The correct order of draw follows:
- Blood culture tube or bottle
- Sodium citrate tube (eg, blue closure)
- Serum tubes, including those with clot activator and gels (eg, red, red-speckled, gold closures)
- Heparin tube with or without gel (eg, dark green, light green, speckled green closures)
- EDTA tube with or without gel separator (eg, lavender, pearl, pink closures)
- Sodium fluoride/potassium oxalate glycolytic inhibitor (eg, gray closure)
Full Answer
What is the correct order of draw for a blood test?
Test Tube Guide and Order of Draw When using a winged blood collection set is used and the first tube to be drawn is a citrate coagulation tube, a discard tube (non additive tube) should be drawn first. The discard tube is used to fill the "dead space" in the tubing to ensure proper blood-to-additive ratio in the citrate tube.
What is the best order to draw tubes?
The order is universal for glass and plastic tubes, and irrespective of whether samples are drawn with a tube holder or syringe. The recommended order is as follows: Sodium citrate tubes (e.g., blue-stopper)
How are blood samples drawn by a phlebotomist?
Blood samples must be drawn by phlebotomists in a specific order to avoid cross-contamination of the sample by additives found in different collection tubes. Phlebotomy order of draw is the same for specimens collected by syringe, tube holder, or into tubes preevacuated at the time of collection.
What is the Order of blood draw tubes and additives?
Order of Blood Draw Tubes and Additives 3/19/2019 Blood samples must be drawn by phlebotomists in a specific order to avoid cross-contamination of the sample by additives found in different collection tubes. Phlebotomy order of draw is the same for specimens collected by syringe, tube holder, or into tubes preevacuated at the time of collection.
Why is it important to know the order of lab tubes?
This is extremely important when collecting blood because if you use the wrong tube your results can be greatly affected or simply not have the ability to run a test.
Why should blood cultures be collected first?
Blood cultures should always be collected first to prevent the risk of any contamination from other tubes or additives.
What is lavender tube?
This tube is mainly collected when hematology studies. In a hematology tests, whole blood needs to be inspected therefore, common tests you will see with the lavender tube include but are not limited to complete blood count (CBC), Erythrocyte sedimentation rate (ESR), reticulocytes, Monospot test for Epstein Barre Virus (EBV), etc.
What is the purpose of the XA tube?
This tube is collected when testing for coagulation studies such as Von Willebrand disease (most common blood clotting disorder), Clotting factors, D-dimer to rule out thrombosis, Anti factor Xa to monitor patients on high dose low molecular weight heparin, Prothrombin time, etc.
Is the gold tube used more often than the gold tube?
This tube is not used very often but when it is it accompanies an order for routine biochemistry. However, the gold tube is used more frequently than this one.
Does a blood clot tube have additives?
There is no additive inside this tube which means it will allow the blood to clot naturally.
How long to stop a drug infusion before drawing?
If stopping the infusion will not affect hemodynamic stability, stop the infusion for 3 to 5 minutes before drawing the specimen. If stopping the infusion may cause instability, draw the specimen from a different site. 3.
What gauge is the distal port of a CVAD?
The distal port (16 gauge) of the CVAD is recommended. 2. If IV solutions or medications are infusing through the CVAD, determine whether stopping the infusion will affect the patient’s hemodynamic stability. If drawing for a drug level, DO NOT draw from the port the medication is infusing (i.e.: heparin).
Can you draw blood from a CVAD?
Have you ever looked at your patient’s labs and think “there is no way these labs are correct”? When drawing blood from a Central Venous Access Device (CVAD) you could inadvertently contaminate the blood sample with IV fluids and medications. This contamination causes extra work, such as the nurse having to draw the labs again, patients having more blood drawn and lab having to run the test again. This quick tip sheet is to remind us about the proper procedure to draw labs from a CVAD while avoiding contamination.
What is the correct order for drawing blood tubes?
The order of draw is based on CLSI Procedures and Devices for the Collection of Capillary Blood Specimens; Approved Standard – Sixth Edition, September 2008. This standard recommends that EDTA tubes be drawn first to ensure good quality specimen, followed by other additive tubes and finally, serum specimen tubes.
Which vein is the first choice for venipuncture?
