively.> Part 2: Effects of Transportation of Under-filled Blood Specimens and> Anticoagulated Specimens> We obtained 10 mL of blood from each donor. The first 1 mL of blood was> drawn into a 5 mL Vacuette clot activator tube, and only 20% of the tube> capacity was filled. Another 5 mL Vacuette clot activator tube was> filled with 5 mL of blood, and a 4 mL Vacuette lithium-heparin tube was> simultaneously filled with 4 mL of blood. Then all 3 specimens were> transported by the PTS 5 times with sponge-rubber inserts.> Part 3: Effects of Transportation of Serum> The amount of 7 mL of blood from each donor was drawn into 2 Vacuette> clot activator tubes and allowed to clot for 30 minutes. Pooled sera> from the 2 tubes were aliquotted into 3 Vacuette tubes after> centrifugation. One of them was hand carried for 1 time; the others were> transported by the PTS for 1 time or 9 times, respectively.> > In each part of the study, a standardized procedure was followed to> eliminate certain variables: all measurements of each part were tested> in the same run; all blood specimens were routinely centrifuged for 10> minutes at 2,500 × g; hand carrying was always done by the same> person.> Sample Analysis> Lactate dehydrogenase activity was measured on the Hitachi 7600> instrument (Hitachi, Tokyo, Japan) with an IFCC-recommended method. An> ISE method was used for measuring potassium levels. The calibration was> processed with Randox calibrators (Randox Laboratories, Crumlin, United> Kingdom) in accordance with the manufacturer's instructions, and> internal quality controls were performed in the same batch with these> analytical specimens.> Statistical Analysis> All statistical analyses were used by SPSS 15.0 or Med-Calc 9.6> software. The paired t-test or one-way ANOVA and LSD analyses were used> to evaluate the statistical differences among groups. P<0.05 was> regarded as statistically significant.> Previous Section> <http://labmed.ascpjournals.org/content/40/12/728.full#sec-5> Next> Section <http://labmed.ascpjournals.org/content/40/12/728.full#sec-17> > Results Part 1: Effects of r Inserts and Transportation Times> To determine the effects of the PTS with different carrier inserts on> the results of serum LDH and potassium, we compared specimens sent to> the laboratory via a PTS with hand-carried specimens drawn from the same> donors at the same time. Table 1> <http://labmed.ascpjournals.org/content/40/12/728.full#T1> shows the> statistically significant changes in LDH between specimens that were> hand carried and those sent through the PTS with no carrier insert (mode> N). Among the 3 modes (S, P, N), significant differences were found> between mode N and modes S and P (P<0.001). For potassium, there were> rising trends during the PTS transportation (Figure 1> <http://labmed.ascpjournals.org/content/40/12/728.full#F1> ).> View this table:> * In this window> <http://labmed.ascpjournals.org/content/40/12/728/T1.expansion.html>> * In a new window> <http://labmed.ascpjournals.org/content/40/12/728/T1.expansion.html>> Table 1> Summary of Statistical Data on Specimens Sent via PTS for Different> Times in 4 Sending Modes> [Figure 1] > <http://labmed.ascpjournals.org/content/40/12/728/F1.expansion.html> > View larger version:> * In this page> <http://labmed.ascpjournals.org/content/40/12/728/F1.expansion.html>> * In a new window> <http://labmed.ascpjournals.org/content/40/12/728/F1.expansion.html>> > Figure 1> Effect of transportation modes and times on the values of LDH and> potassium. Mean LDH and potassium (±SD) are represented by the box;> medians are plotted as a line inside the box; error bars represent the> 10th and 90th percentiles. Means of each group are linked by a line.> hc1, sent by hand 1 time; sr1, sr5, or sr9, sent via PTS with> sponge-rubber inserts 1 time, 5 times, or 9 times respectively; pb1,> pb5, or pb9, sent via PTS with plastic bag inserts 1 time, 5 times, or 9> times respectively; ni1, ni5, or ni9, sent via PTS without carrier> inserts (no inserts) 1 time, 5 times, or 9 times respectively.> > Table 1 <http://labmed.ascpjournals.org/content/40/12/728.full#T1> also> demonstrates the effects of transport times on results of serum LDH and> potassium under modes S, P, and N. When the transport time increased,> the levels of LDH were higher, and statistical changes were found> (P<0.001). For potassium, there were rising trends between only 1 time> and many times (Figure 1> <http://labmed.ascpjournals.org/content/40/12/728.full#F1> ).> > The PTS with no carrier insert and increased transportation affected the> serum LDH and potassium, but the extent of changes was different.> Part 2: Effects of Transportation of Under-filled Blood Specimens and> Anticoagulated Specimens> Table 2 <http://labmed.ascpjournals.org/content/40/12/728.full#T2> and> Figure 2 <http://labmed.ascpjournals.org/content/40/12/728.full#F2> > show the data of paired specimens when sending them via the PTS 5 times> with sponge-rubber protection. For LDH and potassium, there were> statistically significant changes in under-filled specimens compared to> filled specimens (Pâ‰¤0.0001). In addition, under complete> tube-filling circumstances, statistical differences were also found> between clotted specimens and lithium-heparin anticoagulated ones> (Pâ‰¤0.0001). However, LDH values were higher in anticoagulated> tubes than in serum tubes while potassium was lower.> > The underfilled or the unclotted specimens sent via PTS have an effect> on the results of LDH and potassium. The levels of serum LDH were more> altered by the PTS than potassium.> View this table:> * In this window> <http://labmed.ascpjournals.org/content/40/12/728/T2.expansion.html>> * In a new window> <http://labmed.ascpjournals.org/content/40/12/728/T2.expansion.html>> Table 2> Analytical Results of 3 Kinds of Specimens When Sent via the PTS for 5> Times and Their Significance> [Figure 2] > <http://labmed.ascpjournals.org/content/40/12/728/F2.expansion.html> > View larger version:> * In this page> <http://labmed.ascpjournals.org/content/40/12/728/F2.expansion.html>> * In a new window> <http://labmed.ascpjournals.org/content/40/12/728/F2.expansion.html>> > Figure 2> Effect of transportation specimen types on the values of LDH and> potassium. When 1 mL of blood was drawn into a 5 mL vacuum tube and 4 mL> remained, the levels of LDH and potassium were higher than the values of> fully-filled specimens. However, in complete fully-filled circumstances,> there was a higher value of LDH and a lower value of potassium in plasma> than in serum.> Part 3: Effects of Transportation of Serum> When sera were sent by the PTS many times and by hand 1 time, no> statistical changes of LDH and potassium were found (Table 3> <http://labmed.ascpjournals.org/content/40/12/728.full#T3> ).> View this table:> * In this window> <http://labmed.ascpjournals.org/content/40/12/728/T3.expansion.html>> * In a new window> <http://labmed.ascpjournals.org/content/40/12/728/T3.expansion.html>> Table 3> Summary of Statistical Data of Serum LDH and Potassium with 2 Sent Means> for Different Times> Previous Section> <http://labmed.ascpjournals.org/content/40/12/728.full#sec-13> Next> Section <http://labmed.ascpjournals.org/content/40/12/728.full#ack-1> > Discussion> Pneumatic tube systems allow rapid and convenient transport of blood> specimens to clinical laboratories and are widely used in modern medical> centers. However, there is growing attention to blood specimen quality> affected by the PTS.> > To the best of our knowledge, few studies have investigated the effect> of PTS on hemolysis. In a study by Stair and colleagues,7> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-7> of the> 291 specimens they studied, 47 of those carried by hand were visibly> hemolyzed on arrival, compared with 40 specimens transported by a PTS.> The hemolysis was determined by a technologist who was blinded to how> the pair of specimens had been reported. There was no significant> difference in hemolysis frequency between sent specimens by hand and via> PTS. Fernandes and colleagues also reported there was no significant> difference in the hemolysis rate between specimens delivered by a PTS> and those delivered by a human courier. In their essays, hemolysis was> measured by visual inspection of the specimens using a 4-point validated> Likert scale based on the plasma hemoglobin concentration.8> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-8> However,> in the Steige and colleagues study, hemoglobin, LDH, and potassium of> the blood specimens would alter when sent through their PTS, which had> some different characteristics when compared to our PTS, such as number> of bends, carriers, inserts, and transport speeds.9> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-9>> > From the published studies, it is apparent that differences exist in> different PTSs. Therefore, PTSs should be evaluated prior to use for> transport of whole blood specimens. The aim of this study was to assess> the influence of the PTS in our hospital on the levels of serum LDH and> potassium that easily leak out of the blood cells.