Supply shortage of sodium citrate collection tubes

Conservation is important, but no change to clinical practice

Salem Health is experiencing a supply shortage of Sodium Citrate (blue top) blood collection tubes due to nationwide backorder. These collection tubes are used for coagulation testing, including PT/INR, PTT, D-Dimer, and Fibrinogen. The reason for the nationwide backorder is due to the increased coagulation disorders seen with COVID patients. We estimate that we will see supply issues through September.  A rapid improvement team made up of stakeholders met to problem solve and implement conservation methods to mitigate this issue. 

Immediate conservation efforts:

• Eliminating extra blue top tube collections
• Discontinuing use of blue to tubes for pilot draws
• Reviewing/adjusting order sets for “nice to have” coagulation testing orders
• Adjusting par levels across the organization

At this time, there is no change to provider practice, but we want applicable parties to understand the nature of the shortage in advance.

What will this mean?

We expect the following is likely to be implemented:

• Collectors will only collect tubes for tests that are ordered. 
• If a pilot (waste) tube is needed while performing a collection, an alternate tube type will be used for the pilot tube.
• A decreased amount of blue top tubes will be seen in your inventory. 
  • For Salem Health inpatient units, Supply Chain Services will be removing the blue top tubes that are above the new par levels.
  • West Valley Hospital lab will be monitoring SHMG blue top tube inventory. 
  • For all other collectors, leaders will be adjusting par levels in your area. This will allow product to be reallocated for patient use.

Additional conservation efforts:

We are in the process of identifying triggers with additional conservation actions. These action items may include adding POC coagulation testing, assessing daily PT/INR and PTT inpatient orders, eliminating providing tubes to our outreach clients, creating an outpatient algorithm for outpatient coagulation testing. Additional stakeholders will be added as necessary. 

Inventory and utilization rate will be monitored daily so additional conservation strategies can be implemented if needed. Stakeholders will report out weekly.