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The case of the floating gel
R Srivastava1, M J Murphy, J Card
1Department of Biochemical Medicine, Ninewells Hospital, Dundee DD1 9SY, UK. rajeev.srivastava@tuht.scot.nhs.uk
Journal of Clinical Pathology
|November 26, 2004
Summary
Blood samples from dialysis catheters can show falsely high sodium levels due to Citra-Lock contamination. This artifact, even in small amounts, can impact patient care if not recognized.
Area of Science:
- Nephrology
- Clinical Chemistry
- Medical Laboratory Science
Background:
- Blood samples for laboratory analysis in patients with chronic renal failure are frequently collected via dialysis catheters.
- Dialysis catheters may contain locking solutions to prevent clotting, which can potentially contaminate samples.
Observation:
- A case of extreme spurious hypernatremia was observed in a blood sample drawn from a haemodialysis patient's catheter.
- The blood sample, collected after catheter locking with Citra-Lock (trisodium citrate), showed a serum sodium level of 744 mmol/litre.
Findings:
- The hypernatremia was identified as an artifact caused by contamination with Citra-Lock, a trisodium citrate solution used for catheter locking.
- Even minimal contamination of blood samples with Citra-Lock significantly elevates measured sodium concentrations.
Implications:
- This artifactual hypernatremia can be easily missed, potentially leading to incorrect clinical decisions and adverse patient outcomes.
- Healthcare providers must be aware of this contamination risk when collecting blood samples from dialysis catheters.
- Implementing strict protocols for blood collection and sample handling is crucial to prevent such errors.