Help with ER blood draw order and tube color! - page 2

by pedsRN121 110,130 Views | 21 Comments

My sister is a new nurse < 1 year and just got her dream job in the ER. Now after 10 months of being a float nurse, she is doing blood draws and is having trouble with what color tube to use for what test. I only know the bare... Read More


  1. 2
    Quote from Sweetooth EMT-P, RN
    I am thinking outside the box here, I really do not think it matters... If anyone has any actual scientific proof that order of tubes effects results please show it to me...

    I think as healthcare professionals we tend to do things a certain way jsut because it has been done that way for years even if what we do doesnt matter in the long run.

    Sweetooth

    I was a phlebotomist for over 5 years and the order of draw absolutley affects the results. If you were to draw an EDTA tube (purple or pink) before you collected the tube that was going to be used for a potassium test the results would be slightly skewed. This is only one of the ways that it will affect the results. I disagree with your idea that we do things a certain way because it is the way that we have always done it. In my eyes we do things through evidence-based practice and continually develop inovative and better ways of performing our jobs.
    DogWmn and CrabbyPatty like this.
  2. 2
    Someone in a previous reply to your Help request stated to draw a rainbow. I would agree with that.

    To the person earlier that stated "they didn't think it matters as to what order the tubes are drawn". Actually it does very much matter. There are several educational sites on Phlebotomy that will clearly spell out the reasons for "cross contamination" of chemicals in the tubes.

    If your sister still needs help, I would like to talk to you or her personally. I joined this website just to respond to your HELP request. You can contact me if you want privately through here if you want.

    I have a tool that will help her remember the order of draw and would like to mail her one. Not sure how to get private contact info being just new here and knowing that they also frown on personal emails being posted.
    ZA007 and CrabbyPatty like this.
  3. 0
    Every lab is different but when I worked in the lab I used to tell people when in doubt draw red and get it to the lab asap. The color of the tube usually is related to the additive in the tube that affects the sample. Red tops typically are whole blood (no additive) meaning the lab can usually transfer blood to other types of tubes if the specimen hasn't clotted. We also draw coags first (blue) and for the most part Green/gold/tiger top are fairly interchangable although your lab might disagree (they all are serum seperators) and most chemistry labs can be done on serum.
  4. 0
    Read previous post...and provide test tube needed and sequence of draw. Information extracted information from: Fischbach, F. (2002) Common Laboratory and Diagnostic Test, 3rd ed. Lippincott, Philadelphia

    The following sequence for blood drawn:
    1. Yellow-top tube
    - blood cultures
    2. Gold-top (SST) / red top non-additive tube
    - chemistry
    3. Light blue-top coagulation tube
    - plasma-coag studies, ie PT and PTT, D-dimer
    4. Light green-top (PST) / green-top additive tube
    - ammonia, hormone, electrolyte
    5. Lavender-top additive tube
    - CBC, hematology, genetic, RBC folate
    6. Grey-top additive tube
    - Glucose
    7. Royal blue-top tube with EDTA
    - cadmium, mercury, toxicology, nutritional chemistry
    8. Royal blue-top without EDTA
    - aluminum, arsenic, chromium, copper, nickel, zinc
    9. Yellow- top (ACD) tube
    10. Tan-top tube
  5. 2
    Actually It DOES matter...here is a way to remember the Order of Draw:
    Because Better Specimens Generate Perfect Results :
    BeCause = Blood Cultures( skin must be prepared with providone iodine.) This is only if BC's are ordered..if not go on to next one.
    Better = Lt. Blue (Sodium Citrate)
    Specimens = Serum Tubes (SST, Red, No additive,ect..)
    Generate= Green (lithium, ammonium. or sodium heparin tubes)
    Perfect= Purple, lavs, EDTA
    Goals= Gray (Potassium Oxalate and Sodium Flouride or Lithium Iodoacetate and Heparin)

    It may not matter to the Doctor...because he may not know....
    If your using the doubled ended needle vacutainer system this order of draw, keeps the following tubes from being contaminated by the additive in the previous tubes... If you are in an emergency situation and you receive an erroneous result due to YOUR order of draw, then your patient suffers the consequences. Then the doctor cares.... who cares if the chances are minute that it may happen...the seriousness of it is...it can...why take the chance. Order of draw is simple to remember and once you get it down..you wont forget and everyone is happy...you, the lab, the doctor, and most of all your patient because he wasnt put on a med he didnt need, or got the accurate treatment he did. But hey im just a phlebotomy student..

    This is the NCCLS/CLSI order of draw published in 2003
    Last edit by lecroy520 on Oct 14, '08
    ZA007 and RussA like this.
  6. 0
    I like your mnemonics in remembering draw sequence.
    Russ
  7. 0
    Quote from Sweetooth EMT-P, RN
    I am thinking outside the box here, I really do not think it matters... If anyone has any actual scientific proof that order of tubes effects results please show it to me...

    I think as healthcare professionals we tend to do things a certain way jsut because it has been done that way for years even if what we do doesnt matter in the long run.

    Sweetooth
    The order that tubes is drawn does not matter in the least. It's kind of like how many questions did you get on the NCLEX. Nothing to it!
  8. 0
    Quote from BinkieRN
    The order that tubes is drawn does not matter in the least. It's kind of like how many questions did you get on the NCLEX. Nothing to it!

    Actually Binkie it does matter. There can be cross contamation. I work in the lab. IF you draw a green with has a heparin additive and than a blue top it could affect your PTT results. There is a reason for the order of draw and if your drawing blood cultures lets say and you decide to draw them whenever you want you could contamite them giving false positive results.
  9. 0
    According to the CLSI guidelines formally NCCLs, the order of blood draw recommeded is:
    yellow - blood cultures
    Blue - citrate
    Gold or /tiger top- SST
    red- serum
    Green- heparin
    Lavender- EDTA
    Gray- Fluoride Tube

    However, I did hear that when drawing from central lines, the order of draw is different and that blues are generally drawn last. Has anyone heard of this?
  10. 0
    According to the NaCCLS Guidelines (NCCLS H3-A5, vol 23, No 32,8.10.1) The recommended order of draw is as follows:
    Blood Cultures
    Blue - Sitrate
    Gold or Tiger top - SSt
    Green - Heparin
    Lavender - EDTA
    Gray - floride

    This is for veinapuncture draws. I have heard recently that the order of draw is different for Catheter draws, where the coag(blue) is drawn last. Has anyone heard of this?


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