Ihab Salloum[ad_1]
Historically, in 1947, Joseph Kleiner invented Vacutainer tubes in glass. Since 1949, BD (Becton, Dickinson and Company) has been manufacturing and marketing these tubes. Vacutainer is a registered trademark of Becton, Dickinson and Company. During 1991-1993, at Becton Dickinson Research Center, RTP, NC, the plastic version known as Vacutainer PLUS was developed by co-inventors E. Vogler, D. Montgomery, and G. Harper.
The first evacuated tube invented by Joseph Kleiner was originally called Evacutainer. However, when BD hired Kleiner as a consultant, they changed the name to Vacutainer®.
Before the invention of evacuated tubes, blood collection involved preparing and dispensing solutions for additive tubes like EDTA and citrate into test tubes for blood anticoagulation. To determine the correct draw volume, lines were etched into the borosilicate glass tubes. Phlebotomists would collect blood specimens using needles and glass syringes. After collection, the blood had to be transferred into a series of test tubes, and these tubes were sealed with black rubber stoppers for transport to the laboratory. Mineral oil was added to tubes for electrolyte measurements to prevent CO2 loss. Wooden applicator sticks were used to loosen clots from the tube walls for serum specimens.
These older techniques had numerous shortcomings. Patients had to endure multiple needle entries, and errors during the collection and transfer process were unavoidable. The safety risks were also significant.
The introduction of vacuum blood collection systems brought about increased safety, ease of handling, speed, and accuracy in blood-to-additive ratios. With evacuated tubes, one end of the needle enters the patient’s vein while the other end penetrates the rubber stopper as the tube is pushed into the open end of the holder. The vacuum allows the tube to fill with the appropriate volume of blood.
Initially, vacutainer tubes were packaged and shipped in vacuum tins similar to coffee cans, which was a breakthrough at the time. Before this, a heavy clamp was used to secure the stoppers during autoclaving. However, there are now regulatory agencies and guidelines in place to ensure consistency in the design and manufacture of blood collection systems, such as the Food and Drug Administration (FDA), International Standardization Organization (ISO), Clinical Laboratory Standards Institute (CLSI), the Medical Device Amendment (1976), and the Safe Medical Devices Act (1990).
A Vacutainer tube and apparatus consist of a plastic hub, a hypodermic needle, and a vacuum tube. Vacutainer tubes also contain additives to stabilize and preserve blood specimens before analysis. These tubes come with various labeling options and closure colors, as well as a range of draw volumes, with or without safety-engineered closures.
Vacutainer tubes have gained recognition for their functional ease. The traditional syringe method of venipuncture requires elaborate preparations for blood sample analysis, including the addition of appropriate additives into the tubes, which carries a greater risk of sampling and analytical errors.
The color-coded plastic caps of Vacutainer tubes indicate the blood additives they contain. These additives, such as anticoagulants like EDTA, sodium citrate, and heparin, preserve the blood for processing in the laboratory. Some Vacutainer tubes contain a gel that separates blood cells from the serum during centrifugation.
To avoid cross-contamination of additives, a standardized sequence called the Order of Draw is followed when using multiple tubes. This sequence ensures that additives from one tube do not contaminate the next one. It has become a universal protocol in the medical field.
Recent trends in Vacutainers include tubes made of polyethylene terephthalate and various types of blood collection needles. These tubes are strong, dimensionally stable, and resistant to chemicals and breakage. Some tubes are coated with silicone and micronized silica particles to speed up clotting and reduce adherence of red cells to the tube walls.
Vacutainer tubes should be stored at 4-25’C (39-77’F) and require proper inversions after drawing blood. The inversion recommendations vary depending on the type of tube.
In recent years, Vacutainer tubes with unique rubber stoppers covered by a plastic shield have entered the market. These closures protect laboratory personnel from contact with blood on the stopper or around the outer rim of the tube and prevent blood splattering when the tube is opened.
Additionally, Vacutainer tubes with gel barriers have been introduced. These tubes require specific handling procedures, including inversion and centrifugation, to separate the serum or plasma from blood cells.
The gel in these tubes consists of inert components and silica particles that serve as clot activators. Thoroughly mixing the blood and particles by inverting the tube is necessary for optimal performance.
Overall, Vacutainer tubes have revolutionized blood collection, providing greater safety, ease of handling, and accuracy in analysis. As technology advances, manufacturers continue to introduce new improvements to enhance the functionality and performance of these tubes.
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