Remembering the proper order during a venipuncture procedure on a patient is important for a few reasons:
- Decrease the time it takes to perform the procedure
- Reduce patient discomfort
- Avoid complications for patient
- Prevent misdiagnosis of patient
- Prevent cross-contamination of additives between blood collection tubes
Why is the Order of draw important in blood collection?
One step in this process is the action of blood collection. When a patient requires blood tests, often more than one tube is required. These blood tubes may contain different additives which may affect certain results should they contaminate another tube. For this reason, an order of draw was established.
Is Order of draw still relevant in modern practice?
Recently there have been conflicting opinions as to whether following an order of draw is still legitimate in modern practice. In their opinion paper published in Clinical Chemistry and Laboratory Medicine, a group of researchers set out to review the evidence.
What is the Order of the draw table?
Order of Draw Table Blood Draw Order Tube Color Name/Additive # of Inversions 1 Varies Blood Cultures 8 – 10 2 Light Blue Sodium Citrate 3 – 4 3 Red Clot Activator 4 – 5 4 Gold SST (Serum Separator Tube) 4 – 5 4 more rows ...
What happens when the Order of draw is disregarded?
It also discusses what can happen when the order of draw is disregarded. Additive carryover occurs when the needle filling a tube comes in contact with the blood/additive mixture as the tube fills, and transfers a minute amount of blood and additive into the next tube filled. This can occur with both syringe and vacuum draws.
Why does the order of blood draw matter?
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 draw for?
The "Order of Draw" is designed to eliminate the possibility of cross contamination that may result in erroneous results. It is based on CLSI Procedures for Collection of Diagnostic Blood Specimens by Venipuncture; Approved Standard Sixth Edition, October 2007.
What happens if you draw blood in the wrong order?
In the era of lyophilized anticoagulants, order of draw is no longer important. Contamination of serum samples with K EDTA will occur routinely if order of draw is not followed. During syringe collections, contamination with K EDTA may rarely occur if order of draw is not followed.
What is the purpose of the order of draw poster?
This full-color poster, measuring 10" x 22" and laminated for protection and longevity, depicts the order in which blood collection tubes must be filled to prevent additive carryover from altering test results.
Does it matter what order you draw labs?
0 tubes were contaminated with EDTA. The incorrect order of draw of blood samples does not result in EDTA sample contamination. In ideal phlebotomy conditions, the order of draw has no effect on serum biochemical results.
How do you remember the order of draw?
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.
Why do you draw a blue top first?
Blue Top – Tube contains Sodium Citrate. Must be drawn prior to collection of serum tubes to prevent contamination with clot activator and interference with coagulation cascade.
What does dark blood mean when drawn?
This is common should blood be taken from an artery, which takes blood from the lungs to the rest of the body. Deoxygenated blood is found in veins, which take blood from the body back to the lungs. Blood drawn from a vein will appear dark red or even black.
What are the most common errors in specimen collection?
Two of the most common errors that occur during specimen collection and handling are clotting and inaccurate volume. Exposure to temperature extremes may also cause specimens to be rejected for testing. Clotting compromises the integrity of a specimen, making it unsatisfactory for testing.
What is the correct order of draw in phlebotomy?
The recommended order is as follows: Blood culture tubes. Sodium citrate tubes (e.g., blue-stopper) Serum tubes with or without clot activator, with or without gel separator (e.g., red-, gold-, speckled-stopper)
What is the order of draw for blood culture?
Standard order of draw: BLOOD CULTURES, royal blue, red, light blue, SST (Gold), green, tan, yellow, pink, pearl, lavender. 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.
What is the order of draw quizlet?
The correct order of draw is:Blood cultures.Light blue top tubes.Serum (red top or red/gray tube)Green tubes.Lavender tube.Gray top tubes.
What is the order of the draw for phlebotomy?
The recommended order of draw for plastic collection tubes is:First - blood culture bottle or tube (yellow or yellow-black top)Second - coagulation tube (light blue top). ... Third - non-additive tube (red top)Last draw - additive tubes in this order:
What order should Bloods be taken?
The recommended order is as follows:Blood culture tubes.Sodium citrate tubes (e.g., blue-stopper)Serum tubes with or without clot activator, with or without gel separator (e.g., red-, gold-, speckled-stopper)Heparin tubes with or without gel (e.g., green-stopper)EDTA tubes (e.g., lavender-stopper)More items...
What blood tube colors are for which test?
Blood Collection TubesTube cap colorAdditiveRed or gold (mottled or "tiger" top used with some tubes)Serum tube with or without clot activator or gelGreenSodium or lithium heparin with or without gelLavender or pinkPotassium EDTAGraySodium fluoride, and sodium or potassium oxalate1 more row
What is the order of draw for blood culture?
Standard order of draw: BLOOD CULTURES, royal blue, red, light blue, SST (Gold), green, tan, yellow, pink, pearl, lavender. 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.
What is the order of draw in phlebotomy?
Phlebotomists must collect blood samples using collection tubes in a specific order while performing venipuncture on patients to avoid cross-contamination of the various additives between tubes. This process is known as the order of draw.
Why is it important to remember the proper order of venipuncture?
Remembering the proper order during a venipuncture procedure on a patient is important for a few reasons: Decrease the time it takes to perform the procedure. Reduce patient discomfort. Avoid complications for patient. Prevent misdiagnosis of patient.
Why do you need to use proper order of collection tubes?
As a result of applying the proper order of collection tubes, you’re 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 patient’s results will come back accurate and result in proper diagnosis and treatment.
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.
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.
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 ...
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.)
What order of draw is used for blood culture?
The guidelines cover order-of-draw recommendations, which continue to be present in the guidelines as blood culture first , followed by citrated tubes, serum tubes, heparin, then EDTA, with special emphasis on not collecting the EDTA tube before the serum tube.
Is order of draw important in anticoagulants?
In the era of lyophilized anticoagulants, order of draw is no longer important.
Is order of draw important for routine venipuncture?
However, in general what the European Federation for Clinical Chemistry Working Group for Preanalytical Phase concluded was: order of draw was not important for routine venipuncture using a vacutainer adaptor, but contamination still did occur during syringe transfer.
Is order of draw important in lab?
Modern lab equipment can tell the difference between K from the EDTA tube and K from the patient, so order of draw is not important.
Can you draw EDTA from purple top to serum tube?
So it seems that order of draw is still important, and with syringe draws particularly you can carry over K EDTA from the purple top to the serum tube if you do not dose them in the correct order or essentially follow the recommended order of draw.