The Correct Order of Draw for Blood Collection: Importance and Guidelines

Summary

• The correct order of draw for blood collection is crucial in ensuring accurate Test Results and patient safety.
• The order of draw for multiple tubes during a phlebotomy procedure in the United States typically follows a specific sequence endorsed by clinical guidelines.
• Adhering to the proper order of draw helps prevent sample contamination and ensures the reliability of laboratory Test Results.

Introduction

Phlebotomy, the process of drawing blood for laboratory testing, is a common and essential procedure in healthcare settings. Proper technique during blood collection is vital to ensure accurate Test Results and patient safety. One critical aspect of phlebotomy is the correct order of draw when collecting blood into multiple tubes. This article will discuss the recommended order of draw for blood collection during a phlebotomy procedure in the United States.

The Importance of Order of Draw

The order of draw refers to the sequence in which blood is collected into different tubes during a phlebotomy procedure. Adhering to the correct order of draw is crucial for several reasons:

1. Preventing contamination: Following a specific order of draw helps minimize the risk of sample contamination, which can lead to inaccurate Test Results. Contamination can occur when additives from one tube carry over into subsequent tubes, affecting Test Results.
2. Ensuring test accuracy: Certain additives or anticoagulants used in blood collection tubes can interfere with specific laboratory tests. By following the proper order of draw, phlebotomists can help ensure that each blood sample is collected in a tube that is appropriate for the tests ordered.
3. Patient safety: Collecting blood in the correct order helps minimize the risk of adverse reactions or complications for patients. Using the right tubes in the proper sequence can prevent issues such as clotting, hemolysis, or inaccurate Test Results that could impact patient care decisions.

Recommended Order of Draw

The Clinical and Laboratory Standards Institute (CLSI) and other professional organizations provide guidelines on the proper order of draw for blood collection. While specific protocols may vary slightly depending on the facility and laboratory, the following is a common sequence recommended for blood collection into multiple tubes:

Order of Draw:

1. Yellow or SPS tubes: Blood Culture tubes are typically drawn first to minimize the risk of contamination with additives from other tubes.
2. Light blue tubes: These tubes contain Sodium Citrate and are used for coagulation studies such as Prothrombin Time (PT) and Activated Partial Thromboplastin Time (aPTT).
3. Red tubes: These tubes usually do not contain additives and are used for serum tests such as chemistry panels and blood bank cross-matching.
4. Gold or tiger-top tubes: These tubes contain a gel separator and Clot Activator and are used for chemistry tests, including comprehensive metabolic panels (CMP) and lipid panels.
5. Light green or dark green tubes: These tubes contain Heparin and may be used for chemistry tests such as electrolytes or ammonia levels.
6. Lavender tubes: These tubes contain EDTA Anticoagulant and are used for hematology studies, such as complete blood counts (CBC) and Blood Smears.
7. Gray tubes: These tubes usually contain Sodium Fluoride and Potassium Oxalate and are used for glucose and alcohol testing.

Conclusion

Adhering to the correct order of draw during blood collection is essential for ensuring accurate laboratory Test Results and patient safety. By following established guidelines for the order of draw, phlebotomists can help prevent sample contamination, ensure test reliability, and minimize the risk of adverse events for patients. Understanding and implementing the proper sequence for blood collection into multiple tubes is a fundamental aspect of quality phlebotomy practice in healthcare settings.

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