Sodium Citrate Tubes Are the World's Next Big Supply Chain Shortage

The pandemic has caused a depletion of inventories. This is because of the excessive testing that has been carried out.

A Severe shortage of Sodium Citrates

In the summer of 2021, manufacturers of blood collection tubes will face severe shortages of sodium citrates due to the COVID-19 pandemic. Globally, the disruption of the supply chain has affected clinical laboratories. COVID-19 is very unpredictable, which has had a massive impact on patients. 

It is important to monitor the coagulation factors of COVID patients constantly because they tend to develop pulmonary thromboembolism and other types of thromboses frequently. This is why these tubes are essential for monitoring patients' coagulation factors. Global inventories of blue tubes of all sizes have been severely depleted due to the increase in the number of tests ordered to diagnose and monitor coagulopathies--prothrombin time, activated partial thromboplastin time, and D-dimer--all of which are collected in sodium citrate tubes. 

Therefore, demand has drastically increased, and one needs to go by it.

Beckton Dickinson and Greiner Bio-One

• The health authorities have warned of extended supply chain disruptions due to Beckton Dickinson and Greiner Bio-One confirming major shortages that have resulted from COVID-19 infection rates and the development of vaccines and treatments.
• As a result of increasing demand during the COVID-19 pandemic and vendor issues, the U.S Health and Human Services Department announced that it was nearly expanding the list of medical devices on which there are shortages, including complete blood specimen collection tubes.
• Health care and laboratory persons are also advised to limit the frequent use of all blood tubes (for blood collection) by drawing blood only if it is deemed medically necessary and sharing samples among departments if and only if all specimens are readily available.
• The agency granted emergency-use authorization to Becton Dickinson's tubes (sodium citrate specimen for collecting blood) a month later to help identify plus treat bleeding disorders among patients with COVID-19.

Steps to Conserve the Tubes

MEDVAC Citrate Tubes (9NC 0.109M)/(9NC 0.129M) are available for you if the shortage has affected your facility. These tubes are mainly used in coagulation studies. In addition to buffered sodium citrate solution. Consequently, we are able to provide citrate concentrations of 0.109M (3.2%) or 0.129M (3.8%). One part citrate to nine parts blood is the typical mixing ratio.

Here are some of the steps you can take to help conserve the tubes:

• Eliminate the collection of extra blue top tubes
• Do not continue taking constant orders for certain coagulation tests if possible
• Discard coagulation tubes rather than using them as discard tubes
• Patients taking non-vitamin K antagonists such as dabigatran, apixaban, or rivaroxaban, should not have Lupus Screens (LAB478) performed. They greatly impact Clot-based coagulation tests. Tests should be carried out before drug administration or during a trough. 

Most health departments use ITM-1148595 and ITM-1148596, so that this global shortage may affect them. This is helping to ensure that we continue to receive great weekly allocations of the products by closely monitoring the supply chain and looking at the situation. 

We can expect the following changes are likely to be implemented:

There are likely to be the following changes implemented:

• Collectors can collect only tubes ordered by patients. 
•  If a (wasted) tube is necessary during collection, the pilot tube can be an alternative.
• Your inventory shows a variable reduction in blue top tubes. 
• Earlier this month, Supply Chain Services removed blue top tubes above the new par levels from some inpatient units.
• The hospital lab will also monitor the inventory of blue top tubes at SHMG. 
• Leaders may also be able to adjust par levels quite well for some other collectors. With this, the patient can now use the product more effectively.

Survival tips when there is a shortage of supplies

• To survive supply shortages, it is recommended that sales reps stay in close contact with the company and provide blanket orders and forecasts whenever possible.  

• Lab professionals should also take into account shortages when purchasing consumables. Make use of your supply chain partners, who often have access to several different avenues for product procurement. It is also helpful to have regular communication and relationships with distributors and manufacturers. Therefore, when an issue arises, you have someone intimately familiar with your operation and can respond accordingly. However, keep an open mind. Although clinical results are of utmost importance, it is crucial to comprehend all the available and viable options during times of crisis. To do that, you might need to think outside the box and break away from traditional brand preferences."

Efforts to Conserve More

As part of the conservation effort, hospitals are identifying triggers. In addition, POC coagulation testing will be added, daily PT/INR and PTT inpatient orders reevaluated, and outreach tubes will no longer be provided to outreach clients, creating an outpatient algorithm for outpatient coagulation testing. It may be necessary to include additional stakeholders to overcome this shortage. 

Monitoring the inventory and utilization rate daily will enable you to implement additional conservation strategies if necessary easily. Reporting is available weekly to stakeholders.

There is a Global Shortage of Lab Supplies

Globally, laboratories continue to be plagued by shortages caused by the pandemic. According to the FDA, sodium citrate blood specimen collection tubes are the latest item on the device shortage list1, with the agency recommending they not be used in routine blood sample collections or IV insertions unless medically necessary. The FDA recommends clear top tubes or red stoppers without additives as an alternative to light-blue top tubes. Additionally, there are vitamin C tubes, vials, systems, serum separators, tubes, vials, and blood collection tubes that only contain vitamin C. The shortage remains, and it's not evident when it will last.

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