EH 3_2015

EUROPEAN HOSPITAL Vol 24 Issue 3/15 10 LABORATORY ‘With our latest generation of Hemo Control analyser we strengthen its position as a premium product in POC haemoglobin testing,’ Katja Lemburg of EKF Diagnostics points out. ‘We have enhanced data man- agement and connectivity functions to enable simple direct integra- tion with customers’ existing IT environment, an increasingly com- mon request from the POC mar- ket. Uniquely, the next generation device offers a high degree of flex- ibility to meet our customers’ con- nectivity demands as they develop; meaning they can upgrade their data management functionality at a later date after initial purchase of the analyser.’ Principal applications ‘Hemo Control is used for POC test- ing of haemoglobin and haemato- crit in primary care settings, blood banks and hospitals. Haemoglobin and haematocrit are key param- eters in the diagnosis of anaemia, the most common blood disorder affecting about 25% of the global population, and Hemo Control is used worldwide in anaemia screen- ing programmes. In blood banks, the level of haemoglobin is tested before donation to ensure the safety of the donor. Often blood banks are directly integrated in hospitals and perform haemoglobin testing routinely. ‘Also within hospitals, anaemia can be caused by blood loss, e.g. after trauma or major operations. Here the decision for a blood trans- fusion must be taken quickly and the effect of the treatment mon- itored closely. POC haemoglobin devices, such as Hemo Control, deliver fast laboratory quality results directly in emergency rooms or operating theatres.’ Very little training ‘Since it is generally used at the POC by routine medical staff, such as nurses, Hemo Control’s user friendly features ensure that very lit- tle training is required. Step-by- step instructions on-screen, and a user-selectable language menu, guide the user through the test procedure.’ Integration POC analys- ers provide results that d i r e c t l y influence p a t i e n t s ’ treatments. To ensure the correct usage and performance of the device, as well as traceability of results, in most cases POC devices are supervised by the Central Laboratory. For this, bi-directional connectivity with Future haemo Haemolysis must be avoided Inferior blood sampling results in late treatments, wasted lab resources – and even bad blood between doctors and nurses EFK Diagnostics is to show, for the first tim Control point-of-care haemoglobin analyser with Katja Lemburg, Global Product Manage explained how this new analyser aims to me connectivity of point-of-care (POC) devices. Blood sampling via intravenous cath- eters frequently occurs because patients in intensive care already have intravenous catheters in place, and patients admitted to accident and emergency units are immediate- ly set up with intravenous catheters – providing easy access to blood. However, studies have identified this route as a cause of haemolysis (rupture of erythrocytes causing hae- moglobin release into the plasma or serum), as well as meaningful biases in blood/gas analyses. Poor blood sampling will not only delay treatment, waste lab time, result in incremental material costs for re-testing and, potentially, cause discord between doctors and nurs- es – usually responsible for blood collection. Therefore, understanding why samples can become useless is vital for better healthcare. They found the risk is even greater in blood collection when intravenous catheters are used combined with primary evacuated blood collection tubes, and less with blood collection tubes with manual aspiration. An essential part of the clinical decision-making is laboratory diag- nostics, given that the total testing process goes along with a high degree of quality. Several lines of evi- dence attest that the manually inten- sive activities of the pre-analytical phase are more prone to uncertain- ties and errors than those belonging to the analytical and post-analytical phases. This inherent vulnerability is mostly attributable to inappropriate, incorrect or mishandled procedures used for obtaining blood specimens (Lippi et al ClinBiochem 46 (2013) 561-564). The researchers pointed out that among various pre-analytical non- conformances that can be encoun- tered in routine laboratory practices, sample haemolysis represents the primary source of problems, in terms of prevalence and likelihood of sam- ple rejection. The in vitro haemolysis is occurring during, or after sample collection, once potential sources of haemolytic anaemia have been ruled out. Although artefactual (in vitro) hae- molysis recognises several patient- and operator-dependent causes that have been comprehensively reviewed elsewhere, several lines of evidence consistently attest that collection of blood tubes using intra- venous catheters may be associated with a high likelihood to gener- ate erythrocyte injury. Nevertheless intravenous catheters are used regu- larly in A&E departments and even at other procedural units or shorter stay. Nurses frequently draw blood from newly established intravenous lines, which is. faster and more con- venient than searching for another venipuncture site. Although