> > The first part of the study showed protection played an important role> in the specimens' transportation. Statistical differences existed> between hand-carried blood speciments and those transported via the PTS> without sponge-rubber or plastic-bag inserts for 1 time, statistical> differences occurred compared to hand-carried ones. In addition, we> found there were statistical changes between modes S, P, and N despite> the number of times sent. These indicate blood specimens should be> protected with carrier inserts during transportation by the PTS.> Furthermore, with increased transportation, the rising LDH values showed> the statistical difference under modes S, P, and N. All of these> demonstrated that during the transportation of blood specimens, too many> slight shakings had inevitably influenced the stability of some blood> constituents.> > In addition, blood specimens transported in incompletely filled tubes> appeared to have been shaken more than those transported in completely> filled tubes, which was consistent with findings by Harold and> colleagues.9> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-9> > Additionally, we found the PTS had more influence on anticoagulated> blood specimens than completely clotted specimens. The anticoagulated> blood specimens induced more increased LDH values than clotted specimens> transported by the PTS. It has been well known the values of LDH are> higher in serum tubes than in heparin ones when these tubes were> transported by hand (the routine way). However, the extent of influence> was different between LDH and potassium. The probable explanation of our> results was that the concentration of red cell LDH was 160-fold greater> than that present in the plasma10> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-10> or 150> times greater than that of normal serum. However, the distribution of> intracellular and extracellular potassium is not as obvious as LDH (ie,> the concentration of potassium inside the RBC was only 23 times as much> as that found in plasma).10> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-10> The> shakings induced by a PTS were so slight the changes of potassium were> not similar to LDH, which was higher in heparin tubes than in serum ones> after being transported by the PTS. No slight influence of PTS is more> easily ignored than high value variables. Although a World Health> Organization document recommended plasma specimens for the test of LDH> and potassium, our results showed the changes of LDH and potassium in> lithium-heparin tubes after sending via the PTS could not be ignored.11> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-11>> > In addition, we found there were no statistical changes when sera were> transported several times through the PTS. This reminds us the> transportation of serum is available. The whole blood specimen should be> centrifuged after completed clotting, and the sera were aliquoted into> another tube to be sent via the PTS.> > In conclusion, although the use of a PTS increased work efficiency and> decreased TATs, all clinical laboratory staff should recognize the> negative side of PTS with regards to the stability of blood> constituents.> Previous Section> <http://labmed.ascpjournals.org/content/40/12/728.full#sec-17> Next> Section> <http://labmed.ascpjournals.org/content/40/12/728.full#ref-list-1> > Acknowledgments> We gratefully acknowledge Jianyou Su, Lianying Chen, and Jianhui Xu of> the Clinical Chemistry Laboratory Section and Yinchun Chen of the Blood> Sampling Center for their skillful work.> > * Copyright© by the American Society for Clinical Pathology (ASCP)> Previous Section> <http://labmed.ascpjournals.org/content/40/12/728.full#ack-1> > References> 1. 1.â†µ> <http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-1-1>> 1. Guss DA,> 2. Chan TC,> 3. Killeen JP> . The impact of a pneumatic tube and computerized physician order> management on laboratory turnaround time. Ann Emerg Med.> 2008;51:181–185. CrossRef> <http://labmed.ascpjournals.org/external-ref?access_num=10.1016/j.anneme\> rgmed.2007.03.010 & link_type=DOI> Medline> <http://labmed.ascpjournals.org/external-ref?access_num=17467118 & link_ty\> pe=MED>> 4. 2.â†µ> <http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-2-1>> 1. on PO,> 2. CM,> 3. Gaze DC,> 4. et al.> Changes in blood gas samples produced by a pneumatic tube system. J Clin> Pathol. 2002;55:105–107. Abstract/FREE Full Text> <http://labmed.ascpjournals.org/cgi/ijlink?linkType=ABST & journalCode=jcl\> inpath & resid=55/2/105>> 5. 3.â†µ> <http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-3-1>> 1. Wenham PR,> 2. Hanson T,> 3. Ashby JP> . Interference in spectrophotometric analysis of cerebrospinal fluid by> hemolysis induced by transport through a pneumatic tube system. Ann Clin> Biochem. 2001;38:371–375. Abstract/FREE Full Text> <http://labmed.ascpjournals.org/cgi/ijlink?linkType=ABST & journalCode=rsm\> acb & resid=38/4/371>> 4. 4.â†µ> <http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-4-1>> 1. Kratz A,> 2. Salem RO,> 3. Van Cott EM> . Effects of a pneumatic tube system on routine and novel hematology and> coagulation parameters in healthy volunteers. Arch Pathol Lab Med.> 2007;131:293–296. Medline> <http://labmed.ascpjournals.org/external-ref?access_num=17284116 & link_ty\> pe=MED>> 4. 5.â†µ> <http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-5-1>> 1. Health Technical Memorandum (HTM)> 2009. Pneumatic air tube transport systems: Management policy. Available> at> http://195.92.246.148/knowledge_network/documents/HTM2009%20Pneumatic%20\> air%20tube%20transport%20systems%20Management%20policy%20200312313301728\> 1.pdf> <http://195.92.246.148/knowledge_network/documents/HTM2009%20Pneumatic%2\> 0air%20tube%20transport%20systems%20Management%20policy%2020031231330172\> 81.pdf> . Accessed November 26, 2008.> 2. 6.â†µ> <http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-6-1>> 1. Sodi R,> 2. Darn SM,> 3. Stott A> . Pneumatic tube system induced hemolysis: Assessing sample type> susceptibility to hemolysis. Ann Clin Biochem. 2004;41:237–240.> Abstract/FREE Full Text> <http://labmed.ascpjournals.org/cgi/ijlink?linkType=ABST & journalCode=rsm\> acb & resid=41/3/237>> 4. 7.â†µ> <http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-7-1>> 1. Stair TO,> 2. Howell JM,> 3. Fitzgerald DJ,> 4. et al.> Hemolysis of blood specimens transported from ED to laboratory by> pneumatic tube. Am J Emerg Med. 1995;13:484. Medline> <http://labmed.ascpjournals.org/external-ref?access_num=7605542 & link_typ\> e=MED>> 5. 8.â†µ> <http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-8-1>> 1. Fernandes CM,> 2. Worster A,> 3. Eva K,> 4. et al.> Pneumatic tube delivery system for blood samples reduces turnaround> times without affecting sample quality. J Emerg Nurs.> 2006;32:139–143. CrossRef> <http://labmed.ascpjournals.org/external-ref?access_num=10.1016/j.jen.20\> 05.11.013 & link_type=DOI> Medline> <http://labmed.ascpjournals.org/external-ref?access_num=16580476 & link_ty\> pe=MED>> 5. 9.â†µ> <http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-9-1>> 1. Steige H,> 2. JD> . Evaluation of pneumatic-tube system for delivery of blood specimens.> Clin Chem. 1971;17:1160–1164. Abstract/FREE Full Text> <http://labmed.ascpjournals.org/cgi/ijlink?linkType=ABST & journalCode=cli\> nchem & resid=17/12/1160>> 3. 10.â†µ> <http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-10-1>> 1. Narayanan S> . The preanalytic phase. An important component of laboratory medicine.> Am J Clin Pathol. 2000;113:429–452. Abstract/FREE Full Text> <http://labmed.ascpjournals.org/cgi/ijlink?linkType=ABST & journalCode=ajc\> p & resid=113/3/429>> 2. 11.â†µ> <http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-11-1>> 1. Banfi G,> 2. Bauer K,> 3. Brand W,> 4. et al.> Use of anticoagulants in diagnostic laboratory investigations. Geneva,> Switzerland: World Health Organization; 2002 WHO document> WHO/DIL/LAB/99.1 Rev 2.> « Previous <http://labmed.ascpjournals.org/content/40/12/724.short> > | Next Article »> <http://labmed.ascpjournals.org/content/40/12/732.short> Table of> Contents <http://labmed.ascpjournals.org/content/40/12.toc> This> Article> 1. doi: 10.1309/LMZNZ2Y1P3KRDQYL (2009) LabMedicine, 40, 728-731.> > 1. Abstract> <http://labmed.ascpjournals.org/content/40/12/728.abstract>> 2. 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May 24, 2012

