All About Vacutainer Tubes

Historically, glass vacutainer tubes were invented in 1947 by Joseph Kleiner. Manufactured and sold by BD [Becton, Dickinson and Company] since 1949. Vacutainer is a registered trademark of Becton, Dickinson and Company. The plastic version known as Vacutainer PLUS was co-inventor E. Vogler, D at Becton Dickinson Research Center in RTP, North Carolina from 1991 to 1993. Developed by Montgomery and G. Harper.

The first tube invented by Joseph Kleiner was called a refugee. BD hired Kleiner as a product consultant and renamed his tube to Vacutainer®.

Prior to the invention of the vacuum tube system, before collecting blood, solutions for additive tubes such as EDTA and citrate were prepared and dispensed into test tubes for blood anticoagulation. The laboratory then etched a line into a borosilicate glass tube to identify the appropriate suction volume. Hematologists collect blood samples with needles and glass syringes. After collection, the blood is transferred to a series of test tubes, which are sealed with black rubber stoppers to transport the test tubes to the laboratory. For electrolyte measurements, mineral oil was added to the tube to prevent CO2 loss. For serum samples, a wooden applicator stick was used to loosen the clot from the tube wall [Franklin Lakes, 1996].

There were a number of drawbacks to these technologies. The patient was challenged with multiple needle penetrations into the vein. Errors and safety risks during the collection and transfer process were inevitable [Franklin Lakes, 1996].

The introduction of a vacuum blood collection system has started an era in which the ratio of blood to additive is safer, easier to handle, faster, and more accurate. During blood collection with a vacuum tube, one end of the needle entered the patient's vein. When the tube was pushed into the open end of the holder, the other end penetrated the rubber stopper. The vacuum filled the tube with the appropriate amount of blood.

At first, vacutainer tubes were shipped in vacuum cans similar to coffee cans. Previously, this was a breakthrough at the time because heavy clamps were used to prevent the stopper from popping out during autoclaving [Franklin Lakes, 1996]. However, there are now regulatory bodies and guidelines that ensure consistency in the design and manufacture of blood collection systems such as the Food and Drug Administration [FDA]. International Organization for Standardization [ISO]; Clinical Laboratory Standards Association [CLSI]; Medical Device Revision [1976] and Safe Medical Device Act [1990].

The vacutainer tube and device consist of a plastic hub, hypodermic needle and vacuum tube. The vacutainer tube also contains additives to stabilize and store blood samples prior to analysis. The vacutainer offers a variety of labeling options and closure colors. It can also be used in a variety of draw volumes with or without safety-designed closures.

Function classification:

Vacutainer tubes are widely recognized for their functional ease of use. Venous puncture protocols using syringes require elaborate preparation for blood sample analysis in that appropriate additives are added to the tube that are at high risk of sampling and analysis errors.

The vacutainer tube has a color-coded plastic cap. The cap color code indicates the blood additive in the tube. Additives are chemicals that store blood for processing in the laboratory.

Additives include anticoagulants such as EDTA, sodium citrate, and heparin. Some vacutainer tubes contain gels with an intermediate density between blood cells and serum. During centrifugation of these gels, including tubes, blood cells sink to the bottom of the tube, covered with a layer of gel, and serum remains on top. If plasma containing platelets is needed for the analysis, centrifuge using a vacutainer without gel or coagulant. Because color codes have standard protocols, they have universal use in the medical field.

Lottery order:

As mentioned earlier, vacutainer tubes facilitate multiple blood draws, and needles that pierce multiple tubes can carry additives that interfere with blood analysis from one tube to the next. Therefore, a standardized sequence of such multiple aspirations is required to avoid additive cross-contamination. Order of Draw is a term that refers to a standard protocol developed for sequences that fill these tubes.

Recent trends and recommendations:

Recent trends in vacutainers include the use of tubes made of polyethylene terephthalate and various types of blood collection needles. Recently introduced vacutainer tubes are made with a special blend of plastic and polyethylene terephthalate, which is very strong, dimensionally stable and resistant to chemicals and breakage. The manufacturer specifies that all non-gel blood collection tubes, including those containing heparin, EDTA, and non-gel serum tubes, can be centrifuged at ≤1300RCF for 10 minutes. Some tubes need to be rotated at a speed of 1000-1300 RCF at room temperature for 10 minutes for swinging bucket centrifuges and 15 minutes for fixed angle centrifuges.

