Advanced Research and Diagnostic Laboratory, University of Minnesota, Minneapolis, MN, United States; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States.
Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, MN, United States.
Clin Biochem. 2019 Nov;73:115-117. doi: 10.1016/j.clinbiochem.2019.08.001. Epub 2019 Aug 6.
A laboratory investigation was initiated after a renal failure patient had a 2.18 mg/dL decrease in serum creatinine, which was not explained through medical intervention. The investigation revealed specimens providing questionably low results had been collected from a peripherally inserted central catheter (PICC) line.
Patient specimens and serum pools were analyzed by the Siemens Vista enzymatic creatinine measurement procedure. A simulation of the patient's infusion protocol examined potential PICC line carryover and specimen collection technique.
A simultaneously collected specimen set, arterial line and PICC line, yielded a difference of 1.86 mg/dL. Infusion and collection simulation studies suggested the most likely scenario was the infusion pump was not shut off while the specimen collection occurred and contaminated the specimen.
Providers should be aware of erroneously low creatinine results when administering catecholamine drugs and collecting specimens through the same catheter. The mechanism of specimen contamination is consistent with a siphoning effect from one lumen to the other during collection with the infusion pumps still running.
一名肾衰竭患者的血清肌酐水平下降了 2.18mg/dL，但未通过医疗干预进行解释，因此开展了一项实验室调查。调查显示，来自外周插入中心导管（PICC）的标本提供了可疑的低结果。
采用西门子 Vista 酶法肌酐检测程序分析患者标本和血清池。模拟患者的输液方案，检查潜在的 PICC 线携带和标本采集技术。
同时采集的标本集，动脉和 PICC 线，结果相差 1.86mg/dL。输液和采集模拟研究表明，最可能的情况是在采集标本时，输液泵未关闭，污染了标本。
当通过同一导管给予儿茶酚胺药物和采集标本时，医护人员应注意肌酐结果异常降低。标本污染的机制与在输液泵仍在运行时，通过采集从一个腔室虹吸到另一个腔室的效果一致。
