Blood gas analysis syringes containing spray-dosed droplet liquid heparin may decrease sample rejection ratios

Year 2021, , 284 - 290, 24.09.2021

Kamil Taha Uçar , Nilhan Nurlu

https://doi.org/10.38053/acmj.953050

Abstract

Aim: The objective of this study is to evaluate blood gas analysis (BGA) sample rejection ratios (SRRs) in our laboratory and investigate the effect of various BGA syringes on SRR.
Material and Method: 3 groups were formed based on the type and use period of BGA syringes. Syringes containing spray-dosed droplet liquid Lithium Heparin were used in Group 1 (November 2018–May 2019), syringes containing lyophilized dried Lithium Heparin were used in Group 2 (July 2019–January 2020), and another syringes containing spray-dosed droplet liquid Lithium Heparin were used in Group 3 (March 2020–September 2020), and the groups were determined based on such use. SRRs of these groups were calculated, causes for sample rejection were identified, and department-based investigations were conducted. Comparisons between groups were performed according to the indicated variables.
Results: Mean SRRs of the groups by percentage (%) were calculated as 6.1±1.5, 10.0±0.9, and 3.8±0.9, respectively, and showed a statistically significant difference (p<0.001). Based on the post-hoc Scheffé’s test, a lower SRR was calculated in Group 3 (P<0.05). The most frequent causes for sample rejection by percentage were found as clotted sample (73.4±10.7), insufficient sample (14.7±9.1), and inappropriate (nonconforming) sample (5.5±2.0). No statistically significant difference was observed based on the causes for sample rejection among the groups. Based on the frequency of SRRs by percentage, the departments were determined as the Emergency Department (ED) (44.3±11.6), Intensive Care Unit (ICU) (22.2±6.5), and Pediatric & Neonatal Emergency Department (PNED) (16.8±6.6). For department-based results among the groups, SRRs for ED and PNED were found to be higher in terms of statistical significance in Group 2 whereas a lower SRR for ICU was determined in Group 3 (P<0.05).
Conclusion: It was observed that BGA syringes containing spray-dosed droplet liquid Lithium Heparin decreased SRRs. Therefore, SRR follow-up may help clinics and laboratories evaluate sample quality as well as developing solutions.

Keywords

Blood gas analysis, sample rejection ratio, preanalytical phase, blood collection device, lithium heparin.

