Impact of Pneumatic Transport System on Preanalytical Phase Affecting Clinical Biochemistry Results

Abstract

Introduction PTS (pneumatic transport system) is extensively being used in modern hospitals for rapid transportation of blood samples and other specimens. However, it has a potential impact on blood components, which should be investigated and nullified accordingly. This study was part of a correction program aimed at reducing hemolysis. It was done by comparing paired samples transported manually and by PTS. Materials and Methods This study was initiated to monitor the impact of PTS on hemolysis of clinical biochemistry blood samples. It was performed in two phases—before and after the corrective action taken. Phase I: done after PTS installation but before the corrective action was taken. Duplicate samples from 100 healthy individuals were collected, one set transported by PTS and the other by human carriers. Both sets were assessed for 25 biochemistry analytes, hemolysis index (HI), and acceleration profiles using a data logger. Corrective measures were then taken, followed by phase II of the study. In phase II, the sample size and study design remained the same as phase I. All the test results of PTS and hand-carried samples were statistically analyzed for any significant difference. Result In phase I, all the hemolysis-manifesting parameters, LDH (lactate dehydrogenase), potassium, AST (aspartate transaminase), and phosphorus, were raised in PTS samples as compared with the manual samples. Their differences were significant as the p-values were 0.001, 0.000, 0.025, and 0.047, respectively. The differences for LDH and potassium were clinically significant as well. HI (9%) and peak acceleration (15.7 g) were high in PTS samples.In phase II, no statistically significant difference between paired samples was found for all biochemistry parameters except for a few which were clinically nonsignificant. For PTS samples, HI was 2.5% and the peak acceleration was 11.2 g, whereas for manual samples, HI was 2%. Conclusion Evidence of hemolysis was found in PTS samples as compared with handheld samples, which was resolved after several corrective actions were taken. Thereafter, PTS became reliable for sample delivery in a routine biochemistry laboratory. Hence, each hospital should scrutinize their PTS for its effects on sample integrity to get rid of PTS-induced preanalytical errors.

A Systematic Review of the Impact of Pneumatic Tube System Transport on Blood Chemistry and Hematology Parameters

“…On the other hand, specimens collected from a limited group of population were the limitation of most studies. To cite, samples from mostly healthy volunteers or patients may not truly assess the effects of the PTS [ 3,9,11,14,16,17,18]. Contrarily, samples from terminally ill patients may give erroneous results when subjected to PTS [6,9].…”

“…Lastly, some studies stated that restricting their analysis on the effects of PTS as their limitation. For instance, analyzing only the hemolysis-sensitive and platelet-speci c tests despite the possibility that other laboratory variables may be associated with the acceleration forces of PTS in various ways [9] and measuring only the speci c analytes sensitive to hemolysis [5].…”

“…However, one study [13] has not reported the p-value but indicated that potassium levels had no signi cant impact on PTS transport. On the other hand, nine studies [1,2,5,6,8,9,10,13,15] have speed ranges from 3 to 13 m/s, and two studies [4,11] have not reported such characteristics. In addition, each study used a different length of PTS, the nine studies reported the following length of the PTS: 170 m, 250 m, 6.096 m, 463 m, 73-297 m, 42.6-1, 423 m, 106 m, 106 m, and 685 m, respectively.…”

A Systematic Review of the Impact of Pneumatic Tube System Transport on Blood Chemistry and Hematology Parameters

“…Eleven research studies [1,2,4,5,6,8,9,10,11,13,15] investigated the impact of PTS on potassium levels. Statistically signi cant differences were found in ve studies [1,4,8,9,11 ] with p-values of 0.001, 0.0, 0.002, 0.042, and < 0.02, respectively.…”

“…Out of seven studies [4,5,6,9,11,12,18], only one study [6] however, the study showed an increase in hemolysis index and was considered signi cant. The study of Wang et al showed the longest length of PTS was used with a measurement of 1000 m, while two studies did not report the length of PTS.…”