|Year : 2016 | Volume
| Issue : 1 | Page : 7-11
Bank to bedside: A reliable and efficient transportation of blood by pneumatic tube system
Manish Raturi, Shamee Shastry, Aaditya Shivhare
From the Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal University, Karnataka, India
|Date of Web Publication||3-Mar-2016|
From the Department of Immunohematology and Blood Transfusion, Kasturba Medical College, Manipal, Manipal University, Karnataka
Source of Support: None, Conflict of Interest: None
Background: Turnaround time (TAT) is an important quality indicator in blood banking. This study evaluated the effectiveness of the pneumatic tube system (PTS) to reduce TAT and its effect on the quality of the blood products.
Materials and Methods: The PTS (Swisslog GMBH, Germany) which connects to 29 stations was installed at our 2032-bedded tertiary care referral center. The system transports the carrier at an average speed of 25 feet/s (7.6 m/s). Acknowledgment slips were sent along with the blood components through this carrier system to know the time of receipt. Quality control parameters were checked before and after PTS transport in 10 bags of each of the blood components (packed red blood cells [PRBC], platelet concentrate, and fresh frozen plasma [FFP]). Data were analyzed using IBM SPSS Statistics 20.
Results: PTS was used for 220 events to deliver 69% PRBC (n = 152), 15% FFP (n = 34), 14% platelets (n = 30), and 2% cryoprecipitate (n = 4), respectively, to 11 destinations. The average transport time by PTS was 1.36 ± 0.34 min and for human-based transport, it was 7.92 ± 1.40 min and this difference was found to be statistically significant (P < 0.001). The mean latent time was 5.85 ± 4.39 min. Conveyance in the PTS did not reinforce any negative changes on the quality of any blood component.
Conclusion: PTS is rapid and reliable for the transport of the blood products to bedside.
Keywords: Pneumatic tube system, quality control, turnaround time
|How to cite this article:|
Raturi M, Shastry S, Shivhare A. Bank to bedside: A reliable and efficient transportation of blood by pneumatic tube system. Glob J Transfus Med 2016;1:7-11
|How to cite this URL:|
Raturi M, Shastry S, Shivhare A. Bank to bedside: A reliable and efficient transportation of blood by pneumatic tube system. Glob J Transfus Med [serial online] 2016 [cited 2019 Mar 25];1:7-11. Available from: http://www.gjtmonline.com/text.asp?2016/1/1/7/178001
| Introduction|| |
Time taken by the service providers is one of the most important quality indicators in healthcare sector. Inefficient and inadequate intrafacility logistics may increase turnaround time (TAT), healthcare delivery costs, and energy costs apart from various other factors. Therefore, current trends in healthcare require optimal utilization of resources and innovative technologies for an extended safety and quality care to the patients. The transportation of specimens, request forms, reports, blood, and blood components across the hospital, indirectly influence the quality of the patient care. Several hospitals in India have already adopted latest technologies in healthcare, including automation, surgical robotics, modular operating theaters, minimal access surgery systems, telemedicine, radiology, etc. However intrafacility logistics such as materials transportation and supply chain largely remain overlooked. At present, the methods used by the hospital for such spontaneous transports are human-based transport (HBT) using ward boys, housekeeping staff, patient's attendants, or relatives, which leads to delay thereby further reducing the process efficiency. With respect to the blood components, their timely delivery to the bedside is important as it may affect the quality of the product as well as the quality of patient care.
Pneumatic tube system (PTS) is one such mechanism, which facilitates transport of the materials to and from the laboratory. A predecessor of PTS which consisted of pulleys with a continuous conveyor belt was in use in the 1940s. The current systems use pressurized air or vacuum. However, it is important to validate and standardize the process before we implement it for routine transportation of blood components. Still the debate is on regarding the safety of PTS to transport blood samples as there are opposing opinions on this issue.,,
Our transfusion center supports a 2032-bedded tertiary care referral hospital and on an average of 130 units of blood components are issued for transfusion daily. Following the implementation, we aimed to compare the efficiency of the PTS over the conventional HBT and also to assess its effect on the quality of the blood products.
| Materials and Methods|| |
Description of pneumatic tube system
The PTS was installed at our center in September 2011 and has been commissioned in six zones, comprising a total of 29 stations within the hospital premises. This has a computer-controlled network of tubes (6.5 inches diameter) supplied by Swisslog Germany. System specifications are described in [Table 1]. The system requires negative and positive air pressure generated by a motor located at the pneumatic station hub for the transportation of the carriers, which traverse a maximum of 829 feet (253 m) involving 16 bends and eight transfer units at a speed of 25 feet/s (7.6 m/s). The “tube carriers” are made of high impact resistant polycarbonate material. They are 4.5 inches in diameter and 15 inches in length. Sponge carrier insert was used for protection of blood bags during transportation. The allowable maximum load that could be transferred in one carrier at a time was 3 kg. Upon arrival at the destination station, the carrier is decelerated by an air cushion and dropped gently into a receiving basket. Once the carriers are sent through the tubes, its movement can be tracked from the computer control room. The time of dispatch and the time of delivery can be monitored and the time taken between two stations can be calculated.
