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RST tube — plastic Catalog no. Fluoride tubes — plastic Catalog no. The walls of BD Vacutainer serum separation tubes are coated with silica particles as a clot activator. The coating process creates a film on the tube surface that appears white and slightly cloudy.
The tubes are fine to use. However, it is important to remember to invert the SST tube at least five times after filling. This ensures adequate mixing of silica particles with the blood, which is required for optimal performance. It is not recommended to use BD gel tubes for any tri-cyclic antidepressant drug testing.
Capability Please Select Anesthesia delivery Biopsy Biosciences Biosurgery Cervical cancer screening Diabetes care Drug delivery systems Gastrointestinal care Hazardous drug safety Hernia repair and fixation Home care Infection prevention Infusion therapy Interventional specialities Lab automation Medication and supply management Microbiology solutions Molecular diagnostics Patient monitoring and temperature management Prostate health Sharps disposal solutions Software solutions Specimen collection Surgical instruments Syringes and needles Urology and kidney health Vascular access Vascular surgery Wound care.
Product Line Please Select. Further, blood does not flow smoothly over hydrophobic plastic surfaces, which can result in the adherence of platelets, fibrin, or clotted blood on the tube walls This can make it difficult to cleanly separate serum from the blood clot by centrifugation, especially for microcollection tubes or during centrifugation of vacuum tubes. The hydrophilicity of plastic surfaces can be increased by using plasma-enhanced chemical vapor deposition to introduce polar functional groups Alternatively, the interior plastic surfaces can be coated with SFs, water-soluble polymers, or hydrophilic-hydrophobic copolymers 23 , although SFs may dissolve in blood and interfere with clinical tests 8.
There are ongoing efforts to incorporate SFs into plastic tubes to prevent exudation into blood specimens 9 , Rubber stoppers are routinely color-coded according to anticoagulant type and the presence of a separator gel. The stopper should be readily penetrated by a needle and self-seal upon needle removal 23 , maintaining the internal pressure differential Suitable materials include polychloroprene, silicone, styrene butadiene, isobutyleneisopropene, chlorinated ethylene-propylene co-polymers, and isobutylene-isoprene rubber 23 , 25 , Butyl rubber, a copolymer of isobutylene and isoprene, and halogenated butyl rubber are commonly used materials 23 , 25 , 26 ; butyl rubber exhibits superior air and moisture impermeability, superior resistance to chemical attack and heat resistance, and good processability 25 , To reduce the potential for splatter from the blood specimen when the rubber stoppers are removed from the collection tube, a stopper shield is used e.
The stopper shield can be made from thermoplastic materials, such as polyethylene, polypropylene, and polyvinylchloride 8 , Discrepancies in the bioavailability and bioequivalence of tests for blood specimens collected into tubes whose rubber stoppers containing the plasticizer tris- 2-butoxyethyl -phosphate TBEP have been reported TBEP has been reported to alter the drug distribution of quinidine, propranolol, lidocaine, tricyclic antidepressants, and several phenothiazine drugs, including fluphenazine and chlorpromazine Therefore, tube manufacturers have decreased or eliminated production of rubber stoppers containing TBEP Janknegt et al.
However, other stopper components can also pose problems. Curry et al. Metals such as calcium, aluminum, magnesium, and zinc are used to manufacture rubber stoppers; it is essential that these metals are not extracted upon contact with blood 32 ; specially formulated rubber stoppers have been made to limit divalent cation leaching Sulfur, sulfur-containing vulcanization accelerators, fatty acids, and peroxides in stoppers can also potentially affect lab tests; therefore, most stoppers are manufactured with low-extractable rubber or have been modified to minimize leaching into the blood specimens The complete filling of BCTs dilutes any leached material and helps reduce the effects Lubricants, such as silicone oils, fluids, and glycerol, facilitate the insertion and removal of stoppers 6 , 9 , Lubricants minimize red blood cell and clot adherence to stoppers in order to prevent serum or plasma contamination 6 , 9 , However, glycerol should not be used to lubricate stoppers used for specimens measuring glycerol or triglyceride when a non-glycerol blank assay is used Siliconized stoppers are generally preferred because they are less likely to interfere with assays, although silicone may falsely elevate ionized magnesium and total triiodothyronine levels 7 and may confound peaks during mass spectrometry MS analysis and peak interpretation Although serum is used for most assays, plasma is a useful alternative due to its rapid processing time.