The median cubital vein is the larger and more stable vein and is preferred for venipuncture.
What is the purple blood tube for?
The purple top tube provides blood for infectious disease tests and ascertaining important data such as ABO/Rh (blood type), as well as whether the blood is positive or negative for cytomegalovirus (CMV), HIV, hepatitis, and West Nile virus, to name a few.
What is the Order of draw in blood tubes?
When collecting diagnostic blood specimens by venipuncture into evacuated tubes the order of draw is, based on Clinical and Laboratory Standards Institute’s (CLSI) standard H3-A6 from November, 2007, as follows: 1.) Blood cultures (yellow) SPS (sterile) 2.) Light blue (buffered sodium citrate tube)
Discard Tube 3 Ml No Additive Must Be Used Only If Drawing A Citrate (Blue) Tube With A Tube Holder And Butterfly Needle
When multiple blood specimens are scheduled for collection from a patient, the royal blue tube should be drawn first within its additive group. Etched lines in borosilicate glass tubes reflected the amount of blood the phlebotomist needed to collect.
The Correct Order Of Draw Follows
If a coag tube (light blue) is the only tube or the first tube to be drawn, a 5 ml discard tube must be drawn first.
If A Coag Tube (Light Blue) Is The Only Tube Or The First Tube To Be Drawn, A 5 Ml Discard Tube Must Be Drawn First
Used only to remove air from tubing. Blood cultures, royal blue, red, light blue, sst (gold), green, tan, yellow, pink, pearl, lavender. Must be drawn first to reduce the potential hazard of bacterial, fungal, quantitative, cmv, and/or any other specimen.
If A Coag Tube (Light Blue) Is The Only Tube Or The First Tube To Be Drawn, A 5 Ml Discard Tube Must Be Drawn First
Wash hands and put on gloves. Digoxin, dilantin, drug levels, homocystine, lithium, tegretol, theophylline. Blood collection order of draw for tubes and bottles tube type tests instructions blood culture bottles.
What happens when a blood tube is inverted?
When the tube position is inverted relative to horizontal, i.e., the stopper of the tube is lower than the bottom of the tube, the tube fills from top to bottom, contaminating the needle that pierces the stopper. In practice, those who draw blood samples cannot always control the orientation of the tubes as they are filled when using a tube holder.
What is a heparin tube?
Heparin tubes with or without gel (e.g., green-stopper) EDTA tubes (e.g., lavender-stopper) Glycolytic inhibitor tubes (e.g., gray-stopper) [Note: some facilities have conducted internal studies that support a variation to the recommended order of draw.
What is a carryover in a syringe draw?
In a syringe draw, the carryover occurs with the needle of the safety transfer device. (According to OSHA, blood collected by syringe should be transferred to the tubes using a safety transfer device, not the same needle used to perform the venipuncture.)
Why did the order of draw change?
Whereas glass is a natural clot activator, plastic is not. So in order for blood to clot in safer plastic tubes, manufacturers coat the inside of the tube with a substance to facilitate clotting, like silica particles. However, if the tube following the clot activator tube remained the coag tube, as was the recommended order prior to 2003, carryover threatens the coag results. With the consensus of all major U.S. tube manufacturers, CLSI issued one single change in the order of draw when the venipuncture standard was revised in 2003: serum tubes that used to precede the blue-stopper coag tube were relocated to follow coag tubes. This change was only possible because a myth about tissue thromboplastin was disproved.
Why is it important to follow the order of draw?
Neglecting this key concept can contribute to medical mistakes that can be potentially catastrophic to the patient. Because ignoring the order of draw can have severe consequences to the patient, it is critical that all who draw blood samples adhere to the established order of draw. Do you have to follow the order of draw? Absolutely.
When was the last time the order of draw changed?
This order of draw has changed over the years, the last occurring in 2003. Necessitating the change was the industry-wide transition from glass blood collection tubes to plastic. Whereas glass is a natural clot activator, plastic is not. So in order for blood to clot in safer plastic tubes, manufacturers coat the inside ...
Can bacteria be in blood cultures?
When blood cultures are collected at the same time as other lab work and not filled first, bacteria from the non-sterile stoppers of the tubes can contaminate the bottles used for blood cultures.
