Thursday, September 21, 2023

Blood Collection Tubes Order Of Draw

Special Notes On Slide Preparation

Order of Draw and Additives | Blood Collection

1. Slides must not be touched on any area except the long slide edges or frosted ends.

2. Prepare the film immediately, as soon as the drop of blood has been placed on the slide. Any delay will result in abnormal distribution of the white cells, with many of the larger white cells accumulating at the thin edge of the smear. Rouleaux of the red cells and platelet clumping will also occur.

3. Criteria:

  • The thin portion should be about 1 inch long, and the entire film should cover approximately half of the area of the entire slide.
  • No portion of the film should extend to the edges of the slide.
  • The film should be free of waves, holes, and ridges, and it should have a smooth appearance and feathered edge.
  • All microscopic slides, as well as paraffin blocks, should be clearly labeled using two patient identifiers.
  • The accession designation used in the pathology report should include the case type, year, and a unique accession number.

4. Common causes of a poor blood film.

Figure 15

Order Of Draw When Using Evacuated Tubes

When collecting diagnostic blood specimens by venipuncture into evacuated tubes the order of draw is, based on Clinical and Laboratory Standards Institutes standard H3-A6 from November, 2007, as follows:

1.) Blood cultures SPS

2.) Light blue

3.) Red , or Tiger-Top mottled red

4.) Green heparin and light green

5.) Lavender

6.) Pink, white, or royal blue

7.) Gray

8.) Dark blue

This order of draw should ALWAYS be followed to prevent erroneous results due to additive crossover. Incorrect order of draw can lead to problems and misdiagnosis of health conditions or disease.

If coagulation testing is the only laboratory work that needs to be drawn the phlebotomist should first draw a plain red top tube to remove tissue fluid contamination. This tube is then discarded into the biohazard receptacle. The next step is to draw the blood sample into a sodium citrate collection tube which must be filled to the proper level and is then gently inverted to mix.

If additional laboratory work is ordered, including coagulation testing, the second tube would be the sodium citrate collection tube. Remember that all of the processes involved in specimen collection, from ordering supplies, to selecting the proper collection devices, to proper collection site and technique, to adhering to all in-house and legal requirements when handling and shipping the specimens are all important steps of obtaining valid and timely laboratory test results.

Why The Tubes Are Important In Phlebotomy

In order to become a Phlebotomy Technicians, you must understand some topics theory behind phlebotomy as well as clinical practice. The theory topics cover human A& P, infection control, and legal issues in healthcare. One of the theory topics that overlap with the clinical aspect of phlebotomy is the tubes. Tubes used in phlebotomy are vacated cylinders. They are used to collect the blood from a patient during a venipuncture. However, what you must know is that each tube contains a unique additive used for a particular type of testing. Lucky the tubes used in phlebotomy procedures are color coronated allowing healthcare professionals to quickly grab the tube they need on the fly. Here are some quick tips to help you memorize your tubes!

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The Identifying Parts Of A Tube

The color of the tube can be identified by the colored cap. Each color has a unique additive which is either clot activators or an anticoagulants . Also, the tube may contain a substance called Thixotropic Gel which helps the layers of the blood separate. Depending on the additive, a certain specimen is being tested. Specimens are either whole blood, Plasma or Serum. The Lab Uses of the tubes are extremely important to know. This is because when a doctor orders blood work what they want to be tested is located on the requisition form NOT THE COLOR OF THE TUBE. So, phlebotomist must know the lab uses of the tubes to understand which tube to grab for the requested test.

Efficacy Of Order Of Draw

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The articles that sustained the importance of following the recommended order of draw were 3 observational studies and 1 in vitro and observational study.

The prospective study of Cornes et al. measured levels of serum EDTA, zinc, magnesium, calcium, and alkaline phosphatase in samples with serum potassium 6.0 mmol/L. A total of 28 of 117 hyperkalemic samples were contaminated with EDTA. The spurious values obtained were hyperkalemia, hypocalcemia, hypomagnesaemia, and hypozincemia. In conclusion they confirmed that EDTA contamination was common, and at low concentrations of EDTA, it can only be confidently detected by measurement of serum EDTA .

