Reducing hemolysis in emergency departments: effectiveness of BD Barricor™ low-vacuum tubes

Hemolysis is the leading cause of sample rejection in laboratories, particularly in emergency departments (EDs), where rates often exceed recommended limits. Hemolysis not only delays diagnosis and treatment but also increases costs. Despite protocol reinforcement and staff training, in our tertiary hospital's ED we experienced consistently high hemolysis rates, meaning a high percentage of results were not reported to clinicians due to the interference. Low-vacuum tubes, such as BD Barricor™ (that has a mechanical separator), may reduce hemolysis and improve sample quality.

We conducted a single-centre prospective pilot study over 1 week substituting standard lithium-heparin tubes with BD Barricor™ tubes in the ED. Sample handling, transportation, centrifugation, and analysis remained unchanged. Hemolytic index (HI), potassium, LDH, AST, creatinine and phosphate results were extracted from the laboratory information system for the trial week and 2 weeks before and after. Statistical analysis was performed with R (v.4.2.3).

During the trial week, median HI decreased a 28 % (p<0.05). Samples exceeding established HI thresholds dropped from 16-19 % to <6 % (p<0.05). The proportion of unreported tests fell from an average of 250 per week to 43 (0.8 %) during the trial week. The use of Barricor™ tubes enabled nearly all results to be reported.

Implementing low-vacuum Barricor™ tubes in our ED significantly reduced hemolysis and decreased non-reported tests. Our findings suggest that implementing technological solutions may be hihgly effective when protocol reinforcement alone did not work. Long-term studies are warranted to assess cost-effectiveness and broader clinical impact.