As you say this is a controled study on one system. Each system results would

have to be looked at in the same way. Some may have less effect on k then

others. As long as the test tube is full. If test tube not full effect on K is

higher.

Might be intersting to have study done on WRJ tube system. BTW at least part of

the consistency of a courier system has been addressed.

From the WRJ VA site. We started the year by reintroducing our patients and

staff to Romeo and t, a cute couple on wheels. Romeo and t are a pair

of automated delivery robots or tugs as we call them in the hospital setting.

The tugs navigate hallways, avoid obstacles, and remotely call elevators to

deliver lab specimens from the Medical Center inpatient setting to the hospital

laboratory for analysis.

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> > Lab Medicinelabmed.ascpjournals.org

> > 1. doi: 10.1309/LMZNZ2Y1P3KRDQYL (2009) LabMedicine, 40, 728-731.

> > Changes of Serum Lactate Dehydrogenase and Potassium Levels Produced

> by

> > a Pneumatic Tube System

> > 1. Ming Cui

> >

> <http://labmed.ascpjournals.org/search?author1=Ming+Cui & sortspec=date & su\

> \

> > bmit=Submit> , PhD1

> > <http://labmed.ascpjournals.org/content/40/12/728.full#aff-1> ,

> > 2. Rongrong Jing

> >

> <http://labmed.ascpjournals.org/search?author1=Rongrong+Jing & sortspec=da\

> \

> > te & submit=Submit> , PhD1

> > <http://labmed.ascpjournals.org/content/40/12/728.full#aff-1> and

> > 3. Huimin Wang

> >

> <http://labmed.ascpjournals.org/search?author1=Huimin+Wang & sortspec=date\

> \

> > & submit=Submit> , PhD1

> > <http://labmed.ascpjournals.org/content/40/12/728.full#aff-1> ,2

> > <http://labmed.ascpjournals.org/content/40/12/728.full#aff-2>

> >

> > + <http://labmed.ascpjournals.org/content/40/12/728.full#> Author

> > Affiliations

> >

> > 1. 1Center of Laboratory Medicine, Affiliated Hospital of Nantong

> > University

> > 2. 2Public Health Institute of Nantong University, Nantong, Jiangsu

> > Province, People's Republic of China

> >

> > Next Section

> > <http://labmed.ascpjournals.org/content/40/12/728.full#sec-5> Abstract

> > Objective: Errors in laboratory measurements could be derived from

> many

> > pre-analytical factors. The aim of this study was to assess the

> > influence of the hospital's pneumatic tube system (PTS) on serum

> > lactate dehydrogenase (LDH) and potassium.

> >

> > Methods: Forty-five healthy blood donors were involved. We studied LDH

> > and potassium delivered to the laboratory by a PTS with different

> > carrier inserts and transport times. In addition, influences of the

> PTS

> > sending different types of specimens on LDH and potassium were

> > determined.

> >

> > Results: Blood specimens sent via PTS several times or without carrier

> > inserts had statistical changes in LDH; the potassium had a slightly

> > rising trend. Of the under-filled blood draw tubes or lithium heparin

> > tube specimens, changes were caused by the PTS, but there were no

> > effects on pure serum specimens.

> >

> > Conclusions: Many minor shakings derived from the transportation of

> the

> > PTS inevitably influenced LDH and potassium.

> >

> > Rapid sample delivery systems, usually pneumatic tube systems (PTSs),

> > have been installed in hospitals to transport blood specimens from the

> > phlebotomy site to the core laboratory and deliver patient reports to

> > clinicians. The use of such rapid sample delivery systems can

> > significantly reduce the turnaround times (TATs) of results, which

> > account for approximately 40% in the laboratory median TATs.1

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-1> However,

> > the forces applied on a blood specimen transported by a PTS include

> > sudden accelerations/decelerations, changes in air pressures, movement

> > of blood in the test tube, and vibrations. It should be noted that the

> > strong forces from the PTS can potentially affect some clinical

> > laboratory measurements, such as blood gas measurements,2

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-2>

> > spectrophotometric analysis of cerebrospinal fluid,3

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-3> routine

> > and novel hematology, and coagulation analyzations.4

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-4> In some

> > cases it will induce blood cell deterioration caused by rapid a

> > ccelerations and decelerations along its trajectory.5

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-5> Thus,

> > considering the blood specimen's quality, Sodi and colleagues

> > stressed that all laboratories should investigate their blood

> > specimen's susceptibility to hemolysis when transported through the

> > PTS.6 <http://labmed.ascpjournals.org/content/40/12/728.full#ref-6>

> >

> > The aim of this study was to evaluate the possible changes to the

> levels

> > of 2 sensitive indicators, lactate dehydrogenase (LDH) and potassium.

> > Both easily leak out of the blood cells in blood specimens when

> > transported through the PTS in our hospital.

> > Previous Section

> > <http://labmed.ascpjournals.org/content/40/12/728.full#abstract-1>

> Next

> > Section <http://labmed.ascpjournals.org/content/40/12/728.full#sec-13>

> > Materials and Methods Description of the PTS

> > The PTS (Sumetzberger, Vienna, Austria) installed in our hospital had

> 2

> > subsystems, 52 stations, a constant speed of 6 m/s, and the longest

> > route of 600 m. In our present study, the test specimens were

> > transported by the PTS from the phlebotomy site to the clinical

> > chemistry laboratory, which is approximately 90 m including 17

> vertical

> > and horizontal bends (800 mm radius) and 2 switches. The carriers have

> a

> > diameter of 160 mm and a length of 440 mm. Two kinds of carrier

> inserts

> > (sponge-rubber and plastic-bag) were used for protection during the

> > transportation in the PTS.

> > Specimens and Experimental Design

> > The study subjects consisted of 45 healthy blood donors (21 males and

> 24

> > females, mean age 29 years, range 22–35 years). All subjects gave

> > informed consent to participate in the study. The collection of venous

> > blood specimens was performed by a single venipuncture from the

> > antecubital vein by trained phlebotomists. Two kinds of Vacuette blood

> > collection tubes, 5 mL clot activator tubes and 4 mL lithium heparin

> > tubes, were used in this study.

> > Part 1: Effects of r Inserts and Transport Times

> > A total of 50 mL of blood from each donor was collected into 10

> Vacuette

> > clot activator tubes. Of the 10 specimens, No. 1 was hand carried from

> > the phlebotomy site to the clinical chemistry laboratory (mode H).

> > Numbers 2, 3, and 4 were protected with sponge-rubber inserts (mode S)

> > and transported by the PTS 1 time, 5 times, or 9 times, respectively.

> > Numbers 5, 6, and 7 were protected with plastic-bag inserts (mode P)

> and

> > sent via the PTS for the above times respectively. Numbers 8, 9, and

> 10

> > were transported with no inserts (mode N) by the PTS for the same

> times

> > respectively.

> > Part 2: Effects of Transportation of Under-filled Blood Specimens and

> > Anticoagulated Specimens

> > We obtained 10 mL of blood from each donor. The first 1 mL of blood

> was

> > drawn into a 5 mL Vacuette clot activator tube, and only 20% of the

> tube

> > capacity was filled. Another 5 mL Vacuette clot activator tube was

> > filled with 5 mL of blood, and a 4 mL Vacuette lithium-heparin tube

> was

> > simultaneously filled with 4 mL of blood. Then all 3 specimens were

> > transported by the PTS 5 times with sponge-rubber inserts.

> > Part 3: Effects of Transportation of Serum

> > The amount of 7 mL of blood from each donor was drawn into 2 Vacuette

> > clot activator tubes and allowed to clot for 30 minutes. Pooled sera

> > from the 2 tubes were aliquotted into 3 Vacuette tubes after

> > centrifugation. One of them was hand carried for 1 time; the others

> were

> > transported by the PTS for 1 time or 9 times, respectively.

> >

> > In each part of the study, a standardized procedure was followed to

> > eliminate certain variables: all measurements of each part were tested

> > in the same run; all blood specimens were routinely centrifuged for 10

> > minutes at 2,500 × g; hand carrying was always done by the same

> > person.

> > Sample Analysis

> > Lactate dehydrogenase activity was measured on the Hitachi 7600

> > instrument (Hitachi, Tokyo, Japan) with an IFCC-recommended method. An

> > ISE method was used for measuring potassium levels. The calibration

> was

> > processed with Randox calibrators (Randox Laboratories, Crumlin,

> United

> > Kingdom) in accordance with the manufacturer's instructions, and

> > internal quality controls were performed in the same batch with these

> > analytical specimens.

> > Statistical Analysis

> > All statistical analyses were used by SPSS 15.0 or Med-Calc 9.6

> > software. The paired t-test or one-way ANOVA and LSD analyses were

> used

> > to evaluate the statistical differences among groups. P<0.05 was

> > regarded as statistically significant.

> > Previous Section

> > <http://labmed.ascpjournals.org/content/40/12/728.full#sec-5> Next

> > Section <http://labmed.ascpjournals.org/content/40/12/728.full#sec-17>

> > Results Part 1: Effects of r Inserts and Transportation Times

> > To determine the effects of the PTS with different carrier inserts on

> > the results of serum LDH and potassium, we compared specimens sent to

> > the laboratory via a PTS with hand-carried specimens drawn from the

> same

> > donors at the same time. Table 1

> > <http://labmed.ascpjournals.org/content/40/12/728.full#T1> shows the

> > statistically significant changes in LDH between specimens that were

> > hand carried and those sent through the PTS with no carrier insert

> (mode

> > N). Among the 3 modes (S, P, N), significant differences were found

> > between mode N and modes S and P (P<0.001). For potassium, there were

> > rising trends during the PTS transportation (Figure 1

> > <http://labmed.ascpjournals.org/content/40/12/728.full#F1> ).