The evaluations asserted by Sharrat et al. were announced after over a 1-month period of investigation of all the samples with more than 6.0 mmol/L of potassium or from patients with hypocalcemia, hypomagnesemia, and hypozincemia. During the period of the study, 12,895 samples were analyzed, and 289 presented hyperkalemia. Among these, 9 were identified as EDTA-contaminated by routine screening. Out of 7319, 569, and 295 samples processed for bone profile, magnesium, and calcium, respectively, 104 were hypomagnesemic, 133 hypocalcemic, and 139 hypozincemic. Among these samples, 22 were identified as EDTA-contaminated. Sharratt et al. concluded that factious hyperkalemia, hypocalcemia, and hypomagnesemia caused by EDTA contamination are relatively common .

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Order Of Draw Of Blood Collection Tube

Vacuum blood collection tubes are widely used in hospital and clinic, but not everyone knows the correct sequence blood collection tubes order of draw. The order of blood collection, depends on blood collection tube colors and tests, Below let we show the blood collection tube color guide for you.

Blood collection tubes must be drawn in a specific order to avoid cross-contamination of additives between tubes. The recommended order of draw for plastic vacutainer blood collection tubes are:

First blood culture bottle or tube

Second coagulation tube .

Third non-additive tube

Last draw additive tubes in this order:

SST . Contains a gel separator and clot activator.

Sodium heparin

EDTA Glucose , Oxalate/fluoride or other additivesNOTE: Tubes with additives must be thoroughly mixed. Clotting or erroneous test results may be obtained when the blood is not thoroughly mixed with the additive.You may ask why we need follow this sequences. Please at the same time see blood collection tubes and tests chart.

1. Blood cultures should always be drawn first to reduce the potential hazard bacterial, fungal, quantitative, CMV and/or other specimen contamination. Blood culture vials and tubes:

Blue, Purple culture vials contain enriched Soybean-Casin broth with CO2 and are used for bacterial and fungal blood cultures.

Yellow stopper tubes contain nutrient solution and Black stopper Isolator tubes contain a blood lysis solution.

Tubes with additives:

Phlebotomy Order Of Draw

As you may already know, blood must be drawn and collected in tubes in a specific order, known as the Order of Draw.

This is necessary to avoid cross-contamination of additives between the tubes.

Unfortunately, this order can be hard to remember for those in training and even those in the field.

Weve recognized this and created a handy guide using multiple proven study techniques.

*Tip: Bookmark this page for future reference by pinning it as an image!

Everybody effectively learns and remembers in different ways. So, we designed several learning tools below to help you learn the proper order of draw and easily remember it in the field.

*Tip: If you’re looking for a pocket-sized guide to carry around with you in the field that gives you quick access to the Order of Draw and other vital information then you have to check out the best-selling Phlebotomy Notes: Pocket Guide To Blood Collection.

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Order Of Draw For Skin Puncture

Skin puncture specimens have to be collected according to a certain order as recommended by CLSI, which is as follows:

  • Lavender micro-collection tube
  • Plasma additive micro-collection tubes, such as green light green , gray
  • Serum micro-collection tubes, such as red , gold
  • This is to ensure that specimens requiring anticoagulants are drawn first. Whenever clot appears in a micro-collection tube with a lavender stopper/shield, the specimen will be rejected. An added precaution is to never use iodine or Betadine solutions to cleanse the skin before collecting blood samples to prevent possible interference of test results, especially in the analysis of potassium, glucose, and total protein.

    Why must the order of draw be followed accordingly?

    As already mentioned, this is done to avoid cross-contamination and unreliable test results. How can this happen?

    A tube with EDTA, for example, is rich in potassium and can cause an increase in potassium levels. Therefore, if a test for potassium is required, the tubes used must be those that are placed before those that contain EDTA. The same thing is true when a coagulation test need to be performed. Since tubes with clot activators can interfere with the results, tubes with light blue stopper or shield must be used before those that have red/gray stopper, gray/yellow stopper, gold shield, red shield and orange shield tubes.