For the study purpose, we divided the PTS connectivity inside the hospital premises in three zones according to the distance (in meters) from the blood bank.
- Zone 1: Distance from blood bank ≤200 m (Intensive Care Unit [ICU]-1, ICU-2, triage, casualty)
- Zone 2: Distance from blood bank = 200–1000 m (ICU-3, ICU-4, operation theatre, Neonatal ICU, Pediatric ICU)
- Zone 3: Distance from blood bank ≥1000 m (PD-3, WH-2).
Location of pneumatic tube system “station hub/control room”
PTS station hub/control room is situated about 275 m away from the blood bank. At our center, in case the carriers get stuck in the tubes, it can be visualized in this computer control room. This helps in quickly identifying the route where there is blockage so that necessary repairs can be undertaken immediately.
We compared the time taken by the PTS and the HBT to deliver the blood components from the blood bank to the bedside. The TAT was defined as the total time taken from the point of issue of blood till it reaches the patients' bedside. The TAT for HBT was calculated by measuring the mean time taken by 10 different individuals to reach their respective destinations. The TAT for PTS was the time of sending the carrier and reaching the desired destination, which was obtained from the computerized display. Along with the components, acknowledgment slips were also dispatched through the PTS carrier to the wards.
These acknowledgment slips were duly signed by the nursing staff and returned to the blood bank by PTS. The difference between the delivery time displayed by the system and that mentioned by the nursing staff on these slips was considered as the “latent time.” This represents the time taken by the nursing staff to attend the carriers that were dropped at the receiving bin. As per our departmental policy, whenever there was any delay in the receipt of the slips for more than 10 min, a phone call was made to the wards for the confirmation of receipt of the carrier. Therefore, any technical error or failure of the delivery of the carrier to its destination was also tracked and subsequently noted for further action if a need for any such situation arose. We prepared a standard operating procedure on transport of blood components through PTS and got it approved by the hospital transfusion committee before the process standardization.
Analysis of quality parameters of blood components
Pretransportation, samples were obtained from the bag under aseptic precautions. Later, the blood bags were transported by PTS to the hub and immediately returned to the blood bank. Similarly, the posttransportation samples were drawn from the bag too. The impact of PTS on the quality was studied on 10 bags of each of following blood components.
Packed red blood cells quadruple and double bags
Plasma hemoglobin (Hb) (HemoCue ®/Plasma low Hb system, Quest diagnostics, Sweden), serum potassium, and lactate dehydrogenase levels were measured. Percent hemolysis was calculated based on the following formula:
Platelet count, mean platelet volume by Sysmex cell counter (Sysmex KX-21, Japan), pH, pO2, pCO2, and HCO3 levels were checked by sending the sample to biochemistry laboratory (Radiometer ABL800, Radiometer, Denmark). Swirling was checked in each platelet unit before and after PTS transport.
Fresh frozen plasma
Prothrombin time (PT), activated partial thromboplastin time (APTT), and fibrinogen levels were measured by Sysmex coagulometer (CS 2000i, Japan) at hematology laboratory.
The donor questionnaire and the consent form used in our center include a statement that the blood bank is permitted to do any additional tests required to ensure blood safety. Since the above tests were done as a part of quality control to ensure the quality and the safety of the components that are transported through PTS, a separate donor consent was not obtained. All the units that passed the quality control criteria mentioned in our departmental protocol were considered for the transfusion.
The data were entered in a spreadsheet and finally analyzed using IBM SPSS Statistics version 20 (IBM, United States). Simple descriptive statistics were expressed as mean ± standard deviation and qualitative data were expressed as percentage. The two-tailed t-test for paired data was used to compare test values before and after transportation by PTS. P < 0.05 was considered statistically significant.
| Results|| |
We prospectively studied the effectiveness of the PTS by collecting the data for consecutive 220 transport events. A total of 152 units of packed red blood cells (PRBC), 34 units of fresh frozen plasma, 34 units of platelets, and 4 units of cryoprecipitate are sent through PTS to 11 connected destinations. The mean transport time taken by PTS was 1.360 ± 0.3413 (0.36–2.5 min) and for manual delivery of blood components was 7.927 ± 1.400 (5.45–11.12 min). The mean latent time was 5.85 ± 4.39 (1–33 min). The difference in the meantime taken to deliver the blood components was found to be statistically significantly lower by the PTS system in comparison to HBT (P < 0.001).
