To ask what would happen if blood test tubes runout

[Whocareswherewego76]

I know there is a shortage but what happens if they run our.

@EBearhug

I understand that there's a global supply issue - but that's the bit that surprises me (whereas government procurement cock-up would not.) For something that is so commonly used - I get it's not as cheap to run sterile factories, but I would still have expected there to be a few more manufactors and suppliers round the world.

I can’t find anything saying this is a global supply issue.

This article says exactly why, how, and what they’ve been told to do, and it’s just the UK:
www.politico.eu/article/uk-faces-supply-chains-crunch-caused-by-brexit-and-coronavirus/
Earlier this month, medical doctors in Britain were told not to carry out blood tests unless they are essential, amid a shortage of blood collection tubes imported from overseas. Guidance issued by NHS England, and seen by POLITICO, instructs GPs to “urgently” postpone tests for suspected allergies, vitamin D deficiencies, fertility issues and routine screening for conditions such as pre-diabetes. This is necessary to prioritize tests for cancer diagnoses, unwell newborns and prenatal screening, NHS England said.

And this:
www.bbc.com/news/business-58324108
It mentions the company making some of the tubes in the US and says
it was experiencing "continued transportation challenges", which included port and transport capacity, air freight capacity and UK border challenges.

I’m leaning toward believing the first article, as no other country seems to be reporting test tube shortages that I can find. Can anyone else find articles that say so? Maybe I’m missing something.

Global perspective

www.letsrecycle.com/news/latest-news/polymer-shortage-in-europe-impacting-production/

hbr.org/2021/03/the-latest-supply-chain-disruption-plastics

www.citadelpackaging.com/blogs/the-art-of-packaging/why-are-continuous-thread-lids-so-hard-to-find

www.theregister.com/2021/06/28/recycled_plastics_in_tech/

www.plasticstoday.com/packaging/reliance-china-plastic-bottles-and-lids-creates-packaging-shortage-domestic-beauty-brands

[quote SexTrainGlue]Global perspective

www.letsrecycle.com/news/latest-news/polymer-shortage-in-europe-impacting-production/

hbr.org/2021/03/the-latest-supply-chain-disruption-plastics

www.citadelpackaging.com/blogs/the-art-of-packaging/why-are-continuous-thread-lids-so-hard-to-find

www.theregister.com/2021/06/28/recycled_plastics_in_tech/

www.plasticstoday.com/packaging/reliance-china-plastic-bottles-and-lids-creates-packaging-shortage-domestic-beauty-brands[/quote]
None of those mention a global shortage of test tubes in particular and none of them are news articles like those mentioning the NHS test tube shortage. And I would think if a bunch of countries suddenly couldn’t give their citizens blood tests, it would be news. And in fact, you can actually buy medical test tubes yourself, online, in stock, right now, in Europe.

(I looked in French and English, found no news of shortage, AND medical test tubes, not just decorative, for sale).

I really think this is a UK supply chain issue, because we’re getting ours from the US and the US was hit by the storm they mention. And EU suppliers can’t afford to deal with the UK border costs (as it says in that first article, 95%, which is mad, of providers here say costs have risen so much they’re a problem).

No, they don't.

The shortage isnt test tubes, btw.

It's plastic vials, and those articles all mention the plastics - and there's a global shortage.

The manufacturer was let down supply side, and cannot fulfil an order. Other plastic items are experiencing outages too.

There are indeed small plastic bottles available on google shopping. They are not however, from what I can see, the same ones as used by NHS (not the standard size, not filled with the reagents)

Now, is the global plastic supply (note the article showing the early US concern) really a Brexit issue? Or is it just bad luck that at a time of a global plastic shortage, one of the affected items is high profile?

Also, I was just catching up on the other thread on this, and want to repeat it here:

Westchesterarms
The American FDA took the same measures in June that the NHS is taking now. I don't know if they're fully sorted there now or not. But it's wider than just the UK and Brexit

I've checked, and blood testing bottles are definitely in the device shortage working list, and have been since at least June.

Here is but one example of the warning notices

www.fda.gov/medical-devices/letters-health-care-providers/sodium-citrate-blood-specimen-collection-tube-conservation-strategies-letter-health-care-and

@HoppingPavlova

It's a shame staff have been throwing away out of date unused blood collection tubes for years, now when we need them we dont have enough.

How would this help? You can’t use tubes if culture medium, anti-coagulants etc have gone off so how would expired stock help.

Proper stock rotation in hospitals and GP surgeries would have meant the oldest used first, so they should never have been allowed to get out of date, hence no need for throwing them away. It's not rocket science!

I work in community nursing in Scotland and haven’t heard anything about shortages of blood tubes yet, 30ml syringes on the other hand.

As other have said each bottle is used to test for different things so can’t really reduce how many bottles are used, some samples need spun etc which would effect the results for other tests.

