The Correct Order of Draw for Phlebotomy: Tips and Guidelines

Summary

• Understanding the correct order of draw for phlebotomy is crucial in preventing Cross-Contamination and ensuring accurate Test Results.
• There are specific tube colors and additives used in the correct order of draw for phlebotomy in the United States that phlebotomists must adhere to.
• The order of draw typically begins with tubes that do not contain additives, followed by tubes with anticoagulants and then tubes with other additives.

The Importance of the Correct Order of Draw in Phlebotomy

Phlebotomy is the process of drawing blood from a patient for diagnostic testing, transfusions, donations, or research. It is a crucial step in healthcare that requires precision and attention to detail to ensure accurate Test Results. One essential aspect of phlebotomy that phlebotomists must understand and follow is the correct order of draw.

The order of draw refers to the sequence in which different blood collection tubes should be filled during a blood draw. Following the correct order of draw helps prevent Cross-Contamination between tubes, which can impact Test Results and lead to inaccurate diagnoses. It also ensures the integrity of the blood samples collected and maintains patient safety.

Specific Tube Colors and Additives Used in Phlebotomy

In the United States, phlebotomists follow a standard order of draw that specifies the colors of blood collection tubes and the additives they contain. Each tube is designed for specific types of tests, and following the correct order of draw helps maintain sample quality and accuracy. The specific tube colors and additives used in the correct order of draw for phlebotomy in the United States are as follows:

1. Tubes Without Additives

1. Red-top tubes: These tubes typically do not contain any additives and are used for serum tests, chemistry tests, blood bank procedures, and serology tests.
2. Gold-top tubes: Also known as "SST" or serum separator tubes, these tubes have a gel separator and are used for chemistry tests, hormone tests, and drug screens.
3. Light Blue-top tubes: These tubes contain Sodium Citrate as an Anticoagulant and are used for coagulation tests, such as PT and APTT.

2. Tubes With Anticoagulants

1. Light Green-top tubes: These tubes contain lithium Heparin as an Anticoagulant and are used for chemistry tests, such as electrolytes and basic metabolic panels.
2. Dark Green-top tubes: These tubes contain sodium Heparin as an Anticoagulant and are used for chemistry tests, such as ammonia and STAT electrolytes.
3. Lavender-top tubes: These tubes contain EDTA (ethylenediaminetetraacetic acid) as an Anticoagulant and are used for hematology tests, such as CBC and ESR.

3. Tubes With Other Additives

1. Gray-top tubes: These tubes contain Potassium Oxalate and Sodium Fluoride as additives and are used for glucose testing.
2. Light Yellow-top tubes: These tubes contain ACD (acid-citrate-dextrose) as an Anticoagulant and are used for blood cultures.
3. Black-top tubes: These tubes contain Sodium Citrate and are used for sedimentation rate tests.

The Correct Order of Draw

When performing a Venipuncture procedure, phlebotomists must follow the correct order of draw to ensure Sample Integrity and accurate Test Results. The typical order of draw for phlebotomy in the United States is as follows:

1. Yellow-top tubes (blood cultures)
2. Light Blue-top tubes (coagulation tests)
3. Red-top tubes (serum tests)
4. Gold-top tubes (SST)
5. Light Green-top tubes
6. Dark Green-top tubes
7. Lavender-top tubes
8. Gray-top tubes
9. Black-top tubes

Following this order of draw helps prevent contamination between tubes and ensures accurate Test Results. Phlebotomists must also adhere to proper Venipuncture techniques, such as using a new needle for each patient, properly identifying patients, and labeling tubes accurately.

Conclusion

Understanding the correct order of draw for phlebotomy and knowing the specific tube colors and additives used in blood collection tubes are essential for phlebotomists in the United States. By following the standardized order of draw, phlebotomists can prevent errors, ensure Sample Integrity, and maintain patient safety. Adherence to proper phlebotomy practices is vital in healthcare settings to provide accurate diagnostic Test Results and deliver quality patient care.

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