Supporting Institution

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Project Number

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Thanks

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References

• Lippi G, Baird GS, Banfi G, et al. Improving quality in the preanalytical phase through innovation, on behalf of the European Federation for Clinical Chemistry and Laboratory Medicine (EFLM) Working Group for Preanalytical Phase (WG-PRE). Clin Chem Lab Med 2017; 55: 489–500.
• Lippi G, Panteghini M, Bernardini S, et al. Laboratory testing in the emergency department: An Italian Society of Clinical Biochemistry and Clinical Molecular Biology (SIBioC) and Academy of Emergency Medicine and Care (AcEMC) consensus report. Clin Chem Lab Med 2018; 56: 1655–9.
• Davis MD, Walsh BK, Sittig SE, Restrepo RD. AARC clinical practice guideline: blood gas analysis and hemoximetry: 2013. Respir Care 2013; 58: 1694–703.
• Baird G. Preanalytical considerations in blood gas analysis. Biochem Medica 2013; 23: 19–27.
• Shaw JLV. Practical challenges related to point of care testing. Pract Lab Med 2016; 4: 22–9.
• Quig K, Wheatley EG, O’Hara M. Perspectives on blood-based point-of-care diagnostics. Open Access Emerg Med 2019; 11: 291–6.
• Aykal G, Keşapli M, Aydin Ö, et al. Pre-test and post-test applications to shape the education of phlebotomists in a quality management program: An experience in a training hospital. J Med Biochem 2016; 35: 347–53.
• Gunnur Dikmen Z, Pinar A, Akbiyik F. Specimen rejection in laboratory medicine: Necessary for patient safety? Biochem Medica 2015; 25: 377–85.
• CLSI. Procedures for the collection of diagnostic blood specimens by Venipuncture; approved standard—sixth edition. CLSI document GP41-A6. Wayne, PA: Clinical and Laboratory Standards Institute; 2007.
• Oliver P, Fernandez-Calle P, Mora R, et al. Real-world use of key performance indicators for point-of-care testing network accredited by ISO 22870. Pract Lab Med 2020; 22.
• Lippi G, Betsou F, Cadamuro J, et al. Preanalytical challenges-time for solutions. Clin Chem Lab Med 2019; 57: 974–81.
• Dukić L, Kopčinović LM, Dorotić A, Baršić I. Blood gas testing and related measurements: National recommendations on behalf of the Croatian society of medical biochemistry and laboratory medicine. Biochem Medica 2016; 26: 318–36.
• Peck Palmer OM, Wheeler SE, Plebani M, Patterson PD, Korpi-Steiner NL, Martin C. Recognition of the prehospital preanalytical phase: collaborative efforts between laboratory medicine and emergency medicine to ensure quality testing. Clin Chem 2020; 66: 998–1005.
• Cantero M, Redondo M, Martín E, Callejón G, Hortas ML. Use of quality indicators to compare point-of-care testing errors in a neonatal unit and errors in a STAT central laboratory. Clin Chem Lab Med 2015; 53: 239–47.
• Tang NY, Leanse JH, Tesic V, van Wijk XMR. A comparison of venous blood gas analysis with paired specimens collected in syringes and evacuated blood collection tubes. Clin Chim Acta 2020; 510: 671–4.
• Uyanik M, Sertoglu E, Kayadibi H, et al. Comparison of blood gas, electrolyte and metabolite results measured with two different blood gas analyzers and a core laboratory analyzer. Scand J Clin Lab Invest 2015; 75: 97–105.
• Lima-Oliveira G, Lippi G, Salvagno GL, Montagnana M, Picheth G, Guidi GC. Different manufacturers of syringes: A new source of variability in blood gas, acid-base balance and related laboratory test? Clin Biochem 2012; 45: 683–7.
• Gruber MA, Felbermeir S, Lindner R, Kieninger M. Preanalytics: The (in-)stability of volatile POCT parameters and the homogeneity of blood in syringes at the market. Clin Chim Acta 2016; 457: 18–23.
• Triplett KE, Wibrow BA, Norman R, et al. Can the blood gas analyser results be believed? A prospective multicentre study comparing haemoglobin, sodium and potassium measurements by blood gas analysers and laboratory auto-analysers. Anaesth Intensive Care 2019; 47: 120–7.
• Oyaert M, Van Maerken T, Bridts S, Van Loon S, Laverge H, Stove V. Analytical and pre-analytical performance characteristics of a novel cartridge-type blood gas analyzer for point-of-care and laboratory testing. Clin Biochem 2018; 53: 116–26.
• Küme T, Şişman AR, Solak A, Tuğlu B, Çinkooğlu B, Çoker C. The effects of different syringe volume, needle size and sample volume on blood gas analysis in syringes washed with heparin. Biochem Medica 2012; 22: 189–201.
• Mohammed-Ali Z, Bagherpoor S, et al. Performance evaluation of all analytes on the epoc® Blood Analysis System for use in hospital surgical and intensive care units. Pract Lab Med 2020; 22: e00190.
• Chothia MY, Kassum P, Zemlin A. A method comparison study of a point-of-care blood gas analyser with a laboratory auto-analyser for the determination of potassium concentrations during hyperkalaemia in patients with kidney disease. Biochem Medica 2020; 30: 1–7.
• Salvagno GL, Lippi G, Gelati M, Guidi GC. Hemolysis, lipaemia and icterus in specimens for arterial blood gas analysis. Clin Biochem 2012; 45: 372–3.
• Liu D, Li YX, Huang Y. Analysis of hemolysis, icterus and lipemia in arterial blood gas specimens. Clin Chem Lab Med 2017; 55: e69–71.
• Lippi G, Ippolito L, Fontana R. Prevalence of hemolytic specimens referred for arterial blood gas analysis. Clin Chem Lab Med 2011; 49: 931–2.
• Duhalde H, Skogö J, Karlsson M. Point-of-care hemolysis detection in blood gas specimens directly at the emergency department. Scand J Clin Lab Invest 2019; 79: 283–7.
• Lippi G, Fontana R, Avanzini P, Sandei F, Ippolito L. Influence of spurious hemolysis on blood gas analysis. Clin Chem Lab Med 2013; 51: 1651–4.
• O’Kane MJ, McManus P, McGowan N, Lynch PLM. Quality error rates in point-of-care testing. Clin Chem 2011; 57: 1267–71.
• Moreno ALQ, Sáez PO, Calle PF, et al. Clinical, operative, and economic outcomes of the point-of-care blood gases in the nephrology department of a third-level hospital. Arch Pathol Lab Med 2020; 144: 1209–16.
• Hedberg P, Majava A, Kiviluoma K, Ohtonen P. Potential preanalytical errors in whole-blood analysis: Effect of syringe sample volume on blood gas, electrolyte and lactate values. Scand J Clin Lab Invest 2009; 69: 585–91.
• Orhan B, Sonmez D, Cubukcu HC, et al. The use of preanalytical quality indicators: a Turkish preliminary survey study. Clin Chem Lab Med 2021; 59: 837–43.
• Küme T, Ali R, Özkaya A, Çoker C. Preanalytical errors of specimens sent from the emergency department to the laboratory. J Turkish Clin Biochem 2009; 7: 49–55.
• Dukić L, Šimundić AM. Institutional practices and policies in acid-base testing: A self reported Croatian survey study on behalf of the Croatian society of medical biochemistry and laboratory medicine Working Group for acid-base balance. Biochem Medica 2014; 24: 281–92.
• Lippi G, Becan-McBride K, Behúlová D, et al. Preanalytical quality improvement: In quality we trust. Clin Chem Lab Med 2013; 51: 229–41.
• West J, Atherton J, Costelloe SJ, Pourmahram G, Stretton A, Cornes M. Preanalytical errors in medical laboratories: a review of the available methodologies of data collection and analysis. Ann Clin Biochem 2017; 54: 14–9.
• Lima-Oliveira G, Volanski W, Lippi G, Picheth G, Guidi GC. Pre-analytical phase management: a review of the procedures from patient preparation to laboratory analysis. Scand J Clin Lab Invest 2017; 77: 153–63.
• Lippi G, von Meyer A, Cadamuro J, Simundic AM. Blood sample quality. Diagnosis (Berlin, Ger) 2019; 6: 25–31.
• Lippi G, Cornes MP, Grankvist K, Nybo M, Simundic AM. EFLM WG-Preanalytical phase opinion paper: Local validation of blood collection tubes in clinical laboratories. Clin Chem Lab Med 2016; 54: 755–60.