Plasma, which contains fibrinogen and other clotting factors, has a higher viscosity and total protein content than serum Serum has a higher concentration of thromboglobulins, potassium, activation peptides for coagulation factors, platelet factor 4, and platelet components released during platelet activation Anticoagulants used to preserve analytes may interfere with other analyte determinations when using plasma Ethylenediaminetetraacetic acid EDTA , heparin, and citrate are the most commonly used anticoagulants 39 — Potassium EDTA Table 1 , an anticoagulant and chelating agent, interferes with calcium assays and clot generation 42 , but it is preferred for hematology testing.
EDTA binds the metallic ions europium immunoassay reagent , zinc, and magnesium enzyme cofactors for immunoassay reagents such as alkaline phosphatase Insufficient sample volumes produce relatively elevated EDTA levels, which can increase the chelation of magnesium and zinc, and can then affect reagent enzymes used for signal generation, such as alkaline phosphatase Reagent antibodies recognize divalent cation complex binding sites on proteins; thus, decreased calcium and magnesium levels may induce conformational changes that decrease antibody binding Heparin salts typically from porcine intestinal mucosa are also extensively used as anticoagulants in BCTs Table 1 Heparin complexes with and induces a conformational change of antithrombin III to accelerate the inhibition of thrombin and Factor Xa 35 , which prevents thrombin activation and the generation of fibrin from fibrinogen.
Since heparin binds electrolytes and changes the concentration of bound and free ions 45 , manufacturers have created electrolyte-balanced formulations However, heparin can interfere with a variety of clinical assays.
Heparin also slows some antibody-antigen reaction rates 46 , particularly during the precipitation step in second-antibody systems, although this problem can be avoided with the use of solid-phase systems Heparin should also be avoided in cryoprotein investigations since it precipitates cryofibrinogen 43 , Exogenously administered heparin alters serum thyroid hormone levels 43 , Falsely low albumin levels have been observed when heparinized tubes have been used on hemodialysis patients It is has been proposed that heparin inhibits the binding of bromocresol green to albumin, leading to less colorimetric complex formation Proteomic studies show that heparinized plasma causes non-specific protein binding, which influences the separation and MS of peptides Recently, Lippi et al.
Trisodium citrate in a 3. It can inhibit both aspartate aminotransferase and alkaline phosphatase by the chelation of cations Sodium citrate, which is used in acid citrate dextrose and citrate theophylline adenosine dipyrridamole 51 , inhibits platelet activation and is used to measure plasma levels of platelet-derived components.
Oxalate can also inhibit several enzymes, such an amylase, lactate dehydrogenase, and acid and alkaline phosphatase Sodium fluoride Table 1 inhibits the glycolytic enzyme enolase and is used to limit the ex vivo consumption of glucose by cells in a collected blood specimen Hence, complete inhibition of glycolysis in fluoride-containing tubes can take up to 4 hours at room temperature with a normal blood cell count Fluoridated tubes can affect diabetes diagnosis, which uses fixed plasma glucose levels established using blood that was iced, centrifuged, and had the plasma removed In fact, the American Diabetes Association no longer recommends using sodium fluoride only to inhibit in vitro glycolysis Sodium fluoride may be unsuitable for enzymatic immunoassays because of its enzyme inhibitory activity Fluoride may also interfere with electrolyte measurements by altering cell membrane permeability 51 and promoting hemolysis by red blood cell ATP with subsequent potassium efflux Iodoacetate preserves glucose concentrations by inhibiting glyceraldehydephosphosphate dehydrogenase, but it can interfere with the measurement of glucose, sodium, potassium, chloride, and lactate dehydrogenase measurements and can cause hemolysis Although anticoagulants and antiglycolytics can be unsuitable for certain assays, assay manufacturers do not always specify the plasma sources used to validate their tests.
Consequently, it is important that clinical laboratories assess tube performance with their particular assays, instruments, and platforms. Separator gels are used to separate serum from clotted whole blood or plasma from cells In this regard, serum separator tubes SST are easy to use, require short processing times, yield higher serum levels, limit hazardous aerosolization, require only one centrifugation step, allow primary tube sampling, and require a single label During centrifugation, the thixotropic gel used in these tubes lodges between packed cells and the top serum layer The position of the gel after centrifugation is influenced by many tube characteristics, such as specific gravity, yield stress, viscosity, density, and tube material.
