Impact of Use of Smaller Volume, Smaller Vacuum Blood Collection Tubes on Hemolysis in Emergency Department Blood Samples.

OBJECTIVES: Hemolyzed blood samples commonly occur in hospital emergency departments (EDs). Our objective was to determine whether replacing standard large-volume/high-vacuum sample tubes with low-volume/low-vacuum tubes would significantly affect ED hemolysis. METHODS: This was a prospective intervention of the use of small-volume/vacuum collection tubes. We evaluated all potassium samples in ED patients and associated hemolysis. We used χ2 tests to compare hemolysis incidence prior to and following utilization of small tubes for chemistry collection. RESULTS: There were 35,481 blood samples collected during the study period. Following implementation of small-volume tubes, overall hemolysis decreased from a baseline of 11.8% to 2.9% (P < .001) with corresponding reductions in hemolysis with comment (8.95% vs 1.99%; P < .001) gross hemolysis (2.84% vs 0.90%; P < .007). CONCLUSIONS: This work demonstrates that significant improvements in ED hemolysis can be achieved by utilization of small-volume/vacuum sample collection tubes.

Does Pneumatic Tube System Transport Contribute to Hemolysis in ED Blood Samples?

INTRODUCTION: Our goal was to determine if the hemolysis among blood samples obtained in an emergency department and then sent to the laboratory in a pneumatic tube system was different from those in samples that were hand-carried. METHODS: The hemolysis index is measured on all samples submitted for potassium analysis. We queried our hospital laboratory database system (SunQuest(®)) for potassium results for specimens obtained between January 2014 and July 2014. From facility maintenance records, we identified periods of system downtime, during which specimens were hand-carried to the laboratory. RESULTS: During the study period, 15,851 blood specimens were transported via our pneumatic tube system and 92 samples were hand delivered. The proportions of hemolyzed specimens in the two groups were not significantly different (13.6% vs. 13.1% [p=0.90]). Results were consistent when the criterion was limited to gross (3.3% vs 3.3% [p=0.99]) or mild (10.3% vs 9.8% [p=0.88]) hemolysis. The hemolysis rate showed minimal variation during the study period (12.6%-14.6%). CONCLUSION: We found no statistical difference in the percentages of hemolyzed specimens transported by a pneumatic tube system or hand delivered to the laboratory. Certain features of pneumatic tube systems might contribute to hemolysis (e.g., speed, distance, packing material). Since each system is unique in design, we encourage medical facilities to consider whether their method of transport might contribute to hemolysis in samples obtained in the emergency department.

Treatment of resectable intrathoracic sarcomas: a single institution experience over twenty years.

BACKGROUND: There are very few published data on the management of primary intrathoracic sarcoma, defined as sarcomas arising from the lung, pleura, and mediastinum, excluding the chest wall. Therefore, the aim of this study was to evaluate the outcome of patients with intrathoracic sarcoma treated at an academic referral center over a 21-year period. METHODS: A retrospective search was performed to identify patients with intrathoracic sarcomas treated with surgical resection from January 1990 to November 2011 at the University of Washington Medical Center. Local control and overall survival were analyzed in relation to the treatment received. RESULTS: Thirty-five patients were identified. Hazard ratios for local control, adjusted for tumor margin status, at 5 years were 0.74 (95 % CI [0.21, 2.58]) for the addition of chemotherapy (CT) to surgery, 0.57 (95 % CI [0.15, 2.23]) with the addition of (radiation therapy) RT, and 0.50 (95 % CI [0.06, 4.03]) with the addition of both CT and RT. At 7 years, the ratios for local control were 0.69 (95 % CI [0.20, 2.36]) for CT added to surgery, 0.58 (95 % CI [0.15, 2.27]) for RT, and 0.41 (95 % CI [0.05, 3.33]) with the addition of both CT and RT. Hazard ratios for overall survival, adjusted for sarcoma stage, at 5 years were 0.61 (95 % CI [0.16, 2.39]) for the addition of CT to surgery, 1.03 (95 % CI [0.26, 4.08]) for the addition of RT, and 0.54 (95 % CI [0.11, 2.69]) for the addition of both CT and RT. The 7-year hazard ratios for overall survival were 0.77 (95 % CI [0.23, 2.60]) for CT added to surgery, 0.99 (95 % CI [0.25, 3.84]) for the addition of RT, and 0.42 (95 % CI [0.09, 2.05]) for both CT and RT with surgery. At 10 years, hazard ratios for overall survival were 0.71 (95 % CI [0.21, 2.38]) for added CT, 0.81 (95 % CI [0.21, 3.08]) for added RT, and 0.33 (95 % CI [0.07, 1.65]) for the addition of both CT and RT to surgery. CONCLUSIONS: Our series is the largest published study of intrathoracic sarcoma which focuses on the survival benefit of adding RT, chemotherapy or both to surgery in resectable intrathoracic sarcoma. Our data suggest a potential benefit in local control and survival from adjuvant therapy, with the greatest benefit likely to come from combined CT and RT, though none of the results achieved statistical significance. As intrathoracic sarcomas are rare and histologically heterogeneous, larger collaborative studies are necessary to determine treatment efficacy and elucidate which histologic subtypes are likely to benefit most from adjuvant therapy.

Treatment of chest wall sarcomas: a single-institution experience over 20 years.

OBJECTIVE: To evaluate the impact on the outcome of radiation therapy and chemotherapy in the treatment of localized chest wall sarcomas. METHODS: A retrospective review of 65 patients with stage IIB and III chest wall sarcomas seen over 20 years at the University of Washington Medical Center. Overall and disease-free survival outcomes were analyzed on the basis of the treatment received: surgery alone; surgery and radiation therapy; surgery and chemotherapy; and surgery, radiation therapy, and chemotherapy. RESULTS: Disease recurrence was observed in 32.3%, and, of these, 33.3% were local only, 42.9% distant only, and 23.8% were both local and distant. As compared with surgery alone, disease-free survival at both 5 and 10 years improved by 92% with the addition of radiation therapy to surgery, by 82% with the addition of chemotherapy to surgery, and by 89% and 90% with the addition of both chemotherapy and radiation therapy at 5 and 10 years, respectively. Overall survival also improved with radiation therapy, chemotherapy, or the combination of both, with the greatest improvement seen in patients treated with both radiation therapy and chemotherapy, which showed reduced mortality at 5 and 10 years of 49% and 45%, respectively, compared with surgery alone. CONCLUSIONS: The addition of radiation therapy, chemotherapy, or both to surgery in localized chest wall sarcoma improves outcome and should strongly be considered for patients with acceptable comorbidities. A trend toward improvement in overall survival was also shown with the use of radiation therapy and chemotherapy. As chest wall sarcomas are rare and histologically heterogenous, larger studies are necessary to elucidate which histologic subtypes may gain the most benefit from radiation therapy and chemotherapy.