> > View this table:

> > * In this window

> > <http://labmed.ascpjournals.org/content/40/12/728/T1.expansion.html>

> > * In a new window

> > <http://labmed.ascpjournals.org/content/40/12/728/T1.expansion.html>

> > Table 1

> > Summary of Statistical Data on Specimens Sent via PTS for Different

> > Times in 4 Sending Modes

> > [Figure 1]

> > <http://labmed.ascpjournals.org/content/40/12/728/F1.expansion.html>

> > View larger version:

> > * In this page

> > <http://labmed.ascpjournals.org/content/40/12/728/F1.expansion.html>

> > * In a new window

> > <http://labmed.ascpjournals.org/content/40/12/728/F1.expansion.html>

> >

> > Figure 1

> > Effect of transportation modes and times on the values of LDH and

> > potassium. Mean LDH and potassium (±SD) are represented by the box;

> > medians are plotted as a line inside the box; error bars represent the

> > 10th and 90th percentiles. Means of each group are linked by a line.

> > hc1, sent by hand 1 time; sr1, sr5, or sr9, sent via PTS with

> > sponge-rubber inserts 1 time, 5 times, or 9 times respectively; pb1,

> > pb5, or pb9, sent via PTS with plastic bag inserts 1 time, 5 times, or

> 9

> > times respectively; ni1, ni5, or ni9, sent via PTS without carrier

> > inserts (no inserts) 1 time, 5 times, or 9 times respectively.

> >

> > Table 1 <http://labmed.ascpjournals.org/content/40/12/728.full#T1>

> also

> > demonstrates the effects of transport times on results of serum LDH

> and

> > potassium under modes S, P, and N. When the transport time increased,

> > the levels of LDH were higher, and statistical changes were found

> > (P<0.001). For potassium, there were rising trends between only 1 time

> > and many times (Figure 1

> > <http://labmed.ascpjournals.org/content/40/12/728.full#F1> ).

> >

> > The PTS with no carrier insert and increased transportation affected

> the

> > serum LDH and potassium, but the extent of changes was different.

> > Part 2: Effects of Transportation of Under-filled Blood Specimens and

> > Anticoagulated Specimens

> > Table 2 <http://labmed.ascpjournals.org/content/40/12/728.full#T2> and

> > Figure 2 <http://labmed.ascpjournals.org/content/40/12/728.full#F2>

> > show the data of paired specimens when sending them via the PTS 5

> times

> > with sponge-rubber protection. For LDH and potassium, there were

> > statistically significant changes in under-filled specimens compared

> to

> > filled specimens (Pâ‰¤0.0001). In addition, under complete

> > tube-filling circumstances, statistical differences were also found

> > between clotted specimens and lithium-heparin anticoagulated ones

> > (Pâ‰¤0.0001). However, LDH values were higher in anticoagulated

> > tubes than in serum tubes while potassium was lower.

> >

> > The underfilled or the unclotted specimens sent via PTS have an effect

> > on the results of LDH and potassium. The levels of serum LDH were more

> > altered by the PTS than potassium.

> > View this table:

> > * In this window

> > <http://labmed.ascpjournals.org/content/40/12/728/T2.expansion.html>

> > * In a new window

> > <http://labmed.ascpjournals.org/content/40/12/728/T2.expansion.html>

> > Table 2

> > Analytical Results of 3 Kinds of Specimens When Sent via the PTS for 5

> > Times and Their Significance

> > [Figure 2]

> > <http://labmed.ascpjournals.org/content/40/12/728/F2.expansion.html>

> > View larger version:

> > * In this page

> > <http://labmed.ascpjournals.org/content/40/12/728/F2.expansion.html>

> > * In a new window

> > <http://labmed.ascpjournals.org/content/40/12/728/F2.expansion.html>

> >

> > Figure 2

> > Effect of transportation specimen types on the values of LDH and

> > potassium. When 1 mL of blood was drawn into a 5 mL vacuum tube and 4

> mL

> > remained, the levels of LDH and potassium were higher than the values

> of

> > fully-filled specimens. However, in complete fully-filled

> circumstances,

> > there was a higher value of LDH and a lower value of potassium in

> plasma

> > than in serum.

> > Part 3: Effects of Transportation of Serum

> > When sera were sent by the PTS many times and by hand 1 time, no

> > statistical changes of LDH and potassium were found (Table 3

> > <http://labmed.ascpjournals.org/content/40/12/728.full#T3> ).

> > View this table:

> > * In this window

> > <http://labmed.ascpjournals.org/content/40/12/728/T3.expansion.html>

> > * In a new window

> > <http://labmed.ascpjournals.org/content/40/12/728/T3.expansion.html>

> > Table 3

> > Summary of Statistical Data of Serum LDH and Potassium with 2 Sent

> Means

> > for Different Times

> > Previous Section

> > <http://labmed.ascpjournals.org/content/40/12/728.full#sec-13> Next

> > Section <http://labmed.ascpjournals.org/content/40/12/728.full#ack-1>

> > Discussion

> > Pneumatic tube systems allow rapid and convenient transport of blood

> > specimens to clinical laboratories and are widely used in modern

> medical

> > centers. However, there is growing attention to blood specimen quality

> > affected by the PTS.

> >

> > To the best of our knowledge, few studies have investigated the effect

> > of PTS on hemolysis. In a study by Stair and colleagues,7

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-7> of the

> > 291 specimens they studied, 47 of those carried by hand were visibly

> > hemolyzed on arrival, compared with 40 specimens transported by a PTS.

> > The hemolysis was determined by a technologist who was blinded to how

> > the pair of specimens had been reported. There was no significant

> > difference in hemolysis frequency between sent specimens by hand and

> via

> > PTS. Fernandes and colleagues also reported there was no significant

> > difference in the hemolysis rate between specimens delivered by a PTS

> > and those delivered by a human courier. In their essays, hemolysis was

> > measured by visual inspection of the specimens using a 4-point

> validated

> > Likert scale based on the plasma hemoglobin concentration.8

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-8> However,

> > in the Steige and colleagues study, hemoglobin, LDH, and potassium of

> > the blood specimens would alter when sent through their PTS, which had

> > some different characteristics when compared to our PTS, such as

> number

> > of bends, carriers, inserts, and transport speeds.9

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-9>

> >

> > From the published studies, it is apparent that differences exist in

> > different PTSs. Therefore, PTSs should be evaluated prior to use for

> > transport of whole blood specimens. The aim of this study was to

> assess

> > the influence of the PTS in our hospital on the levels of serum LDH

> and

> > potassium that easily leak out of the blood cells.

> >

> > The first part of the study showed protection played an important role

> > in the specimens' transportation. Statistical differences existed

> > between hand-carried blood speciments and those transported via the

> PTS

> > without sponge-rubber or plastic-bag inserts for 1 time, statistical

> > differences occurred compared to hand-carried ones. In addition, we

> > found there were statistical changes between modes S, P, and N despite

> > the number of times sent. These indicate blood specimens should be

> > protected with carrier inserts during transportation by the PTS.

> > Furthermore, with increased transportation, the rising LDH values

> showed

> > the statistical difference under modes S, P, and N. All of these

> > demonstrated that during the transportation of blood specimens, too

> many

> > slight shakings had inevitably influenced the stability of some blood

> > constituents.

> >

> > In addition, blood specimens transported in incompletely filled tubes

> > appeared to have been shaken more than those transported in completely

> > filled tubes, which was consistent with findings by Harold and

> > colleagues.9

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-9>

> > Additionally, we found the PTS had more influence on anticoagulated

> > blood specimens than completely clotted specimens. The anticoagulated

> > blood specimens induced more increased LDH values than clotted

> specimens

> > transported by the PTS. It has been well known the values of LDH are

> > higher in serum tubes than in heparin ones when these tubes were

> > transported by hand (the routine way). However, the extent of

> influence

> > was different between LDH and potassium. The probable explanation of

> our

> > results was that the concentration of red cell LDH was 160-fold

> greater

> > than that present in the plasma10

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-10> or 150

> > times greater than that of normal serum. However, the distribution of

> > intracellular and extracellular potassium is not as obvious as LDH

> (ie,

> > the concentration of potassium inside the RBC was only 23 times as

> much

> > as that found in plasma).10

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-10> The

> > shakings induced by a PTS were so slight the changes of potassium were

> > not similar to LDH, which was higher in heparin tubes than in serum

> ones

> > after being transported by the PTS. No slight influence of PTS is more

> > easily ignored than high value variables. Although a World Health

> > Organization document recommended plasma specimens for the test of LDH

> > and potassium, our results showed the changes of LDH and potassium in

> > lithium-heparin tubes after sending via the PTS could not be

> ignored.11

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-11>

> >

> > In addition, we found there were no statistical changes when sera were

> > transported several times through the PTS. This reminds us the

> > transportation of serum is available. The whole blood specimen should

> be

> > centrifuged after completed clotting, and the sera were aliquoted into

> > another tube to be sent via the PTS.