I do agree about the waste though, I have loads of patients with leg ulcers that get bandages twice a week in compression bandaging, sometimes more if it’s particularly leaky and gall at the waste but these bandages couldn’t be reused due to leaking through and they lose their compression after the first application so I don’t know what the answers are 🤷‍♀️

@Badbadbunny the tubes that run out the quickest seem to be the tests that aren’t done so routinely, in my experience anyway. We have hello topped glucose bottles and purple ESR bottles that always go out of date so quickly but are not routinely requested, we don’t order many boxes now

I should have said the yellow glucose bottle had nothing in it, no agent or any other liquid so no idea why is goes out of date so quick

@BaklavaBalaclava

Does anyone know anything about anaemia tests? GP has refused to do it.

I went to give blood and they sent me straight to GP instead as haemoglobin (?) levels were super low. 108 ...

GP has automated request form which didn't let me explain why I wanted a blood test, but then automatically rejected it due to the shortage. I guess there is no real reason to worry, as if I hadn't tried to give blood I wouldn't even have been aware?

I wouldn't say that is super low, and since you have the result already you can always go ahead and take iron supplements then have full investigations in a few weeks when things improve again. Why not ring the GP and have a chat? This can be managed without more blood tests immediately. Ideally you would have iron studies, ferritin and folate but it can wait if necessary. Give them a ring! They will want to have a chat about your diet too and to see if there are any other symptoms (eg absorption issues).

Proper stock rotation in hospitals and GP surgeries would have meant the oldest used first, so they should never have been allowed to get out of date, hence no need for throwing them away. It's not rocket science

Or maybe - nothing to do with stock not being rotated properly but simple over ordering and when looking at the last two years, a lot of stock has expired that would not have usually expired, as people have not been able to see GPs/specialists/hospital appointments as usual due to Covid. Greatly decreased servicing means much lower volume of investigations all round, from blood to MRI’s. But sure, if you wish to think everyone in a hospital or GP surgery has no idea of how to deal with expiry dates on medicines or components then go ahead.

I’m up in a hospital lab chain of command helping with this, and would say that we have contingency plans, alternative supply sources, and if absolutely necessary we’ll move over to other kinds of tube. There is likely to be postponing of routine blood tests and we’re trying to cut down blood tests in hospital too but I don’t think it’ll be terrible

I’m undergoing a course of treatment at the moment which requires an injection every other day and a blood test in a month. On Friday the practice nurse advised me that they have been told no routine blood tests until 17th September. They have a stock of tubes but don’t want them to run out. I hadn’t heard it on the news when she told me and I was quite shocked that they could potentially run out of tubes. She also said labs are keeping samples they already have in case it is decided more tests are needed. I had blood taken on 18th and it has already been decided another test is needed and they will use that blood.

@shergar

I’m up in a hospital lab chain of command helping with this, and would say that we have contingency plans, alternative supply sources, and if absolutely necessary we’ll move over to other kinds of tube. There is likely to be postponing of routine blood tests and we’re trying to cut down blood tests in hospital too but I don’t think it’ll be terrible

Lots of experts on this thread who can help you out, have you considered advising labs to pop them through the dishwasher yet?

Many types of blood bottle cannot be resumed. As someone has already said, blood tubes are a mix of glass and plastic. They have specific anticoagulants in them to stop the blood clotting or an sst gel to promote clotting for biochemistry tests. The top is designed so that when the collection needle is attached the vacuum inside the bottle helps to draw in the blood quickly to prevent clotting, especially for the purple topped EDTA tubes and the blue citrate tubes. The cost of recycling these tubes would be too great for the NHS to realistically do so.
Many blood tests such as those for warfarin and HbA1c testing will get done at the surgery on finger prick analysis, which is not as accurate, but is acceptable for monitoring, with any high results having blood taken to send to pathology for more accurate testing… this happens in larger surgeries already, but will likely roll out to smaller surgeries across the country… the patients may have to go to a different practise for their tests if their current practise does not have these machines. The hospital I work in has already reduced blood tests by at least 25% to help with the shortage, this means that patients are still being monitored but some of the more stable ones are being monitored less often.
Some people will have to have to have blood tests such as those undergoing treatments for cancer, people going for operations and investigation procedures.

You can help!

Make sure when you go for a blood test you ask the nurse to fill the bottle to the line. This gives us in the labs the best chance of doing all the tests requested on those bottles and you won’t get called back. Also, once the bloods are taken, make sure the nurse inverts the bottles several times to ensure the anticoagulant mixes throughly with the blood. This will help prevent you from coming back to be re-bled and ensure we can provide accurate results first time. Finally, make sure the nurse labels the bottles with your details before you leave. We reject many bottles each day because the have sent them in unlabelled. We process thousands of blood bottles each day and have no idea which of the unlabelled ones could possibly be yours, so we have to reject them.
Hope this helps

@SexTrainGlue

No, they don't.

The shortage isnt test tubes, btw.

It's plastic vials, and those articles all mention the plastics - and there's a global shortage.

The manufacturer was let down supply side, and cannot fulfil an order. Other plastic items are experiencing outages too.

