Help with ER blood draw order and tube color! - page 2
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... Read More
Oct 9, '08Read 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
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
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
Oct 14, '08Actually 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 2003Last edit by lecroy520 on Oct 14, '08
Oct 14, '08Quote from Sweetooth EMT-P, RNThe 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!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.
Oct 15, '08Quote from BinkieRNThe 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.
Oct 22, '08According to the CLSI guidelines formally NCCLs, the order of blood draw recommeded is:
yellow - blood cultures
Blue - citrate
Gold or /tiger top- SST
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?
Oct 22, '08According to the NaCCLS Guidelines (NCCLS H3-A5, vol 23, No 32,8.10.1) The recommended order of draw is as follows:
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?
Mar 26, '10I found this relevant info about order of lab drawing:
You can possibly get elevated potassium results by "drawing a tube that has an anticoagulant containing potassium prior to a non-anticoagulated tube. This results in specimen contamination of the non-anticoagulated tube with potassium."
Mar 26, '10Regarding the order of lab draw, I found some relevant info:
There can possibly be an incorrect result of elevated potassium by "drawing a tube that has an anticoagulant containing potassium prior to a non-anticoagulated tube. This results in specimen contamination of the non-anticoagulated tube with potassium."