    How do you remember the order of draw?

    Sally Sterile

    Leaves Lavender

    Gravy Gray

    Knowing The Order Of Draw

    Vacutainer tubes and order of draw | Quick review for medical students | Blood Collection

    The order of draw is an order of tubes phlebotomist should follow to prevent testing complications and cross-contamination of additives. The order of draw is Yellow, Light Blue, Red, Light Green, Dark Green, Lavender, and Gray. Way to remember this is by the saying Your brother Robert gives lovely gifts.

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    Preparing Slides Using Venous Blood Collected From Venipuncture

    Follow the steps outlined below.

    1. Put on laboratory personal protective equipment.

    2. Select two clean, grease-free glass collection slides with frosted ends .

    3. Print the patient’s name and date on the frosted ends of both slides.

    Figure 12

    4. Handle all slides only by the frosted ends or by the edges.

    5. Place the collection slides frosted side up and to your right on a padded, flat surface near the chair or bed where the specimen is to be collected.

    6. Immediately after removing the needle from the vein, gently touch the tip of the needle to one of the clean slides, producing a small drop of blood about 1 to 2 mm in diameter, about the size of a match head. The drop of blood should be in the center line, approximately ¼ inch from the frosted end. Repeat for the second collection slide. Activate the needle’s safety feature and dispose of the needle in a sharps container.

    7. Hold the left corners of the collection slide with the left thumb and forefinger.

    8. Hold the spreader by the frosted end between the right thumb and the index finger.

    9. Rest the left end of the spreader at a 45° angle, approximately ½ inch opposite the drop of blood on the slide. This angle prevents the white cells from bunching along the edges.

    Figure 13

    Figure 14

    10. Draw the spreader slide steadily back toward the drop of blood. When the slide contacts the drop, the blood will start to spread to the edges of the spreader slide.

    12. Prepare the second film in the same manner.

    Order Draw Blood Cultures Aerobic Anaerobic Warehouse Of Ideas

    Order of draw blood cultures 1. I Guess We Should Be Grateful That Our Policies Are Only Two. Rns carry a medical directive to order cultures when indicated. The blue blood culture bottle should be filled first, then the purple bottle as the butterfly tubing may contain air. Bd bactec plus aerobic medium bd bactec

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    P009a4 Order Of Draw Blood Collection Tubes

    Correct order of draw. B. All tubes must be gently inverted 8 10 times to provide thorough mixing of additives. C. Shaking the tube vigorously may cause hemolysis of the blood . II. Order of Draw for Vacutainer Collection Tubes 1. Blood Culture Bottles Used for bacterial and fungal cultures. Must be drawn …

    Safety And Infection Control

    Order of draw tube guide for Waikato Hospital

    Because of contacts with sick patients and their specimens, it is important to follow safety and infection control procedures.


    • Wear gloves and a lab coat or gown when handling blood/body fluids.

    • Change gloves after each patient or when contaminated.

    • Wash hands frequently.

    • Dispose of items in appropriate containers.

  • Dispose of needles immediately upon removal from the patient’s vein. Do not bend, break, recap, or resheath needles to avoid accidental needle puncture or splashing of contents.

  • Clean up any blood spills with a disinfectant such as freshly made 10% bleach.

  • If you stick yourself with a contaminated needle:

  • Remove your gloves and dispose of them properly.

  • Squeeze puncture site to promote bleeding.

  • Wash the area well with soap and water.

  • Record the patient’s name and ID number.

  • Follow institution’s guidelines regarding treatment and follow-up.

  • NOTE: The use of post-exposure prophylaxis following blood exposure to HIVhas shown effectiveness in preventing seroconversion


    • Place blood collection equipment away from patients, especially children and psychiatric patients.

    • Practice hygiene for the patient’s protection. When wearing gloves,change them between each patient and wash your hands frequently. Always wear aclean lab coat or gown.

