The New Order of Draw When Collecting Multiple Blood Samples into Different Tubes
When blood is drawn for laboratory testing and analysis it requires special care, training and skills. Every medical facility will pay particular attention to patient comfort, safety and protection of every one from injury and infection. Additionally it is very important that blood samples are not tainted, contaminated or handled in a manner that would affect the quality, or accuracy of the blood analysis, and special considerations apply when it comes to collection for blood cultures and indwelling catheter line draws. If unsure about the proper order of draw or proper techniques places you can contact as sources of free information are:
the manufacturer of the tubes you use (there should be a 1-800 number or website)
your regional hospitals' s hematology lab (just give them a call and speak to the supervisor)
your community college's phlebotomy and nursing instructors
American Red Cross blood donation centers (just walk in and tell them who you are)
Watch this video of multiple blood draws using different types of evacuated tubes:
ATTENTION: Please realize that this video (published from YouTube) is NOT HERE TO TEACH you phlebotomy techniques, but merely to show you different scenarios of the phlebotomist's daily routine. The video may contain techniques, or procedures that do not conform to proper, and/or safe venipuncture protocol.
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 Institute's (CLSI) standard H3-A6 from November, 2007, as follows:
1.) Blood cultures (yellow) SPS (sterile)
2.) Light blue (buffered sodium citrate tube)
3.) Red (plain), or Tiger-Top mottled red (gel separator tube)
4.) Green heparin and light green (sodium or lithium with or without separators)
5.) Lavender (EDTA)
6.) Pink, white, or royal blue (EDTA)
7.) Gray (Na flouride/potassium oxalate)
8.) Dark blue (FDP)
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 (filled to complete vacuum volume) 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.
Order of Draw When Using The Syringe System:
A document by the then National Committee for Clinical Laboratory Standards (NCCLS*) 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 (CLSI) in January 2005.
The current edition of the CLSI catalog and CLSI hematology standards are available upon request from either CLSI membership organizations as well as to non-members directly from CLSI. Contact CLSI for the latest order of draw information.