> >

> > In conclusion, although the use of a PTS increased work efficiency and

> > decreased TATs, all clinical laboratory staff should recognize the

> > negative side of PTS with regards to the stability of blood

> > constituents.

> > Previous Section

> > <http://labmed.ascpjournals.org/content/40/12/728.full#sec-17> Next

> > Section

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-list-1>

> > Acknowledgments

> > We gratefully acknowledge Jianyou Su, Lianying Chen, and Jianhui Xu of

> > the Clinical Chemistry Laboratory Section and Yinchun Chen of the

> Blood

> > Sampling Center for their skillful work.

> >

> > Previous Section

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ack-1>

> > References

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> > 4. et al.

> > Use of anticoagulants in diagnostic laboratory investigations. Geneva,

> > Switzerland: World Health Organization; 2002 WHO document

> > WHO/DIL/LAB/99.1 Rev 2.

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May 24, 2012

Maybe the medical profession should implement a certification process

and require the system be recertified every so many years like they do

gas pumps and scales (If that test is as important as that gallon of

gas!) Maybe Obamacare will take care of it once he teaches them to take

proper BP - could save a lot of money and lives if he did that, IMHO!

> > >

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> > > *

> > > Lab Medicinelabmed.ascpjournals.org

> > > 1. doi: 10.1309/LMZNZ2Y1P3KRDQYL (2009) LabMedicine, 40, 728-731.

> > > Changes of Serum Lactate Dehydrogenase and Potassium Levels

Produced

> > by

> > > a Pneumatic Tube System

> > > 1. Ming Cui

> > >

> >

<http://labmed.ascpjournals.org/search?author1=Ming+Cui & sortspec=date & su\

\

> > \

> > > bmit=Submit> , PhD1

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#aff-1> ,

> > > 2. Rongrong Jing

> > >

> >

<http://labmed.ascpjournals.org/search?author1=Rongrong+Jing & sortspec=da\

\

> > \

> > > te & submit=Submit> , PhD1

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#aff-1> and

> > > 3. Huimin Wang

> > >

> >

<http://labmed.ascpjournals.org/search?author1=Huimin+Wang & sortspec=date\

\

> > \

> > > & submit=Submit> , PhD1

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#aff-1> ,2

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#aff-2>

> > >

> > > + <http://labmed.ascpjournals.org/content/40/12/728.full#> Author

> > > Affiliations

> > >

> > > 1. 1Center of Laboratory Medicine, Affiliated Hospital of Nantong

> > > University

> > > 2. 2Public Health Institute of Nantong University, Nantong,

Jiangsu

> > > Province, People's Republic of China

> > >

> > > Next Section

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#sec-5>

Abstract

> > > Objective: Errors in laboratory measurements could be derived from

> > many

> > > pre-analytical factors. The aim of this study was to assess the

> > > influence of the hospital's pneumatic tube system (PTS) on serum

> > > lactate dehydrogenase (LDH) and potassium.

> > >

> > > Methods: Forty-five healthy blood donors were involved. We studied

LDH

> > > and potassium delivered to the laboratory by a PTS with different

> > > carrier inserts and transport times. In addition, influences of

the

> > PTS

> > > sending different types of specimens on LDH and potassium were

> > > determined.

> > >

> > > Results: Blood specimens sent via PTS several times or without

carrier

> > > inserts had statistical changes in LDH; the potassium had a

slightly

> > > rising trend. Of the under-filled blood draw tubes or lithium

heparin

> > > tube specimens, changes were caused by the PTS, but there were no

> > > effects on pure serum specimens.

> > >

> > > Conclusions: Many minor shakings derived from the transportation

of

> > the

> > > PTS inevitably influenced LDH and potassium.

> > >

> > > Rapid sample delivery systems, usually pneumatic tube systems

(PTSs),

> > > have been installed in hospitals to transport blood specimens from

the

> > > phlebotomy site to the core laboratory and deliver patient reports

to

> > > clinicians. The use of such rapid sample delivery systems can

> > > significantly reduce the turnaround times (TATs) of results, which

> > > account for approximately 40% in the laboratory median TATs.1

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-1>

However,

> > > the forces applied on a blood specimen transported by a PTS

include

> > > sudden accelerations/decelerations, changes in air pressures,

movement

> > > of blood in the test tube, and vibrations. It should be noted that

the

> > > strong forces from the PTS can potentially affect some clinical

> > > laboratory measurements, such as blood gas measurements,2

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-2>

> > > spectrophotometric analysis of cerebrospinal fluid,3

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-3>

routine

> > > and novel hematology, and coagulation analyzations.4

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-4> In

some

> > > cases it will induce blood cell deterioration caused by rapid a

> > > ccelerations and decelerations along its trajectory.5

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-5>

Thus,

> > > considering the blood specimen's quality, Sodi and colleagues

> > > stressed that all laboratories should investigate their blood

> > > specimen's susceptibility to hemolysis when transported through

the

> > > PTS.6

<http://labmed.ascpjournals.org/content/40/12/728.full#ref-6>

> > >

> > > The aim of this study was to evaluate the possible changes to the

> > levels

> > > of 2 sensitive indicators, lactate dehydrogenase (LDH) and

potassium.

> > > Both easily leak out of the blood cells in blood specimens when

> > > transported through the PTS in our hospital.

> > > Previous Section

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#abstract-1>

> > Next

> > > Section

<http://labmed.ascpjournals.org/content/40/12/728.full#sec-13>

> > > Materials and Methods Description of the PTS

> > > The PTS (Sumetzberger, Vienna, Austria) installed in our hospital

had

> > 2

> > > subsystems, 52 stations, a constant speed of 6 m/s, and the

longest

> > > route of 600 m. In our present study, the test specimens were

> > > transported by the PTS from the phlebotomy site to the clinical

> > > chemistry laboratory, which is approximately 90 m including 17

> > vertical

> > > and horizontal bends (800 mm radius) and 2 switches. The carriers

have

> > a

> > > diameter of 160 mm and a length of 440 mm. Two kinds of carrier

> > inserts

> > > (sponge-rubber and plastic-bag) were used for protection during

the

> > > transportation in the PTS.

> > > Specimens and Experimental Design

> > > The study subjects consisted of 45 healthy blood donors (21 males

and

> > 24

> > > females, mean age 29 years, range 22–35 years). All subjects

gave

> > > informed consent to participate in the study. The collection of

venous

> > > blood specimens was performed by a single venipuncture from the

> > > antecubital vein by trained phlebotomists. Two kinds of Vacuette

blood

> > > collection tubes, 5 mL clot activator tubes and 4 mL lithium

heparin

> > > tubes, were used in this study.

> > > Part 1: Effects of r Inserts and Transport Times

> > > A total of 50 mL of blood from each donor was collected into 10

> > Vacuette

> > > clot activator tubes. Of the 10 specimens, No. 1 was hand carried

from

> > > the phlebotomy site to the clinical chemistry laboratory (mode H).

> > > Numbers 2, 3, and 4 were protected with sponge-rubber inserts

(mode S)

> > > and transported by the PTS 1 time, 5 times, or 9 times,

respectively.

> > > Numbers 5, 6, and 7 were protected with plastic-bag inserts (mode

P)

> > and

> > > sent via the PTS for the above times respectively. Numbers 8, 9,

and

> > 10

> > > were transported with no inserts (mode N) by the PTS for the same

> > times

> > > respectively.

> > > Part 2: Effects of Transportation of Under-filled Blood Specimens

and

> > > Anticoagulated Specimens

> > > We obtained 10 mL of blood from each donor. The first 1 mL of

blood

> > was

> > > drawn into a 5 mL Vacuette clot activator tube, and only 20% of

the

> > tube

> > > capacity was filled. Another 5 mL Vacuette clot activator tube was

> > > filled with 5 mL of blood, and a 4 mL Vacuette lithium-heparin

tube

> > was

> > > simultaneously filled with 4 mL of blood. Then all 3 specimens

were

> > > transported by the PTS 5 times with sponge-rubber inserts.

