Abstract Background Lead screening in pediatric populations is a critical public health initiative. However, commonly used trace element vacutainer tubes for lead testing require larger blood volumes than ideal for pediatric patients. For example, Greiner Bio-One (Greiner) offers only 6 mL trace element tubes, while Becton Dickinson (BD) provides 3 mL and 6 mL options. The larger volume requirements can lead to unnecessary blood loss, increased recollections due to short draws, and prolonged venipuncture time, exacerbating patient anxiety. To improve pediatric patient and caregiver satisfaction with lead screening sample collection, we evaluated the feasibility of allowing a 1 mL minimum fill volume for 6 mL trace element tubes. Methods Blood from 20 volunteers was collected into paired 6 mL Greiner and BD trace element tubes containing sodium heparin and K2-EDTA anticoagulants, respectively. Blood volumes were visually verified to be within 0.5 mL of the maximum fill volume before paired tubes were randomly assigned to five groups, four pairs per group. Varying lead quantities (0.37% final volume) were spiked into each group, adding 0, 2.3, 11.5, 28.8, or 57.6 µg/dL to the baseline concentration. To simulate a 1 mL underfilled tube while maintaining anticoagulant concentration, 1.2 mL of blood from each appropriately filled tube was transferred to a new tube. Lead concentrations from all tubes were measured using graphite furnace atomic absorption spectroscopy, and data analysis was performed in Microsoft Excel. Results The average lead concentrations in appropriately filled Greiner and BD tubes across groups 1 through 5 were 0.6, 2.5, 11.9, 29.9, and 59 µg/dL. Bias between all paired Greiner or BD underfilled and appropriately filled tubes remained within the acceptable clinical limit of 2 µg/dL or 10%. Group 1, the lowest concentration group, had an average bias of 0.03 µg/dL (standard deviation = 0.1) for Greiner and -0.1 µg/dL (SD = 0.1) for BD. Groups 2, 3 and 4 showed biases of 0.2 µg/dL (SD = 0.1), -0.2 µg/dL (SD = 0.4) and -0.2 µg/dL (SD = 2.4) for Greiner and -0.3 µg/dL (SD = 0.1), -0.03 µg/dL (SD = 1.3) and -1.1 µg/dL (SD = 1.0) for BD, respectively. In Group 5, the highest concentration group, the average bias was 1.6 µg/dL (SD = 4.9) for Greiner and -0.1 µg/dL (SD = 3.4) for BD. One volunteer*s samples were excluded due to inconsistent lead spiking between paired tubes. Conclusion This study supports implementing a 1 mL minimum fill volume requirement for 6 mL Greiner and BD trace element tubes, which could improve blood conservation, minimize recollections, and shorten venipuncture time, ultimately enhancing the pediatric patient and caregiver experience with lead screening.
Lo et al. (Wed,) studied this question.