There are indeed small plastic bottles available on google shopping. They are not however, from what I can see, the same ones as used by NHS (not the standard size, not filled with the reagents)

Now, is the global plastic supply (note the article showing the early US concern) really a Brexit issue? Or is it just bad luck that at a time of a global plastic shortage, one of the affected items is high profile?

I don’t want a bun fight, and I’m not trying to be a pain but it’s not just me looking at plastic bottles on EBay France or something. They have plenty of “blood test” (tubes à essai) tubes on Fisher Scientific FR for sale to European countries. Yes, the problem is for the US and UK, and yes, it IS a Brexit problem, because you can’t get test tubes from any of these European suppliers suddenly and have to rely on the US, which is having its own shortage due specifically to COVID-19, plus global issue, PLUS their storm that hit manufacturers in the south of the country. Without one of those issues, they might have been okay.

As always, happy to provide receipts.
Polypropylene, which some of the links said the shortage was of. 500+ pieces per order. Medical grade. And this is one page.
www.fishersci.fr/shop/products/falcon-round-bottom-polypropylene-tubes-7/p-196968

There are lots of other options available:
www.fishersci.fr/fr/fr/products/I9C8L7VF/test-tubes.html

And this says exactly what I was trying to say earlier:
However, there are no reports of similar shortages outside the UK.
www.irishtimes.com/business/health-pharma/nhs-rations-blood-tests-over-shortage-of-glass-vials-1.4657645
If it’s global… why isn’t any other country affected but the one where Becton Dickinson is located and the UK? The NHS needed to have contingency plans, other suppliers in other locations, to be able to buy from them so this didn’t happen, and the NHS is instead cut off from European suppliers.

Also, they’re not pre-filled with reagents. We got most of our reagents from Roche in 2020 - a Swiss company. They actually had a shortage back in 2020, but fixed it in a few weeks.
www.bbc.com/news/health-54435226

Also, @BaklavaBalaclava, it says blood disorders are being included as “not urgent,” but doesn’t list the exact disorders. It’s highly possible that includes anemia if you were rejected for shortage. Maybe GPs may just start giving a “safe” dose of iron supplementation in suspected cases?
“Due to the shortage, the NHS has temporarily stopped some blood testing for fertility, pre-diabetes, allergies and certain blood disorders “
www.bbc.com/news/business-58324108

@Fudgein

I work in paeds and still use butterfly & syringes for taking bloods, I haven't actually heard of a shortage which surprises me but we take 100's of samples a day so it is concerning.

I've been on annual leave for two weeks but at least a week before that we had a memo round to for the consultants to keep blood tests to a minimum and for nurses/HCAs taking bloods to check and keep number of sample bottles to a minimum (paeds admin here)

The NHS contracts long antedated Brexit.

But if you're hell-bent on making this issue, which is firmly rooted in the global plastics shortage, into a Brexit one, then no amount of evidence will persuade you otherwise. Yes, there have been some delivery issues too, but the shortage is mainly down to the manufacturer being unable to source the plastic to make them. There isn't some blockage that is stopping available bottles arriving. The manufacturer simply can't supply them.

You have linked other tubes, but will they fit the lab equipment in the affected NHS areas?

Do remember that not all NHS uses that single supplier, and one contingency plan is for the other bottles to be sent to affected areas for less urgent tests (which can then be couriered to the labs with the kit that fits). But that only works if stocks are conserved so that urgent bloods (from theatre, ICU, haem and oncology) can be turned round within a hour or so (depending on test, can be much less) can still be drawn and processed on site.

I’m a blood donor, my next session is due in September. Hope they have enough test tubes then. What if they have to stop receiving much needed blood donations for the lack of test tubes?🥺

Erm… how can this be rooted in the global plastics shortage when the test tubes are glass?

So we spent all this back and forth and they’re glass. I mean, I have to laugh a bit (hopefully, you will as well, @SexTrainGlue ) as we should have both paid more attention - it’s right there in the Irish Times headline. I tried to provide all this information that these plastic blood testing vials were available based on erroneous info from another poster and finally realized, BD tubes are… glass. Says so on the BD website as well.

Anyway, if you have inside NHS information re: contingency plans, I completely understand and I don’t. I only assumed they didn’t since they said the shortage may last months, and I don’t wish to argue further. I can only go on what I see - the Politico article I linked saying Brexit shortages affecting everything from test tubes to chicken, the article from the Irish Times saying no other country is affected (so no global shortage), etc.

Articles kept saying supply chain issues, transport issues, UK border issues, but I never found one NEWS article that mentioned the plastics shortage affecting these vials, and now we know why.

The coloured lids, however, that make the vacuum last, are certainly not glass…..

Nope. BD Vacutainer. They’re rubber.

We’ve had an appointment booked for months for my 1yo to have an investigative blood test. Due next week. Has anyone had their child’s blood test cancelled or heard whether the blanket/mass cancellations will include infants?

The centre of the lid that’s pierced by the needle is rubber. The coloured outer rim isn’t. Most vacutainer tubes are made of polypropylene (though there are glass options too, which mostly we don’t use).

@Tomasinabombadil don’t you fill a whole bag?