> > > Part 3: Effects of Transportation of Serum

> > > The amount of 7 mL of blood from each donor was drawn into 2

Vacuette

> > > clot activator tubes and allowed to clot for 30 minutes. Pooled

sera

> > > from the 2 tubes were aliquotted into 3 Vacuette tubes after

> > > centrifugation. One of them was hand carried for 1 time; the

others

> > were

> > > transported by the PTS for 1 time or 9 times, respectively.

> > >

> > > In each part of the study, a standardized procedure was followed

to

> > > eliminate certain variables: all measurements of each part were

tested

> > > in the same run; all blood specimens were routinely centrifuged

for 10

> > > minutes at 2,500 × g; hand carrying was always done by the same

> > > person.

> > > Sample Analysis

> > > Lactate dehydrogenase activity was measured on the Hitachi 7600

> > > instrument (Hitachi, Tokyo, Japan) with an IFCC-recommended

method. An

> > > ISE method was used for measuring potassium levels. The

calibration

> > was

> > > processed with Randox calibrators (Randox Laboratories, Crumlin,

> > United

> > > Kingdom) in accordance with the manufacturer's instructions, and

> > > internal quality controls were performed in the same batch with

these

> > > analytical specimens.

> > > Statistical Analysis

> > > All statistical analyses were used by SPSS 15.0 or Med-Calc 9.6

> > > software. The paired t-test or one-way ANOVA and LSD analyses were

> > used

> > > to evaluate the statistical differences among groups. P<0.05 was

> > > regarded as statistically significant.

> > > Previous Section

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#sec-5> Next

> > > Section

<http://labmed.ascpjournals.org/content/40/12/728.full#sec-17>

> > > Results Part 1: Effects of r Inserts and Transportation

Times

> > > To determine the effects of the PTS with different carrier inserts

on

> > > the results of serum LDH and potassium, we compared specimens sent

to

> > > the laboratory via a PTS with hand-carried specimens drawn from

the

> > same

> > > donors at the same time. Table 1

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#T1> shows

the

> > > statistically significant changes in LDH between specimens that

were

> > > hand carried and those sent through the PTS with no carrier insert

> > (mode

> > > N). Among the 3 modes (S, P, N), significant differences were

found

> > > between mode N and modes S and P (P<0.001). For potassium, there

were

> > > rising trends during the PTS transportation (Figure 1

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#F1> ).

> > > View this table:

> > > * In this window

> > >

<http://labmed.ascpjournals.org/content/40/12/728/T1.expansion.html>

> > > * In a new window

> > >

<http://labmed.ascpjournals.org/content/40/12/728/T1.expansion.html>

> > > Table 1

> > > Summary of Statistical Data on Specimens Sent via PTS for

Different

> > > Times in 4 Sending Modes

> > > [Figure 1]

> > >

<http://labmed.ascpjournals.org/content/40/12/728/F1.expansion.html>

> > > View larger version:

> > > * In this page

> > >

<http://labmed.ascpjournals.org/content/40/12/728/F1.expansion.html>

> > > * In a new window

> > >

<http://labmed.ascpjournals.org/content/40/12/728/F1.expansion.html>

> > >

> > > Figure 1

> > > Effect of transportation modes and times on the values of LDH and

> > > potassium. Mean LDH and potassium (±SD) are represented by the

box;

> > > medians are plotted as a line inside the box; error bars represent

the

> > > 10th and 90th percentiles. Means of each group are linked by a

line.

> > > hc1, sent by hand 1 time; sr1, sr5, or sr9, sent via PTS with

> > > sponge-rubber inserts 1 time, 5 times, or 9 times respectively;

pb1,

> > > pb5, or pb9, sent via PTS with plastic bag inserts 1 time, 5

times, or

> > 9

> > > times respectively; ni1, ni5, or ni9, sent via PTS without carrier

> > > inserts (no inserts) 1 time, 5 times, or 9 times respectively.

> > >

> > > Table 1 <http://labmed.ascpjournals.org/content/40/12/728.full#T1>

> > also

> > > demonstrates the effects of transport times on results of serum

LDH

> > and

> > > potassium under modes S, P, and N. When the transport time

increased,

> > > the levels of LDH were higher, and statistical changes were found

> > > (P<0.001). For potassium, there were rising trends between only 1

time

> > > and many times (Figure 1

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#F1> ).

> > >

> > > The PTS with no carrier insert and increased transportation

affected

> > the

> > > serum LDH and potassium, but the extent of changes was different.

> > > Part 2: Effects of Transportation of Under-filled Blood Specimens

and

> > > Anticoagulated Specimens

> > > Table 2 <http://labmed.ascpjournals.org/content/40/12/728.full#T2>

and

> > > Figure 2

<http://labmed.ascpjournals.org/content/40/12/728.full#F2>

> > > show the data of paired specimens when sending them via the PTS 5

> > times

> > > with sponge-rubber protection. For LDH and potassium, there were

> > > statistically significant changes in under-filled specimens

compared

> > to

> > > filled specimens (Pâ‰¤0.0001). In addition, under complete

> > > tube-filling circumstances, statistical differences were also

found

> > > between clotted specimens and lithium-heparin anticoagulated ones

> > > (Pâ‰¤0.0001). However, LDH values were higher in

anticoagulated

> > > tubes than in serum tubes while potassium was lower.

> > >

> > > The underfilled or the unclotted specimens sent via PTS have an

effect

> > > on the results of LDH and potassium. The levels of serum LDH were

more

> > > altered by the PTS than potassium.

> > > View this table:

> > > * In this window

> > >

<http://labmed.ascpjournals.org/content/40/12/728/T2.expansion.html>

> > > * In a new window

> > >

<http://labmed.ascpjournals.org/content/40/12/728/T2.expansion.html>

> > > Table 2

> > > Analytical Results of 3 Kinds of Specimens When Sent via the PTS

for 5

> > > Times and Their Significance

> > > [Figure 2]

> > >

<http://labmed.ascpjournals.org/content/40/12/728/F2.expansion.html>

> > > View larger version:

> > > * In this page

> > >

<http://labmed.ascpjournals.org/content/40/12/728/F2.expansion.html>

> > > * In a new window

> > >

<http://labmed.ascpjournals.org/content/40/12/728/F2.expansion.html>

> > >

> > > Figure 2

> > > Effect of transportation specimen types on the values of LDH and

> > > potassium. When 1 mL of blood was drawn into a 5 mL vacuum tube

and 4

> > mL

> > > remained, the levels of LDH and potassium were higher than the

values

> > of

> > > fully-filled specimens. However, in complete fully-filled

> > circumstances,

> > > there was a higher value of LDH and a lower value of potassium in

> > plasma

> > > than in serum.

> > > Part 3: Effects of Transportation of Serum

> > > When sera were sent by the PTS many times and by hand 1 time, no

> > > statistical changes of LDH and potassium were found (Table 3

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#T3> ).

> > > View this table:

> > > * In this window

> > >

<http://labmed.ascpjournals.org/content/40/12/728/T3.expansion.html>

> > > * In a new window

> > >

<http://labmed.ascpjournals.org/content/40/12/728/T3.expansion.html>

> > > Table 3

> > > Summary of Statistical Data of Serum LDH and Potassium with 2 Sent

> > Means

> > > for Different Times

> > > Previous Section

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#sec-13>

<http://labmed.ascpjournals.org/content/40/12/728.full#ack-1>

> > > Discussion

> > > Pneumatic tube systems allow rapid and convenient transport of

blood

> > > specimens to clinical laboratories and are widely used in modern

> > medical

> > > centers. However, there is growing attention to blood specimen

quality

> > > affected by the PTS.

> > >

> > > To the best of our knowledge, few studies have investigated the

effect

> > > of PTS on hemolysis. In a study by Stair and colleagues,7

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-7> of

the

> > > 291 specimens they studied, 47 of those carried by hand were

visibly

> > > hemolyzed on arrival, compared with 40 specimens transported by a

PTS.

> > > The hemolysis was determined by a technologist who was blinded to

how

> > > the pair of specimens had been reported. There was no significant

> > > difference in hemolysis frequency between sent specimens by hand

and

> > via

> > > PTS. Fernandes and colleagues also reported there was no

significant

> > > difference in the hemolysis rate between specimens delivered by a

PTS

> > > and those delivered by a human courier. In their essays, hemolysis

was

> > > measured by visual inspection of the specimens using a 4-point

> > validated

> > > Likert scale based on the plasma hemoglobin concentration.8

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-8>

However,

> > > in the Steige and colleagues study, hemoglobin, LDH, and potassium

of

> > > the blood specimens would alter when sent through their PTS, which

had

> > > some different characteristics when compared to our PTS, such as

> > number

> > > of bends, carriers, inserts, and transport speeds.9

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-9>

> > >

> > > From the published studies, it is apparent that differences exist

in

> > > different PTSs. Therefore, PTSs should be evaluated prior to use

for

> > > transport of whole blood specimens. The aim of this study was to

> > assess

> > > the influence of the PTS in our hospital on the levels of serum

LDH

> > and

> > > potassium that easily leak out of the blood cells.