What is the proper order of draw for a capillary specimen quizlet?
For the Chem 7, the green top tube should be drawn first, followed by the lavender top tube, and then the two light blue top tubes (one waste, one for the coagulation test, or PT) (for the CBC).
What is the correct order of steps to collect a capillary blood sample?
A lancet of the correct size (adult/child) should be used to pierce the palm-side surface of the finger. When creating the puncture, be sure to apply pressure on the finger. You’ll be able to get the blood you need if you do this. To avoid clot formation, carefully flip the Microtainer« 10 times before closing it.
What list of tubes is in the correct order of draw?
Draws should be made in the following order: Bottle or tube for collecting blood samples. Capillary salt-water tube (eg, blue closure) Gels and clot activator tubes and tubes of serum (eg, red, red-speckled, gold closures) Gel or no gel: Heparin tube with or without (eg, dark green, light green, speckled green closures) ΓÇó
Which of the following tubes should be drawn first quizlet?
Drawn first are the coagulation test tubes (blue) (unless blood cultures [yellow] have been ordered, which would then be first). Anticoagulant tubes (red) are next, followed by simple (red) tubes.
Which of these tubes should the Ma draw first?
First, a medical assistant should choose which of the following tubes to draw from in accordance with the correct procedure. The sequence of drawing begins with the yellow tube. Sterile blood cultures may be collected with this device.
Which samples are collected first in a capillary collection?
The draw order. The haematology specimen is taken first, followed by the chemistry and blood bank specimens, when skin punctures are used. To reduce the impact of platelet clumping, this drawing order is necessary.
Why is order of draw important in capillary blood collection?
When drawing capillary blood, it’s crucial to stick to the specified sequence of draws. Using the EDTA capillary blood tube first prevents the blood from clotting before the specimen is taken, to provide one example. The accuracy of the blood count will be compromised if there are clots in this tube.
What order should blood samples be drawn?from clsi.org
Blood samples must be drawn by phlebotomists in a specific order to avoid cross-contamination of the sample by additives found in different collection tubes. Phlebotomy order of draw is the same for specimens collected by syringe, tube holder, or into tubes preevacuated at the time of collection. The correct order of draw follows: 1 Blood culture tube or bottle 2 Sodium citrate tube (eg, blue closure) 3 Serum tubes, including those with clot activator and gels (eg, red, red-speckled, gold closures) 4 Heparin tube with or without gel (eg, dark green, light green, speckled green closures) 5 EDTA tube with or without gel separator (eg, lavender, pearl, pink closures) 6 Sodium fluoride/potassium oxalate glycolytic inhibitor (eg, gray closure)
What is the order of draw in phlebotomy?from clsi.org
Phlebotomy order of draw is the same for specimens collected by syringe, tube holder, or into tubes preevacuated at the time of collection. The correct order of draw follows: Serum tubes, including those with clot activator and gels (eg, red, red-speckled, gold closures)
Why do phlebotomists use mnemonics?from phlebotomyu.com
Many phlebotomists use a mnemonic device to make the memorization process a bit easier. A mnemonic device is a phrase or saying that is easy to remember and relate back to in the future. It’s a great way to remember order of draw (OOD) because you can modify the sentence to be most helpful to you.
Why do we put tubes in reflux order?from phlebotomyu.com
The reason the tubes are assigned this order is to prevent the cross-contamination of chemicals into other tubes which may cause errors in testing. This process is called reflux, which means the chemical can move from the tube and enter the needle.
Can you collect blood before coagulation?from clsi.org
Only blood culture tubes, glass nonadditive serum tubes, or plastic serum tubes without a clot activator may be collected before the coagulation tube. Numerous errors can occur during the collection and handling of blood specimens, which pose significant and avoidable risks to the patient and the phlebotomist.
Can a coagulation tube be placed before a blood culture tube?from clsi.org
Plastic serum tubes containing a clot activator may cause interference in coagulation testing. Only blood culture tubes, glass nonadditive serum tubes, or plastic serum tubes without a clot activator may be collected before the coagulation tube.
Can you buy an order of draw phlebotomy bracelet?from phlebotomyu.com
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 ph lebotomy bracelets because the OOD is something you need to know without relying on a bracelet.