order of draw cheat sheet

Guri Bee

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22-10-2024

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The Ultimate Order of Draw Cheat Sheet for Phlebotomists

Drawing blood is a critical part of healthcare, but getting the order of tubes right is essential for accurate test results. A wrong order can compromise samples, leading to inaccurate diagnoses and delayed treatment. This article will guide you through the order of draw, using information from trusted sources like GitHub, and will break down the key points in a clear and concise way.

What is the Order of Draw?

The order of draw refers to the specific sequence in which blood tubes are filled during a venipuncture procedure. This order ensures that additives in certain tubes don't contaminate samples collected in other tubes. Each tube contains specific additives that are necessary for different tests.

Why is the Order of Draw Important?

• Accuracy: Maintaining the correct order of draw prevents cross-contamination of additives, ensuring accurate test results.
• Safety: Following the order of draw minimizes the risk of inaccurate results and potentially unnecessary repeat procedures for the patient.
• Efficiency: Adhering to the order of draw streamlines the blood drawing process, saving time for both the phlebotomist and the patient.

The Gold Standard: The Order of Draw

The CLSI (Clinical and Laboratory Standards Institute) provides the universally recognized order of draw, which is the standard followed by most healthcare facilities. Here's a breakdown of the order, along with explanations for each tube:

1. Blood Culture Bottles (Yellow)

• Additive: Sodium Polyanethol Sulfonate (SPS)
• Purpose: Used for culturing microorganisms. SPS inhibits the growth of complement, a component of the immune system that can kill bacteria.

2. Sterile (Yellow) Tubes

• Additive: Sodium Heparin
• Purpose: Used for blood cultures when SPS is contraindicated (such as for fungal cultures).

3. Light Blue Tubes

• Additive: Sodium Citrate
• Purpose: Used for coagulation tests, such as PT (Prothrombin Time) and PTT (Partial Thromboplastin Time), which measure blood clotting ability.

4. Serum Separator Tubes (SST) (Gold, Red/Gray, or Orange)

• Additive: Clot activator and gel separator
• Purpose: Used for serological tests, such as for antibodies, hormones, and certain chemistry tests. The gel separates the serum from the blood cells after centrifugation.

5. Red Tubes

• Additive: None (may contain a clot activator)
• Purpose: Used for chemistry tests and serology.

6. Green Tubes

• Additive: Heparin (Lithium, Sodium, or Ammonium Heparin)
• Purpose: Used for chemistry tests and stat tests that require rapid processing.

7. Lavender Tubes

• Additive: EDTA (Ethylenediaminetetraacetic Acid)
• Purpose: Used for hematology tests, such as CBC (Complete Blood Count) and ESR (Erythrocyte Sedimentation Rate), which assess blood cells and their function.

8. Gray Tubes

• Additive: Sodium Fluoride and Potassium Oxalate (sometimes with EDTA)
• Purpose: Used for glucose testing and blood alcohol levels. Fluoride inhibits glycolysis, preventing glucose breakdown.

9. Royal Blue Tubes

• Additive: EDTA or Heparin
• Purpose: Used for trace metal testing. These tubes are often made with a special glass to minimize contamination from metals.

Tips for Mastering the Order of Draw

• Memorize the order: Repetition is key!
• Use mnemonic devices: Create a catchy phrase or acronym to help you remember the sequence.
• Visual aids: Use flashcards or diagrams to visualize the order.
• Practice makes perfect: Get hands-on experience with different blood collection procedures.

Remember, this is a general guideline. Always refer to your laboratory's specific procedures and protocols to ensure compliance and accuracy.

Adding Value Beyond the Basics

• The importance of labeling: Always label tubes with the patient's name, date, and time of collection.
• Tube selection: Use the appropriate tube type for each test. For example, don't use a lavender tube for chemistry tests, as the EDTA can interfere with certain chemical reactions.
• Safety considerations: Remember to wear gloves and follow universal precautions for infection control.

Conclusion

The order of draw is critical for accurate and efficient blood collection. By mastering this essential skill, you can contribute to high-quality patient care and ensure accurate test results.

Disclaimer: This article is for informational purposes only and should not be taken as medical advice. Always consult with your healthcare provider for any health concerns or before making any decisions related to your health.