> > >

> > > The first part of the study showed protection played an important

role

> > > in the specimens' transportation. Statistical differences existed

> > > between hand-carried blood speciments and those transported via

the

> > PTS

> > > without sponge-rubber or plastic-bag inserts for 1 time,

statistical

> > > differences occurred compared to hand-carried ones. In addition,

we

> > > found there were statistical changes between modes S, P, and N

despite

> > > the number of times sent. These indicate blood specimens should be

> > > protected with carrier inserts during transportation by the PTS.

> > > Furthermore, with increased transportation, the rising LDH values

> > showed

> > > the statistical difference under modes S, P, and N. All of these

> > > demonstrated that during the transportation of blood specimens,

too

> > many

> > > slight shakings had inevitably influenced the stability of some

blood

> > > constituents.

> > >

> > > In addition, blood specimens transported in incompletely filled

tubes

> > > appeared to have been shaken more than those transported in

completely

> > > filled tubes, which was consistent with findings by Harold and

> > > colleagues.9

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-9>

> > > Additionally, we found the PTS had more influence on

anticoagulated

> > > blood specimens than completely clotted specimens. The

anticoagulated

> > > blood specimens induced more increased LDH values than clotted

> > specimens

> > > transported by the PTS. It has been well known the values of LDH

are

> > > higher in serum tubes than in heparin ones when these tubes were

> > > transported by hand (the routine way). However, the extent of

> > influence

> > > was different between LDH and potassium. The probable explanation

of

> > our

> > > results was that the concentration of red cell LDH was 160-fold

> > greater

> > > than that present in the plasma10

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-10> or

150

> > > times greater than that of normal serum. However, the distribution

of

> > > intracellular and extracellular potassium is not as obvious as LDH

> > (ie,

> > > the concentration of potassium inside the RBC was only 23 times as

> > much

> > > as that found in plasma).10

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-10> The

> > > shakings induced by a PTS were so slight the changes of potassium

were

> > > not similar to LDH, which was higher in heparin tubes than in

serum

> > ones

> > > after being transported by the PTS. No slight influence of PTS is

more

> > > easily ignored than high value variables. Although a World Health

> > > Organization document recommended plasma specimens for the test of

LDH

> > > and potassium, our results showed the changes of LDH and potassium

in

> > > lithium-heparin tubes after sending via the PTS could not be

> > ignored.11

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-11>

> > >

> > > In addition, we found there were no statistical changes when sera

were

> > > transported several times through the PTS. This reminds us the

> > > transportation of serum is available. The whole blood specimen

should

> > be

> > > centrifuged after completed clotting, and the sera were aliquoted

into

> > > another tube to be sent via the PTS.

> > >

> > > In conclusion, although the use of a PTS increased work efficiency

and

> > > decreased TATs, all clinical laboratory staff should recognize the

> > > negative side of PTS with regards to the stability of blood

> > > constituents.

> > > Previous Section

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#sec-17>

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-list-1>

> > > Acknowledgments

> > > We gratefully acknowledge Jianyou Su, Lianying Chen, and Jianhui

Xu of

> > > the Clinical Chemistry Laboratory Section and Yinchun Chen of the

> > Blood

> > > Sampling Center for their skillful work.

> > >

(ASCP)

> > > Previous Section

> > > <http://labmed.ascpjournals.org/content/40/12/728.full#ack-1>

> > > References

> > > 1. 1.â†µ

> > >

<http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-1-1>

> > > 1. Guss DA,

> > > 2. Chan TC,

> > > 3. Killeen JP

> > > . The impact of a pneumatic tube and computerized physician order

> > > management on laboratory turnaround time. Ann Emerg Med.

> > > 2008;51:181–185. CrossRef

> > >

> >

<http://labmed.ascpjournals.org/external-ref?access_num=10.1016/j.anneme\

\

> > \

> > > rgmed.2007.03.010 & link_type=DOI> Medline

> > >

> >

<http://labmed.ascpjournals.org/external-ref?access_num=17467118 & link_ty\

\

> > \

> > > pe=MED>

> > > 4. 2.â†µ

> > >

<http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-2-1>

> > > 1. on PO,

> > > 2. CM,

> > > 3. Gaze DC,

> > > 4. et al.

> > > Changes in blood gas samples produced by a pneumatic tube system.

J

> > Clin

> > > Pathol. 2002;55:105–107. Abstract/FREE Full Text

> > >

> >

<http://labmed.ascpjournals.org/cgi/ijlink?linkType=ABST & journalCode=jcl\

\

> > \

> > > inpath & resid=55/2/105>

> > > 5. 3.â†µ

> > >

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> > > 1. Wenham PR,

> > > 2. Hanson T,

> > > 3. Ashby JP

> > > . Interference in spectrophotometric analysis of cerebrospinal

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> > by

> > > hemolysis induced by transport through a pneumatic tube system.

Ann

> > Clin

> > > Biochem. 2001;38:371–375. Abstract/FREE Full Text

> > >

> >

<http://labmed.ascpjournals.org/cgi/ijlink?linkType=ABST & journalCode=rsm\

\

> > \

> > > acb & resid=38/4/371>

> > > 4. 4.â†µ

> > >

<http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-4-1>

> > > 1. Kratz A,

> > > 2. Salem RO,

> > > 3. Van Cott EM

> > > . Effects of a pneumatic tube system on routine and novel

hematology

> > and

> > > coagulation parameters in healthy volunteers. Arch Pathol Lab Med.

> > > 2007;131:293–296. Medline

> > >

> >

<http://labmed.ascpjournals.org/external-ref?access_num=17284116 & link_ty\

\

> > \

> > > pe=MED>

> > > 4. 5.â†µ

> > >

<http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-5-1>

> > > 1. Health Technical Memorandum (HTM)

> > > 2009. Pneumatic air tube transport systems: Management policy.

> > Available

> > > at

> > >

> >

http://195.92.246.148/knowledge_network/documents/HTM2009%20Pneumatic%20\

\

> > \

> > >

> >

air%20tube%20transport%20systems%20Management%20policy%20200312313301728\

\

> > \

> > > 1.pdf

> > >

> >

<http://195.92.246.148/knowledge_network/documents/HTM2009%20Pneumatic%2\

\

> > \

> > >

> >

0air%20tube%20transport%20systems%20Management%20policy%2020031231330172\

\

> > \

> > > 81.pdf> . Accessed November 26, 2008.

> > > 2. 6.â†µ

> > >

<http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-6-1>

> > > 1. Sodi R,

> > > 2. Darn SM,

> > > 3. Stott A

> > > . Pneumatic tube system induced hemolysis: Assessing sample type

> > > susceptibility to hemolysis. Ann Clin Biochem.

2004;41:237–240.

> > > Abstract/FREE Full Text

> > >

> >

<http://labmed.ascpjournals.org/cgi/ijlink?linkType=ABST & journalCode=rsm\

\

> > \

> > > acb & resid=41/3/237>

> > > 4. 7.â†µ

> > >

<http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-7-1>

> > > 1. Stair TO,

> > > 2. Howell JM,

> > > 3. Fitzgerald DJ,

> > > 4. et al.

> > > Hemolysis of blood specimens transported from ED to laboratory by

> > > pneumatic tube. Am J Emerg Med. 1995;13:484. Medline

> > >

> >

<http://labmed.ascpjournals.org/external-ref?access_num=7605542 & link_typ\

\

> > \

> > > e=MED>

> > > 5. 8.â†µ

> > >

<http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-8-1>

> > > 1. Fernandes CM,

> > > 2. Worster A,

> > > 3. Eva K,

> > > 4. et al.

> > > Pneumatic tube delivery system for blood samples reduces

turnaround

> > > times without affecting sample quality. J Emerg Nurs.

> > > 2006;32:139–143. CrossRef

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> >

<http://labmed.ascpjournals.org/external-ref?access_num=10.1016/j.jen.20\

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> > \

> > > 05.11.013 & link_type=DOI> Medline

> > >

> >

<http://labmed.ascpjournals.org/external-ref?access_num=16580476 & link_ty\

\

> > \

> > > pe=MED>

> > > 5. 9.â†µ

> > >

<http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-9-1>

> > > 1. Steige H,

> > > 2. JD

> > > . Evaluation of pneumatic-tube system for delivery of blood

specimens.