Temperature during conveyance
The mean pretransportation temperature of inside the carrier was measured as 23.3°C and mean posttransportation temperature was found to be 23.9°C. No statistically significant difference was found between both the temperatures.
|Figure 1: Parts of pneumatic tube system. (a) Blower. (b) Automated station and receiving basket. (c) Polyvinylchloride tubes. (d) Pneumatic tube system carrier with blood bag|
Click here to view
Based on the distance from the blood bank, we divided the wards into three categories. The average time taken by PTS/HBT in Zone 1 (<200 m) was 0.72/6.23 min. Zone 2 (200–1000 m) was 0.79/8.21 min. Zone 3 (more than 1000 m) was 1.80/10.30 min. Statistically, there was a significant difference in the average time taken between PTS and HBT in all the three zones (P < 0.0001) [Figure 2].
|Figure 2: Comparing pneumatic tube system and human-based transport time for blood components based on three different zones|
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Quality parameters of blood components
Conveyance in the PTS did not have any negative impact on the quality of any of the blood component and hence were considered for transfusion. We compared pre- and post-transportation laboratory values and there was statistically no significant change in these parameters [Table 2].
|Table 2: Quality parameters of blood components before and after the pneumatic tube system run|
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Packed red blood cell units
The mean age of five nonadditive PRBC was 12.2 ± 7.65 (6–21 days). The mean age of five additive PRBC was 15.4 ± 7.99 (8–27 days). The mean change in the plasma Hb level in each of the 10 PRBC units with and without additive solution were 0.02 and 0.09, respectively, following transport in PTS. Percentage hemolysis in both the groups was <0.8 and it was comparable among the units transported to the three different zones (0.04, 0.09, and 0.11, respectively).
The mean age of platelet concentrate (PC) used during the study was 3.9 ± 0.87 (3–5 days). Post-PTS transport, swirling was present in all the 10 units and the mean change in pH level was 0.06 units. There was, however, no significant change in the cell counts or the metabolic parameters [Table 2].
Fresh frozen plasma
The mean age of plasma used during the study was 57.4 ± 15.69 (36–82 days). There was no prolongation of PT, APTT, and international normalized ratio values in any of the 10 units used for measurement.
| Discussion|| |
Time is critical when transporting blood. Blood products must be delivered from refrigeration to the right patient's vein within minutes. Speed of delivery for patient specimens can be equally as pressing. Potentially life-saving decisions rest on prompt lab results and those are only possible if patient specimens reach the lab quickly and safely. Cost analyses by hospitals of all sizes show that pneumatic tube delivery systems cost less over time than HBT or employee couriers. In our study, it is worthwhile noticing that the time taken by PTS is 80% lesser than that taken by HBT.
There was no significant rise in temperature inside the carrier due to heat of friction or travel in the tube network, thus making it a blood component friendly carrier system.
Apart from its swiftness to carry blood products bedside, we also looked into the capacity of PTS to act as a potential source of any negative impact on the quality of these blood components.
Similar to the findings of Tanley et al., we did not find any difference in the quality parameters of the blood components following PTS transport. Its capacity to act as a potential source of increased metabolic activity, activation, and release reactions from the platelets does not seem to be of any significance. In accordance with the study done by Sandgren et al., we also propose that stored platelets can be transported with the PTS and this would go on to increase the efficiency of fulfilling the ever rising demand for them. Another study done by Fernandes et al. (Canada) shows that conveyance in PTS did not cause hemolysis rather it reduced the overall TAT. However Kara et al. have noticed a greater frequency of hemolysis, greater mean serum potassium, median creatinine, aspartate aminotransferase, and lactate dehydrogenase levels among blood samples that were transported through PTS than in samples transported manually. They had measured the above parameters following the transport and not compared it with the pretransport values, which appears to be the limitation of their study. The observed percentage hemolysis in PRBC units was well within 0.8% in our study, which is acceptable for the red blood cell components as per recommendations.
We have noticed a latent time of 6 min, which was mainly due to the busy schedule of the nursing staff in the wards. However, it was well within the allowable time frame for starting of blood transfusion. Technical errors are imminent part of automation in any field. There were two instances when the delay was around 15 and 33 min, respectively, due to mechanical error in the automated PTS. Moreover, once it took 11 min due to mixing of the carriers, the sensor of the biochemistry station was out of order causing the jamming of their carriers which also included one carrier that was carrying PCs. However, without any further delay, corrective action was taken and PCs were able to reach bedside, denying its wastage.
| Conclusion|| |
The use of PTS for the transport of blood components was found to be rapid and reliable in the present study, and implementation of this facility will help the healthcare systems to reduce the TAT to a greater extent.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
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[Figure 1], [Figure 2]
[Table 1], [Table 2]