Polymeric gels affect viscosity, density, and other physical properties. Separator gels are typically made from viscous liquids, fillers, or tackifiers with substances like dibenzylidene sorbitol as a gelling agent Fatas et al. In addition, Faught et al. Several reports of gels affecting analyte concentrations have been published. Organochlorine, polychlorinated biphenyl, and progesterone levels may also be significantly reduced A small but statistically significant difference in myoglobin and CK-MB levels has been reported between tubes with and without separator gels 5.
Interestingly, newer separator gels e. Separator gels may also release materials e. Recently, Shi et al. The interference increased according to the length of storage of serum in the tubes and was more pronounced with specimens containing low testosterone levels Modifications of the assay and liquid chromatography-tandem MS parameters did not resolve the tube interference problem with the quantitation of serum testosterone levels Thus, new technologies applied in the clinical laboratory to determine analyte concentrations can be significantly affected by BCTs components such as the separator gel.
Ideally, separator gels should maintain uniform chemical and physical properties for the intended period of use and be inert to the specimens collected in BCTs. Plastic tubes require clot activators that use either intrinsic or extrinsic pathways to ensure rapid and dense clot formation Clot activation by the intrinsic pathway is surface-dependent and a greater density of activating surface sites speeds clotting time.
Siliceous substances e. The amount of clot activator varies by manufacturer Clot activators also diminish latent fibrin formation in the separated serum Clot activation by the extrinsic pathway, coagulation initiated by adding substances extrinsic to blood, is biochemical e. Although these clot activators produce rapid clotting 10 to 20 minutes , the clots formed are gelatinous and do not easily separate from serum Clot activators can be added to tubes by adding small beads or paper coated discs, or they can be sprayed on interior tube surfaces with a carrier e.
These carriers allow rapid clot activator suspension into blood so that the carriers dissolve into both serum and clots as the clotting is initiated PVP and water-soluble SFs also release clot activators into blood specimens to reduce the need for mixing BD has recently released a serum tube containing thrombin rapid serum tubes RST TM ; Table 1 , orange stopper for rapid clot activation within 5 minutes Dimeski et al.
Based on these findings, it is clear that additional studies are needed to ensure that the RST tubes give clinically equivalent results to other commercially available serum tubes, especially for partially filled tubes of blood. Some clot activators are problematic in that they must be thoroughly mixed to allow complete pelleting with the clot.
If soluble fibrin clots form, they can interfere with pipetting device accuracy or in solid-phase binding in immunoassays To limit these problems, plasma gas may be used to introduce heteroatoms non-carbon and hydrogen atoms in the backbone of the molecular structure to the tube wall surface to accelerate clotting without contaminating the serum or clot with binders or activators Various studies have revealed the impact of clot activators on laboratory test performance.
Sampson et al. The clot activators or silicone SFs can interact with ion-specific analyzer membranes, which increase the measured voltage and falsely elevate serum lithium ion concentration. Clot activators can also falsely elevate serum testosterone measurements 69 , but changing the ion pair eliminates this problem Proteome analysis by MS may also be altered by clot activators Silica and silicate clot activators, when sprayed onto plastic tubes, induces the release of pro-, active, and complexed matrix metalloproteinases Recently, it was shown that ficolin-1 and ficolin-2 levels, a group of proteins that can activate the complement pathway, and their binding capacities were significantly affected, presumably, by the silicate material in SST tubes Thus, it is critical that the optimal amounts and composition of clot activators and water-soluble agents be determined and consistently added to different types and sizes of BCTs in order for these substances to function properly without adversely affecting the quality of the blood specimens and test results.
SFs are commonly used to decrease non-specific adsorption, but they must be carefully selected and optimized for immunoassays since, at high concentrations, they may cause the loss of antibodies passively adsorbed onto the solid support beads used in immunoassays Commercially available tubes contain a variety of SFs 7 , 8 , 10 that improve blood flow, distribute clot activator, and prevent proteins, RBCs, and platelets from adsorbing to tube walls Company Video.
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