> > > Clin Chem. 1971;17:1160–1164. Abstract/FREE Full Text

> > >

> >

<http://labmed.ascpjournals.org/cgi/ijlink?linkType=ABST & journalCode=cli\

\

> > \

> > > nchem & resid=17/12/1160>

> > > 3. 10.â†µ

> > >

<http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-10-1>

> > > 1. Narayanan S

> > > . The preanalytic phase. An important component of laboratory

> > medicine.

> > > Am J Clin Pathol. 2000;113:429–452. Abstract/FREE Full Text

> > >

> >

<http://labmed.ascpjournals.org/cgi/ijlink?linkType=ABST & journalCode=ajc\

\

> > \

> > > p & resid=113/3/429>

> > > 2. 11.â†µ

> > >

<http://labmed.ascpjournals.org/content/40/12/728.full#xref-ref-11-1>

> > > 1. Banfi G,

> > > 2. Bauer K,

> > > 3. Brand W,

> > > 4. et al.

> > > Use of anticoagulants in diagnostic laboratory investigations.

Geneva,

> > > Switzerland: World Health Organization; 2002 WHO document

> > > WHO/DIL/LAB/99.1 Rev 2.

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May 24, 2012

Why? If the people using the device are not going to use it correctly what

difference does it make. You as a FASH and HTN professional should be working

on that! IMHO!

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> > > > > Lab Medicinelabmed.ascpjournals.org

> > > > > 1. doi: 10.1309/LMZNZ2Y1P3KRDQYL (2009) LabMedicine, 40, 728-731.

> > > > > Changes of Serum Lactate Dehydrogenase and Potassium Levels

> > Produced

> > > > by

> > > > > a Pneumatic Tube System

> > > > > 1. Ming Cui

> > > > >

> > > >

> > <http://labmed.ascpjournals.org/search?author1=Ming+Cui & sortspec=date & su\

> > \

> > > > \

> > > > > bmit=Submit> , PhD1

> > > > > <http://labmed.ascpjournals.org/content/40/12/728.full#aff-1> ,

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> > > > >

> > > >

> > <http://labmed.ascpjournals.org/search?author1=Rongrong+Jing & sortspec=da\

> > \

> > > > \

> > > > > te & submit=Submit> , PhD1

> > > > > <http://labmed.ascpjournals.org/content/40/12/728.full#aff-1> and

> > > > > 3. Huimin Wang

> > > > >

> > > >

> > <http://labmed.ascpjournals.org/search?author1=Huimin+Wang & sortspec=date\

> > \

> > > > \

> > > > > & submit=Submit> , PhD1

> > > > > <http://labmed.ascpjournals.org/content/40/12/728.full#aff-1> ,2

> > > > > <http://labmed.ascpjournals.org/content/40/12/728.full#aff-2>

> > > > >

> > > > > + <http://labmed.ascpjournals.org/content/40/12/728.full#> Author

> > > > > Affiliations

> > > > >

> > > > > 1. 1Center of Laboratory Medicine, Affiliated Hospital of Nantong

> > > > > University

> > > > > 2. 2Public Health Institute of Nantong University, Nantong,

> > Jiangsu

> > > > > Province, People's Republic of China

> > > > >

> > > > > Next Section

> > > > > <http://labmed.ascpjournals.org/content/40/12/728.full#sec-5>

> > Abstract

> > > > > Objective: Errors in laboratory measurements could be derived from

> > > > many

> > > > > pre-analytical factors. The aim of this study was to assess the

> > > > > influence of the hospital's pneumatic tube system (PTS) on serum

> > > > > lactate dehydrogenase (LDH) and potassium.

> > > > >

> > > > > Methods: Forty-five healthy blood donors were involved. We studied

> > LDH

> > > > > and potassium delivered to the laboratory by a PTS with different

> > > > > carrier inserts and transport times. In addition, influences of

> > the

> > > > PTS

> > > > > sending different types of specimens on LDH and potassium were

> > > > > determined.

> > > > >

> > > > > Results: Blood specimens sent via PTS several times or without

> > carrier

> > > > > inserts had statistical changes in LDH; the potassium had a

> > slightly

> > > > > rising trend. Of the under-filled blood draw tubes or lithium

> > heparin

> > > > > tube specimens, changes were caused by the PTS, but there were no

> > > > > effects on pure serum specimens.

> > > > >

> > > > > Conclusions: Many minor shakings derived from the transportation

> > of

> > > > the

> > > > > PTS inevitably influenced LDH and potassium.

> > > > >

> > > > > Rapid sample delivery systems, usually pneumatic tube systems

> > (PTSs),

> > > > > have been installed in hospitals to transport blood specimens from

> > the

> > > > > phlebotomy site to the core laboratory and deliver patient reports

> > to

> > > > > clinicians. The use of such rapid sample delivery systems can

> > > > > significantly reduce the turnaround times (TATs) of results, which

> > > > > account for approximately 40% in the laboratory median TATs.1

> > > > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-1>

> > However,

> > > > > the forces applied on a blood specimen transported by a PTS

> > include

> > > > > sudden accelerations/decelerations, changes in air pressures,

> > movement

> > > > > of blood in the test tube, and vibrations. It should be noted that

> > the

> > > > > strong forces from the PTS can potentially affect some clinical

> > > > > laboratory measurements, such as blood gas measurements,2

> > > > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-2>

> > > > > spectrophotometric analysis of cerebrospinal fluid,3

> > > > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-3>

> > routine

> > > > > and novel hematology, and coagulation analyzations.4

> > > > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-4> In

> > some

> > > > > cases it will induce blood cell deterioration caused by rapid a

> > > > > ccelerations and decelerations along its trajectory.5

> > > > > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-5>

> > Thus,

> > > > > considering the blood specimen's quality, Sodi and colleagues

> > > > > stressed that all laboratories should investigate their blood

> > > > > specimen's susceptibility to hemolysis when transported through

> > the

> > > > > PTS.6

> > <http://labmed.ascpjournals.org/content/40/12/728.full#ref-6>

> > > > >

> > > > > The aim of this study was to evaluate the possible changes to the

> > > > levels

> > > > > of 2 sensitive indicators, lactate dehydrogenase (LDH) and

> > potassium.

> > > > > Both easily leak out of the blood cells in blood specimens when

> > > > > transported through the PTS in our hospital.

> > > > > Previous Section

> > > > > <http://labmed.ascpjournals.org/content/40/12/728.full#abstract-1>

> > > > Next

> > > > > Section

> > <http://labmed.ascpjournals.org/content/40/12/728.full#sec-13>

> > > > > Materials and Methods Description of the PTS

> > > > > The PTS (Sumetzberger, Vienna, Austria) installed in our hospital

> > had

> > > > 2

> > > > > subsystems, 52 stations, a constant speed of 6 m/s, and the

> > longest

> > > > > route of 600 m. In our present study, the test specimens were

> > > > > transported by the PTS from the phlebotomy site to the clinical

> > > > > chemistry laboratory, which is approximately 90 m including 17

> > > > vertical

> > > > > and horizontal bends (800 mm radius) and 2 switches. The carriers

> > have

> > > > a

> > > > > diameter of 160 mm and a length of 440 mm. Two kinds of carrier

> > > > inserts

> > > > > (sponge-rubber and plastic-bag) were used for protection during

> > the

> > > > > transportation in the PTS.

> > > > > Specimens and Experimental Design

> > > > > The study subjects consisted of 45 healthy blood donors (21 males

> > and

> > > > 24

> > > > > females, mean age 29 years, range 22â€ " 35 years). All subjects

> > gave

> > > > > informed consent to participate in the study. The collection of

> > venous

> > > > > blood specimens was performed by a single venipuncture from the

> > > > > antecubital vein by trained phlebotomists. Two kinds of Vacuette

> > blood

> > > > > collection tubes, 5 mL clot activator tubes and 4 mL lithium

> > heparin

> > > > > tubes, were used in this study.

> > > > > Part 1: Effects of r Inserts and Transport Times

> > > > > A total of 50 mL of blood from each donor was collected into 10

> > > > Vacuette

> > > > > clot activator tubes. Of the 10 specimens, No. 1 was hand carried

> > from

> > > > > the phlebotomy site to the clinical chemistry laboratory (mode H).

> > > > > Numbers 2, 3, and 4 were protected with sponge-rubber inserts

> > (mode S)

> > > > > and transported by the PTS 1 time, 5 times, or 9 times,

> > respectively.

> > > > > Numbers 5, 6, and 7 were protected with plastic-bag inserts (mode

> > P)

> > > > and

> > > > > sent via the PTS for the above times respectively. Numbers 8, 9,

> > and

> > > > 10

> > > > > were transported with no inserts (mode N) by the PTS for the same

> > > > times

> > > > > respectively.

> > > > > Part 2: Effects of Transportation of Under-filled Blood Specimens

> > and

> > > > > Anticoagulated Specimens

> > > > > We obtained 10 mL of blood

>

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