These recent tubes are coated with silicon and finely divided silica particles to promote coagulation. Silicone coating reduces the adhesion of red blood cells to the tube wall. Due to the silica coating, the inner wall of the tube may become cloudy or filmy. This cloudy appearance does not make the tube unusable. Most tubes are packaged in 100 tubes / box and 1,000 tubes / case [10 boxes]. The expiration date of the tube label is listed as month and year. The tube will expire at the end of the month as indicated on the label. The inside of the vacutainer blood collection tube is sterile. Tubes are sterilized by gamma radiation [Wayman, 1994].

These tubes have certain negative pressures. During the re-sterilization cycle, this negative pressure can be disrupted, so the tube may not draw the proper blood volume. Therefore, these tubes are sterilized only inside. Manufacturers do not recommend re-sterilizing tubes with ethylene oxide or autoclaves as pressure changes during the re-sterilization cycle. Some manufacturers offer a sterilized exfoliation pouch containing a 10 mL glass red top serum tube and a 7 mL glass lavender top EDTA tube. 3mL and 6mL plain tubes without added additives used as waste tubes are also available and are useful when drawing blood directly from an indwelling line or catheter. Tubes must be stored at 4-25 ° C [39-77 ° F] and must be inverted after withdrawal. Inversion means that the wrist is fully rotated once and returned 180 degrees in the opposite direction.

Tubes should be inverted according to the manufacturer's recommendations:

SST and serum tube-inverted 5 times

Additive tube [EDTA, heparin, etc.] -8-10 times inversion

Sodium citrate tube [blue at the top] -3-4 times inversion

The market has recently been flooded with vacutainer tubes containing closures with unique rubber stoppers. Covered with a plastic shield to prevent laboratory personnel from coming into contact with blood in the stopper or around the outer edge of the tube. Closing the tube also helps prevent blood from splashing when the tube is opened.

Gel tube

A vacutainer containing a gel that forms a physical barrier between serum or plasma and blood cells during centrifugation was introduced. After blood collection, it is recommended to invert the serum separation tube 5 times, set the clotting time to 30 minutes, and centrifuge at 1000-1300 RCF [g] for 10 minutes in a swinging bucket centrifuge. Invert the plasma separation tube 8 times and centrifuge at 1000-1300 RCF [g] for 10 minutes in a swinging bucket centrifuge.

Gels are composed of inert ingredients, which are part of a unique polyester-based formulation. The silica particles that cover the tube walls are actually coagulant activators. The first activation occurs when blood enters the tube and contacts the tube wall particles. To continue the activation process, the tube must be inverted 5 times to thoroughly mix the blood and particles.

The coating process creates a white, slightly hazy film on the tube surface. There is no problem using the tube. However, remember to invert the SST ™ tube at least 5 times after filling. This ensures proper mixing of the silica particles and blood, which is necessary for optimal performance.

Serum separation and transport tubes contain twice as much gel as regular tubes. This maintains the quality of the sample for lab analysis by providing a thick barrier as the tube is transported. It is primarily intended for use when collecting specimens in a doctor's laboratory or other remote collection station, centrifuging them, and returning them to the laboratory for analysis.

Gel separation tubes should be centrifuged within 2 hours after collection. The manufacturer does not recommend re-centrifuging the gel tube after the barrier has been formed. Freezing the sample over the gel barrier of the primary blood collection tube is not recommended. Freezing and thawing may cause gel separation and contamination of the sample with red blood cells. It is not recommended to use gel tubes for testing tricyclic antidepressants. It has not been verified in trace element testing. For trace element testing, we recommend using a Royal Blue plugged trace element tube.

EDTA vacuum [vacutainer] tube

EDTA is an abbreviation for ethylenediaminetetraacetic acid. EDTA works by binding calcium in the blood and preventing blood from clotting. The nominal concentration of EDTA is 1.8 mg EDTA per milliliter of blood. The latest blood collection tube contains K2EDTA spray-dried on the tube wall. K2EDTA is recommended by CLSI [CLSI Guidelines-Vacuum Tubes and Additives for Blood Sample Collection-5th Edition H1-A5, 2003] and ICSH [International Society for Hematology Standardization Council].

The glass blood collection tube contains K3EDTA, a liquid of EDTA. K3EDTA is a liquid that dilutes the sample by 1-2%. K2EDTA is spray dried on the tube wall and does not dilute the sample. K2EDTA Tubes are intended for routine immune blood tests such as red blood cell grouping, Rh typing and antibody screening. Each facility must establish an acceptable minimum and maximum blood volume to ensure accurate hematology results. Blood collection tubes are designed to add the appropriate blood to ensure the proper blood to additive ratio [Antignani et.al, 2001].

