SmallVolume Tubes to Reduce Anemia and Transfusion Laboratory
Small-Volume Tubes to Reduce Anemia and Transfusion Laboratory Team Training Slides
Study Rationale
Study Rationale Anemia is a common problem in hospitals
Study Rationale Anemia is a common problem in hospital ·Increased 30 -day mortality Anemia is associated with poor outcomes ·Longer ICU length of stay ·Longer hospital length of stay
Study Rationale Anemia is a common problem in hospital Anemia is associated with poor outcomes Anemia leads to high transfusion rates · 40% of all ICU patients receive ≥ 1 RBC transfusions · 75% of patients in ICU for >1 week receive ≥ 1 RBC transfusion · 50% of transfusions given in absence of any hemorrhage
Study Rationale Anemia is a common problem in hospital Anemia is associated with poor outcomes Anemia leads to high transfusion rates RBC transfusions cause harm
Anemia can be caused by different factors
Laboratory Testing Causes Blood Loss · 21 m. L/day taken in patients with acute MI · 41 m. L/day taken in ICU patients ·Like losing 1 unit of blood every ~8 days
Small-volume blood collection tubes ·Also known as ‘soft-draw’ tubes ·Draw 25 -50% less blood due to less vacuum ·Same cost ·Same concentration of anticoagulant ·Same physical dimensions ·Often routinely used in adults
Study Protocol Overview
Intervention Standard-draw tubes Small-volume tubes Standard-Draw (m. L) Soft-Draw or Reduced Volume (m. L) 10. 0, 6. 0, 4. 0, 3. 0 2. 0 10. 0, 6. 0, 4. 0 2. 0 10. 0, 6. 0, 5. 0, 4. 0, 3. 0 Lithium/Sodium Heparin (green) 10. 0, 6. 0, 4. 0 2. 0 Plasma separation (light green) 10. 0, 4. 5, 3. 5 3. 0 4. 5, 2. 7 1. 8 10. 0, 8. 5, 7. 5, 5. 0, 4. 0 3. 5 5. 5, 4. 5 3. 0 Description EDTA (lavender) Fluoride (grey) Serum (red) Citrate (light blue) Serum separator (gold) Barricor Source: BD Lifesciences – Preanalytical Systems, Product Catalogue 2018, Canada
Laboratory
Tube Characteristics ·Same physical dimensions as current tubes ·Both internal and external* ·Fits most collection devices ·Reduced vacuum in tube means less sample drawn into tubes ·Correct anticoagulant concentration with reduced volumes
Fits Most Instruments ·Biochemistry ·Abbott ·Beckman ·Ortho ·Siemens ·Roche ·Haematology ·Beckman Coulter ·Sysmex ·Coagulation
Tube Validation Study Purpose: Demonstrate Equivalence Between “Soft Draw & Regular Tubes” Population: 20 Healthy Adult Males and Females ·Sites: ·Hamilton: Abbott ·Brampton: Siemens and Beckman ·London: Roche Intervention: “Soft-draw” (2 -3 ml) Vacutainer tubes, Becton Dickinson EDTA, Lithium-Heparin Control: Standard (4 -6 ml) Vacutainer tubes, Becton Dickinson EDTA, Lithium -heparin Outcome: Results Comparison
Tube Validation Study - Results
Tube Validations study – Conclusions ü All tests showed acceptable correlation within the limit of error ü None of the tests required further blood collection, therefore “softdraw” volumes were adequate for testing purposes ü The new small volume method meets the acceptable standards of performance
Blood Collection Tubes
Blood Collection Processes If you are not familiar with the institutional guidelines or have any questions, contact your Nurse Educator or the STRATUS Study Research Coordinator at your site.
Small-volume Tubes Same blood collection procedure as standard-volume tubes ·Draw less blood due to less vacuum in the tube ·Same ratio of anticoagulant to sample ·Tube will automatically fill to the maximum fill volume ·The maximum fill-line may be lower than on standard-volume tube This is demonstrated over the next few slides… Standard-volume tubes in these slides may differ from tubes available at your site. Always refer to the fill-line on the tube label!
How to identify the fill-line? The fill line is indicated on the label
Why fill to the fill-line? Tubes have additives in them (e. g. purple, blue, green tubes) Fill to fill-line ensures correct ratio of blood-toadditive Correct test results Less blood drawn from patients ↓ Result errors
Citrate (Blue) Tube 1. 8 m. L tube Small-volume Tube 2. 7 m. L tube Standard-volume Tube Fill line Will be switched to Fill Line Etched on Tube Fill line
Serum (Red) Tube 4 m. L tube Standard-volume Tube Fill line 2 m. L tube Small-volume Tube Will be switched to Fill line
Lithium-heparin (Green) Tube 6 m. L tube Standard-volume Tube Fill line 2 m. L tube Small-volume Tube Will be switched to Fill line
Barricor (Green) Tube 3 m. L tube Small-volume Tube 4. 5 m. L tube Standard-volume Tube Fill line Will be switched to Fill line
PST Gel + Lithium-heparin (Lime-Green) Tube 3. 5 m. L tube Standard-volume Tube Fill line 3 m. L tube Small-volume Tube Will be switched to Fill line
Serum Separation (Gold) Tube 2 m. L tube Small-volume Tube 4 m. L tube Standard-volume Tube Fill line Will be switched to Fill line
EDTA (Lavender) Tube 4 m. L tube Standard-volume Tube Fill line 2 m. L tube Small-volume Tube Will be switched to Fill line
Sodium Fluoride/Na 2(Grey) Tube 4 m. L tube Standard-volume Tube Fill line 2 m. L tube Small-volume Tube Will be switched to Fill line
Thank you for completing this course! This study is a multi-disciplinary collaborative effort. We appreciate your assistance. PHRI Laboratory Medicine Network Hematology/ Transfusion Critical Care Medicine Industry Hospital Administration Contact your site coordinator or stratus@phri. ca if you have questions on STRATUS!
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