The contact of blood coagulation factors, such as Factor XII (Hagemann Factor), with hydrophilic glass surfaces activates the clotting cascade leading to the conversion of fibrinogen to fibrin, thus enabling the separation of the non-adherent clot from blood plasma by centrifugation ( 14). Glass evacuated tubes are manufactured to be airtight, waterproof, and thermally resistant, which allows for vacuum preservation and long shelf lives ( 13). Evacuated tubes were originally made from soda-lime or borosilicate glass, but soda-lime tubes were found to release calcium and magnesium into blood specimens ( 12). Micro-collection tubes for pediatric specimens are 40 to 50 mm in length and 5 to 10 mm in diameter ( 11). Most tubes for adult clinical specimens are 75 mm to 100 mm in length and 13 mm in diameter, and collect 2 to 10 mL of whole blood ( 9, 10).

A widespread surfactant (SF) problem revealed how these devices can adversely affect laboratory test results ( 7, 8) and emphasized the importance of understanding device limitations.Įvacuated BCTs are generally cylindrical, measuring 50 mm to 150 mm in length and 10 mm to 20 mm in diameter ( 9). In the United States, there are two major manufacturers of evacuated tubes: Becton Dickinson (BD) (Franklin Lakes, NJ, USA) and Greiner Bio-One (Monroe, NC, USA).īecause BCTs function properly under most circumstances, many laboratorians are unaware of their complexity and limitations. Despite their similarity, evacuated tubes supplied by different manufacturers vary in the materials and additives used, which can potentially affect test performance ( 6).

Presently, plastic has replaced glass, and polymer gels and clot activators are common additives ( 5). Glass evacuated tubes containing anticoagulants were commonly used from the 1950s to the 1990s ( 4). Thus, the evolution of blood collection tubes have improved specimen quality and workflow efficiency as well as the safety of patients and health care workers. Since the 1940s, evacuated BCTs have been the most commonly used blood collection devices, since they automatically draw a predetermined blood volume and switching between tubes for additional samples poses a lower risk of spillage and needle-stick injury ( 3). Modern chemical sterilization techniques and radiation allowed the replacement of glass syringes by plastic syringes. Glass syringes were expensive to manufacture and were susceptible to breakage ( 2) nevertheless, what ultimately prompted their replacement with sterile disposable syringes ( 1) were the multiple hepatitis outbreaks that resulted from their use ( 1). Early modifications included a refined needle, replacement of the rubber hub with glass, and the Luer-Lok syringe, which modified the needle tip for a more secure attachment to the syringe and ensuring a more reliable and safer drug delivery ( 1). Reusable glass syringes with steel hypodermic needles and a hard rubber hub were the first devices used to collect blood ( 1). This review aims to identify and describe blood collection tube additives and their components and the strategies used to minimize their effects on clinical chemistry assays. Although other authors have described the effects of endogenous substances on clinical assay results, the effects/impact of blood collection tube additives and components have not been well systematically described or explained. Manufacturers, vendors, and clinical laboratorians must consider the pre-analytical challenges in laboratory testing. Accurate laboratory testing requires an understanding of the complex interactions between collection devices and blood specimens. Because of these interactions with blood specimens, blood collection devices are a potential source of pre-analytical error in laboratory testing. Components from blood collection tubes, such as stoppers, lubricants, surfactants, and separator gels, can leach into specimens and/or adsorb analytes from a specimen special tube additives may also alter analyte stability. Vascular access devices, such as catheters and needles, exert shear forces during blood flow, which creates a predisposition to cell lysis.

Improper design or use of blood collection devices can adversely affect the accuracy of laboratory test results.

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