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    Order Of Draw When Using The Syringe System:

    A document by the then National Committee for Clinical Laboratory Standards from 1991 established two distinct orders of draw for vacuum tube draws and by syringe method. This is now obsolete! NCCLS revised these standards in 1998 because there was a lack of evidence that syringes need a separate order of draw. And to avoid confusion, let us remind you that NCCLS became Clinical and Laboratory Standards Institute in January 2005.

    Order Of Draw Bracelet

    If the mnemonic device is not working, you may have heard of another option of buying an order of draw phlebotomy bracelet or other wearable. However, we do not recommend or encourage buying the order of draw phlebotomy bracelets because the OOD is something you need to know without relying on a bracelet.

    As a licensed phlebotomist, it is not only important to know the order of blood drawing but also the correct procedure and standard for drawing that blood. At PhlebotomyU, we value education because we want to provide hospitals, facilities, and laboratories with the best CPT-1 phlebotomy graduates. Our program not only provides teaching in the classroom but also real-time experience in the field. We offer abbreviated classes, weekday and weekend phlebotomy training from 5 to 9 weeks. At end of training, students have hours of hands on experience making it easy to go fromPhlebotomyU to a full time job.

    Sign up for a phlebotomy course today!

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    Blood Collection / Transport Containers

    Following the collection, preparation, and transport instructions suggested by LabCorp supports the best possible test results. Materials for proper specimen collection and transport are supplied by LabCorp. Note: Specimens to be tested by LabCorp should be collected in specimen containers provided by LabCorp.

    Anticoagulants and Preservatives. To ensure accurate test results, all tubes containing an anticoagulant or preservative must be allowed to fill completely. Attempts to force more blood into the tube by exerting pressure, as in collection with a syringe, will result in damage to the red cells . If the vacuum tube is not filling properly, and you are certain that you have entered the vein properly, substitute another tube. Occasionally, vacuum tubes lose their vacuum. If the specimen cannot be properly collected, select another site and using new, sterile collection equipment, collect the specimen.

    Note: Use plastic transport tubes for all frozen specimens.

    Why Is The Order Of Draw Important

    Order of Draw | blood collection

    Remembering the proper order during a venipuncture procedure on a patient is important for a few reasons:

    • Reduce patient discomfort
    • Prevent misdiagnosis of patient
    • Prevent cross-contamination of additives between blood collection tubes

    As a result of applying the proper order of collection tubes, youre providing a safer, more comfortable experience for your patient, which is always the number one priority when drawing blood. Above all, this also ensures that the patients results will come back accurate and result in proper diagnosis and treatment.

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    May Be Used For Routine Blood Donor

    . The MarketWatch News Department was not involved in the creation of this content. Collection of Vacuum Tubes Containing Additives eg anticoagulants preservatives clot activators gel-barrier. First – blood culture bottle or tube yellow or yellow-black top Second -.

    Vacutainer tubes may contain additives designed to stabilize and preserve the specimen prior to analytical testing. The correct order of draw follows. The recommended order of draw for plastic collection tubes is.

    For clot to form keep 10 15 minutes tube at room temper-ature for minimum 30 mins. For illustration purposes Table 23 shows the revised simplified recommended order of draw for vacuum tubes or syringe and needle based on. Prevent cross-contamination of additives between blood collection tubes.

    A Vacuum blood collection tube is a sterile glass or plastic test tube with a colored rubber stopper creating a vacuum seal inside of the tube facilitating the drawing of a predetermined volume of liquid. Plastic tubes need to be inverted to mix the blood with the coagulant. When using a winged blood collection set and a coagulation citrate tube is the rst specimen begin by drawing another partially-lled citrate tube to ensure a proper blood-to-additive ratio.

    The color of the top indicates the additives in the vial. When using vacuum tubes containing an additive. For serum no gel tubes only.

    Phlebotomy Order Of Draw Poster For School Phlebotomy Phlebotomy Study Medical School Studying

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