Order of Draw
When drawing blood for multiple tube collections, it is important to take into consideration proper venipuncture technique and correct order of draw. Taking these factors seriously can lessen discomfort and complications for your patient, lessen procedure time, and prevent errors in diagnosis caused by cross contamination of additives between blood collection tubes.
Please watch this video for information about order of draw.
The first thing to consider when it comes to drawing blood is to ensure that proper aseptic technique is followed. Also, see to it that you have all the equipment you need for your specific phlebotomy procedure: these include your needles, syringes, tourniquets, collection tubes, cotton balls, plaster, and labeling tools. Lastly, before sending off your specimen for analysis, you should double-check your labels to confirm that the right names are on the right tubes, and that the tubes are sent off to the right diagnostic procedures.
Order of Draw, Phlebotomy
The major reason behind establishing a certain order of draw when doing venipuncture for multiple tube collections is to avoid any cross contamination of the chemical additives between different tubes. Cross contamination of these additives can massively change the results and may consequently lead to misdiagnosis and mistreatment of the patient.
The basic order of draw followed by most phlebotomy laboratories is as follows:
- Yellow Top (or Yellow-Black). This tube is used for blood cultures.
- Light Blue. This tube contains sodium citrate, and is used for coagulation assays. A full draw is required with this tube.
- Red. This tube does not contain any additives.
- Gray (with Red) or Gold. This is the serum separator tube (SST) containing a clot activator and a gel separator.
- Dark Green. This tube contains sodium heparin anticoagulant.
- Light Green. This is the plasma separating tube (PST) containing lithium heparin anticoagulant and a gel separator.
- Lavender. This tube contains EDTA (Ethylenediaminetetraacetic acid).
- Pale Yellow. This tube contains acid citrate dextrose.
- Light Gray. This tube contains oxalate or fluoride.
Each tube should be thoroughly mixed by inverting the tube 8-10 times. Exceptions to this rule are the Light Blue tube, which is to be mixed by inverting 3-4 times, and the Red tubes (non-additive and SST), which are to be mixed by inverting 5 times.
Important Exceptions to the Basic Order of Draw
Although not exactly an exception, one important thing to note about the order of draw is that the second and third tubes are often reversed. The non-additive tube (Red Tube) is often drawn first when there is a particular concern for the contamination of the red tube with tissue fluids or thromboplastins if it were to follow the light blue tube. In most cases, however, the light blue tube is drawn first, as it requires a full draw before any specimen can be sent for analysis.
When using a butterfly needle for collection and no blood cultures are being required, a discard tube should be the first draw. This discard tube, preferably a non-additive tube, serves to draw out the “dead space” of the tubing of the butterfly needle set. This ensures that the correct blood-to-additive ratio is maintained in the different collection tubes.
Basic Mnemonic for the Proper Order of Draw
Most phlebotomy laboratories have an order of draw chart that is either made by the laboratory itself, or one that is produced by the manufacturer of the phlebotomy tubes used by the lab. Without these charts, however, you need to know the basic order of draw from heart. This mnemonic, basically a phrase that holds true for all members of the medical industry, is a good way for you to easily recall the proper order of draw.
You Better Read, not Get Downright Lazy, LOVE, or You’ll Probably Lose Greatly.
Which stands for:
Yellow – Light Blue – Red – Gray (with Red) or Gold – Dark Green – Light Green – Lovender (Lavander) – Yellow (Pale) – Light Gray
A simple tip to take note when doing venipuncture for multiple tube collections is to keep your patient calm. Patients tend to be a little apprehensive when multiple tubes are taken, so it becomes your responsibility to assure them that you are there to do your job as best as you can, and that you will do your best to keep them as comfortable as possible. Also, you have to make sure that all of your collections use the right procedure and equipment. Using the wrong needle size, or drawing blood too quickly may cause your specimen to be unsuitable for analysis.