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Niki Nicolas Grigoriou's presentation from the Healthcare DENMARK Ambassador Summit



Lakshmy Ramakrishnan
Cardiac Biochemistry

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  1. 1. CEUTEH‘16 Ms.Lakshmy Ramakrishnan  B.Sc (Chemistry,botany, zoology),M.Sc (Biochemistry) PhD (Biochemistry)  Professor, Cardiac Biochemistry , AIIMS  She has been a principle investigator for many projects for which she had received extramural research funding from ICMR, DST, DBT  She is an author of more than 150 publications, Both national and international  Worked as Research Associate in a National multicentric urban hospital
  2. 2. PNEUMATIC TUBE SYSTEM Lakshmy Ramakrishnan Professor Cardiac Biochemistry
  3. 3. What is PTS? • Network of tubes through which materials are sent using cylindrical containers using compressed air or vacuum
  4. 4. Why PTS • Modern health care-more care at less cost • Reduce length of hospital stay and facilitate early discharge • Speedy diagnosis is of utmost importance • PTS –faster delivery of material and therefore reduce TAT
  5. 5. History • Use dates back to early 19th century • In postal department and departmental stores • move papers • Advent of email and fax • Originally the landing of materials used to be hard • In late 1980s technology developed to control airflow - slow down the containers for soft landing
  6. 6. Simple PTS
  7. 7. Types of PTS Point to point – One way system A----->B – Two way system-Transfer of carriers occurs between two stations A<------>B Semi-automatic Main station is the transfer hub Receives and delivers to multiple remote stations The remote stations can only send directly to main station Fully automatic Allows any station to send and receive from any other station
  8. 8. Point to point PTS
  9. 9. Advanced pneumatic tube station
  10. 10. Application in hospitals • Sending blood samples to laboratory • Blood samples/bags to blood bank • Pathology specimens • Medicine from pharmacy • X-rays • Medical Reports • Small surgical and medical equipments
  11. 11. Components of multipoint PTS Hospitals pneumatic tube system consists of: • Blower-Source of air for motion of carrier. create difference in air pressure between two ends of the system sucks carriers, allows carriers to move • Tubing- Through which carrier moves. PVC/Steel-110mm or 305 mm • Diverters- required at branch point for connecting different system areas- can be 2, 3 or 4 way. One pipe going into it and 3 pipes going out
  12. 12. Components of PTS • Stations also called sample distribution devices, primary component from where user sends and receives samples –Delivery stations –Receiving stations • Manual • Auto-unload-after unloading samples carrier automatically returns to home station –End or pass through
  13. 13. Components of PTS • Master control unit-Microprocessor controlled- Software monitors and controls the movement of carriers • Real time monitoring of transfer • Speed at which carrier moves • Carrier braking ensures soft landing
  14. 14. master control unit • Can control up-to 512 stations in multiple zones • Can send and receive samples to each of the stations • automatically recognizes operating errors, power failures and time-out errors
  15. 15. Carriers • Transporting medium within PTS-Available in different sizes • End opening, side opening, swivel top, screw cover, twist open type • RFID tagged-Each carrier has a unique identifier • Allows home station to be assigned-Carrier automatically returns to the home station after unloading samples • Locking mechanism to prevent leakage
  16. 16. How PTS works • Blood placed inside bags marked as biohazard • Placed inside carrier • X-ray/medicine can be placed directly in the container • Carrier inserted inside station • Destination is selected on the station • Blower gets activated and pulls carrier • Diverters direct carrier on the proper path • Arrives at destination station • Can be automatically unloaded and carrier returned
  17. 17. PTS in CNC, AIIMS
  18. 18. Advantages • Increases turnaround time/Decrease material delivery time • Carriers transported at speed of 6-8 meters/sec • Can transport up-to around 28 kg material @ speed of 8 meters/sec • Less prone to human error • Lesser staff requirement • Less biohazard • Lab services can be centralized • Can connect multiple buildings • Can be underground or overhead
  19. 19. Disadvantages • Heat generated due to friction • Speed of 8 m/s • Rapid acceleration • Bends with in a system- causes deceleration • Excessive acceleration force-Damage to erythrocyte-hemolysis • Hemolysis can affect K, Mg, LDH, AST
  20. 20. Assessing sample quality Hemolysis rates between samples delivered by human courier (10%) vs Pneumatic tube (6%)- J Emerg Nurs. (2006)-No significant difference In another study lesser hemolysis was reported if plain tube with gel is used- Ann Clin Biochem (2004) A recent study concluded no effect on hemolysis index and serum chemistry (LDH, K, AST and creatinine) (Scientific chronicles, 2015) Usage of padded containers, soft cushioned deceleration Longer distance and greater speed can cause hemolysis Data loggers sent through PTS to assess in real time the environmental conditions like temperature, pressure, humidity and acceleration force
  21. 21. Blood gas analysis • Analysis most sensitive to transportation- blood gas analysis • pCO2 and pH not affected • pO2 effected due to air contamination (Arch Pathol Lab Med, 1996) • Purging of air bubbles before sending through PTS-changes in pO2 insignificant • pO2 was shown to be affected but use of pressure sealed containers circumvented this –J Clin Pathol (2002) • Recent studies show no affect on pO2-better PTS with reduced speed and carefully prepared samples with no air bubbles • A recent study showed no impact of PTS on blood gas analysis-Respir Care (2016)
  22. 22. Blood Bank • PRBC, platelet concentrates and fresh frozen plasma -quality parameters within normal reference range (Tanley et al, Transfusion, 1987) • No difference in quality parameters of blood components following PTS transport (Raturi et al, Glob TJ Transfus Med, 2016, Basu et al, Asian J of Transfusion Science, 2015) • Packed RBC (non irradiated and irradiated) could be safely transported through PTS (Dhar et al, Asian J of Transfusion Sci, 2015) • Effective for transport of blood products • Thromboelastography results were shown in recent studies to be affected by PTS transport (International J of Lab Hematology, 2016)
  23. 23. Hematological and coagulation parameters • No differences for complete blood cell count and white cell differential parameter • No difference in PT, APTT, fibrinogen or fibrin monomers (Arch Pathol Lab Med, 2007) • No affect on ESR • Safe to transport through PTS
  24. 24. Limitations • Samples of patients with high WBC malignancies- transported via PTS-caused pseudohyperkalemia • Lysis of WBC during transportation (Dickinson et al, Pediatric Nephrology, 2012) • In patients with very low hematological parameters-PTS may not be appropriate-because of fragile leucocyte membranes • CSF samples -no significant changes in glucose, lactate, erythrocyte counts, NOA or NBA. Small but significant affect on protein (CCLM, 2016) • pathology samples in formalin
  25. 25. PTS in leading hospitals Stanford hospital PTS system 6.5 kms of tubing Used 7000 times a day Has 124 stations, 141 transfer units, 99 inter- zonal connectors and 29 blowers The longest distance from start to finish 1500 feet (around half a kilometer) covered in less than 3 min
  26. 26. Conclusion • PTS improves TAT and reduces cost • Reduces inter departmental movement of staff • Most studies point to PTS being safe for transportation • Variation between different PTS due to distance, speed, number of bends • Laboratory should perform validation to assess the impact of PTS transportation
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Lakshmy Ramakrishnan Professor Cardiac Biochemistry AIIMS


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