the observed frequency of haemolysed samples varies widely throughout different healthcare set- tings, it can be estimated that these are around ~3% of all serum or plas- ma samples referred to central labo- ratories for routine or stat testing. In a recent critical review of the lit- erature, Halm and Gleaves reported that haemolysis occurs in 3.3 to 77% of blood samples obtained through intravenous catheters, whereas the frequency is nearly 20 times lower when blood specimens are drawn by direct venipuncture. When combin- ing intravenous catheters and vacu- um tubes, artifactual haemolysis can be as high as 77%, while the use of syringe draw is effective to decrease the rate of haemolysed specimens by nearly half. Regardless of the specific cause, the generation of catheter- related haemolysis generates a vari- ety of clinical, organisational and economical issues, which are mainly attributable to specimen rejection and / or recollection, suppression of those tests most sensitive to artifac- tual haemolysis, delayed diagnosis and overcrowding due to increasing length of stay of patients in A&E, as well as frequent inquiring between the A&E and laboratory personnel. The greatest number of haemo- lysed specimens is taken in A&E where the relative prevalence can be as high as 10-30% (Lippi et al ClinBiochem 46 (2013) 561-564, cited literature 4-6). The reasons for poor sampling include difficult venipuncture(s), use of unsuitable blood collection devic- es, poor handling (i.e. vigorous mix- ing) and transportation (freezing or trauma) of blood tubes. Regardless of specific causes, the receipt of haemolysed specimens is always a problem, wherein test results of some analytes, such as potassium, lactate dehydrogenase (LD), aspartate aminotransferase (AST) or cardio-specific troponins, among others, should be suppressed, reported with comments, corrected or recalculated or even provided with semi-quantitative comments indicating likely range of results. The results of the meta-analysis – which is limited to published data and the A&E setting – attest that sam- ple collection through intravenous catheters is associated with signifi- cantly higher risk of haemolysis as compared to standard blood drawn by straight needles, and that this risk is further amplified when intrave- nous catheters are associated with primary evacuated blood collection tubes, as compared with blood col- lection tubes S-Monovette (Sarstedt AG & Co., Numbrecht, Germany) used in the aspiration mode. Blood collection is the most vul- nerable step throughout the test- ing process. Although sample col- lection via venipuncture rather than through intravenous catheters should be considered as a standard of care throughout healthcare [17], the latter procedure is virtually unavoidable in procedural or short-stay units such as A&E or cardiac intensive care units. A potential option to reduce the chance of collecting unsuitable sam- ples entails work in the aspiration mode rather than using vacuum force for drawing blood from intra- venous catheters, since the former practice causes a larger shear stress due to the negative pressure when blood is collected by the vacuum technique, as well as turbulence due to difference of pressures between veins, catheter needles, valves and evacuated collection tubes. Results show that the S-Monovette collecting blood by the aspiration technique may be effective to dra- matically reduce the likelihood of erythrocyte injury when drawing blood from intravenous catheters. The frequency of samples with a haemolysis degree equal or greater than 0.5 g/L has been reduced by more than 10-fold using S-Monovette in aspiration mode. In conclusion, the use of S-Monovette presents several advan- tages, especially for drawing blood from intravenous catheters or can- nulae. The device can be used with either vacuum or aspiration principle of collection, thus virtually mirroring the functioning of a syringe. This latter approach allows blood aspiration with limited shear stress, whereas the closed connection for line draws is effective to abolish the hazardous blood transfer from syringe to blood collection tube. The S-Monovette blood collection system combines two blood collection techniques – aspiration and vacuum – and presents advantages in collection from intravenous catheters or cannulae. Source:Sarstedt Editor-in-Chief: Brenda Marsh Art Director: Olaf Skrober Editorial team: Sascha Keutel, Marcel Rasch Senior Writer: John Brosky Executive Director: Daniela Zimmermann Founded by Heinz-Jürgen Witzke Correspondents Austria: Michael Kraßnitzer, Christian Pruszinsky. France: Annick Chapoy, Jane MacDougall. Germany: Anja Behringer, Annette Bus, Walter Depner, Bettina Döbereiner, Matthias Simon, Axel Viola, Cornelia Wels-Maug, Susanne Werner, Holger Zorn. Great Britain: Brenda Marsh, Mark Nicholls. Malta: Moira Mizzi. Poland: Pjotr Szoblik. Russia: Olga Ostrovskaya, Alla Astachova. Spain: Eduardo de la Sota. Switzerland: Dr. André Weissen. USA: Cynthia E. Keen, i.t. Communications, Jacquie Michels, Nat Whitney. 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EH 3_2015

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