Sodium citrate tube

The sodium citrate tube is designed to be within ± 10% of the aspiration volume on the additive tube label throughout the shelf life. CLSI recommends rotating the sodium citrate tube at 1500 RCF for 15 minutes to obtain platelet-poor plasma [platelet count <10,000] and accurate clotting results. The etched fill indicator on the plastic citrate tube indicates the minimum acceptable blood volume in the tube. The automated instrument requires an average of 100 perl for each PT and APTT test, 50 μl of fibrinogen, and 20 μl of factor analysis.

There is a recent research article that shows that there is no need to pull the waste tube before pulling the sodium citrate tube. In the CLSI solidification document [H21-A5], it is recommended that the citrate tube be the second or third tube drawn. However, the VLSI puncture collection [H3-A6] CLSI guidelines state that for routine PT and APTT, the first tube drawn can be used for testing. Because tubes can contain up to 0.5 mL of air, it is also important to ensure that the waste tube is pulled when using a blood collection set and ordering only citrate tubes. The 1.8 mL tube has a light blue rubber stopper covered with a translucent shield, and the 2.7 mL tube has a light blue rubber stopper covered with a light blue solid closure.

Heparin tube

Heparin is derived from the intestinal mucosa of pigs. The green upper heparin tube contains the lithium or sodium salt of the heparin anticoagulant. Do not use lithium heparin to measure lithium. All heparin is spray dried onto the tube wall. Prior to April 1, 2010, heparin levels were approximately 15 USP units of heparin per milliliter of blood. USP is not equivalent to International Unit [IU]. IU is 6.4% larger than USP. As of April 1, 2010, USP and IU are equivalent if a sodium or lithium heparin tube has an uppercase N alphabetic superscript after the word heparin [ie, HeparinN]. Displays the numerical change in the number of USP activity units as a result of harmonization with WHO international standards. When heparin sodium tubes are filled to the proper volume, sodium results are only increased by 1-2 mmol / mL [Bush et.al, 1998].

Trace element / lead pipe

Blood collection tubes can be used to monitor antimony, arsenic, cadmium, calcium, chromium, copper, iron, lead, magnesium, manganese, and zinc. The manufacturer offers trace element tubes containing two different additives. Plastic tubes contain silica particles that can be used for serum analysis. Plastic trace element tubes using K2EDTA can be used to analyze whole blood or plasma [Bush et.al, 1998].

SPS tube

SPS tubes are used to collect blood culture specimens in microbiology. We recommend 8 gentle tube inversions to prevent blood clotting. The blood stays in the SPS tube for 2-4 hours before being transferred to the blood culture bottle.

Blood collection kit

Push-button blood collection sets and safety-winged blood collection sets are recent innovations in the market. Push button blood collection sets and safety blood collection sets can be used with syringes when used without a luer adapter. The syringe is attached to the female side of the push button blood collection set or blood collection set. When blood is drawn into the syringe, the safety mechanism of the winged needle set works properly. The use of needles for the purpose of transferring blood directly from a syringe to a specimen container is still prohibited by the Federal OSHA. The syringe must be connected to a device such as a blood transfer device that meets all blood transfer procedures and safety standards. When collecting sodium citrate tubes for PT and / or APTT testing, it is important to purge air from the blood collection set tubes. Use a waste tube from the plain or another sodium citrate tube first to purge air from the tube and aspirate it completely into the citrate tube. It is also recommended to purge the air from the tube before drawing the additive tube. CLSI recommends filling all additive tubes to the specified volume. PBBCS and SLBCS are available with 21, 23, and 25 gauge needles [Bush et.al, 1998].

Conclusion:

The vacutainer tube is simple, easy to use and safety designed. A safety mechanism after blood collection helps protect against needle stick damage. The tube is pre-installed with a holder to ensure OSHA disposable holder compliance for increased convenience.

My reference

Adcock, DM, Kressin DC, Marlar RA. Effect of 3.2% vs. 3.8% sodium citrate concentration in daily coagulation tests. Am J Clin Path. 1997; 107: 105-110.

Antignani A, Cheng E, Evans J, Grippi et al. & # 39; How to use additive formulations and how to make tubes using additive formulations, US Pat. No. 6,187,553, February 2001.

Becton Dickinson and Company. The origins of Joseph Kleiner and Vacutainer ™. echo. Franklin Lakes, New Jersey, Becton Dickinson and Company: 1991 [Spring]; 11: 3-5, 1991 [September]; 11: 5-7; 1996 [December]; 16: 1

Tubes are sterilized by gamma radiation [Wayman, 1994].