Help with ER blood draw order and tube color!

  1. 0 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 minimum that we use on peds, since most of our pts are done in the ER.
    Can anyone tell me where she can find this info? Thanks.
  2. Enjoy this?

    Join thousands and get our weekly Nursing Insights newsletter with the hottest discussions, articles, and toons.

  3. Visit  pedsRN121 profile page

    About pedsRN121

    From 'Chicago'; Joined May '06; Posts: 18; Likes: 7.

    21 Comments so far...

  4. Visit  traumaRUs profile page
    1
    Its individual to the facility and I found this out the hard way when I did agency in another city and drew the wrong colored tubes! Ugh! Usually, lab has little cheat sheets which tell which color for which tests:

    Lavender - CBC, type and x-match
    Red or tiger top - basic chemistries
    blue - coags
    yellow - blood cultures

    However, this is just at one facility where I work. At other places the colors are different.
    pedsRN121 likes this.
  5. Visit  nursemike profile page
    1
    It happens less these days, but still, when in doubt I call the lab. They are usually helpful.
    pedsRN121 likes this.
  6. Visit  AnnieOaklyRN profile page
    1
    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
    pedsRN121 likes this.
  7. Visit  mom2michael profile page
    1
    We draw a rainbow, that way the lab has tubes for every test. Even blood cultures (one set) can be drawn and placed in a tube but I have to always call the lab to remember which tube.

    And my lab tubes are different than traumaRU's lab tube colors......so it really does vary a bit from place to place.

    When in doubt, call the lab....
    Last edit by mom2michael on Jan 13, '08
    pedsRN121 likes this.
  8. Visit  mom2michael profile page
    1
    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
    Not scientific proof, but interesting rational.


    http://books.google.com/books?id=PY8...LKTXbgtbMBpysQ
    pedsRN121 likes this.
  9. Visit  NotReady4PrimeTime profile page
    1
    I follow the example in mom2michael's reference. The rationale is reasonable, at least in my mind. We have a laminated sheet prepared by our lab services that helps us decide which tubes to use for which tests. We don't tend to use the red top tube in our facility, but we use millions of lavender, green and light blue ones, plus a ton of gold-top serum separators when doing a transplant workup.

    Green: chemistry, drug levels, LFTs, lipid profile, cardiac markers (often interchangeable with red tops)
    Lavender: hematology tests - CBC, diff, group and hold/match, tacrolimus levels
    Light blue: coags, anticoagulant levels
    Gold: serology (replaces red tops in our hospital)
    Dark blue: trace metals
    Gray: lactate (sent on ice)

    Our blood cultures go directly into culture medium bottles. We typically only send aerobic samples in our unit, not sure why.
    pedsRN121 likes this.
  10. Visit  MelBel profile page
    1
    Our labels for the labs tell which tube to use, and our PCAs do most of the blood draws, so I don't remember most of them...I know PT/INR/PTT in blue, BMP in gold, CBC in lavender, etc...as far as the order goes, I know most people I work with draw the blue tops first because you can't get away without filling it, and sometimes after a few tubes my old patients veins aren't giving so much
    pedsRN121 likes this.
  11. Visit  Achoo! profile page
    0
    We always draw whole blodd or SST tubes first, blue tops last, and the rest in between. They claim there is a minute chance of EDTA passing into the blood and messing up results but with the vacutainers nowadays I don't know if that is much a concern than in years past?
  12. Visit  RNcDreams profile page
    0
    My facility requires the blue top (PT/PTT/INR) to be drawn first because they cannot run the specimen unless the entire tube is full... so I guess their rationale is, if you're gonna get one tube and blow it, get the important one!

    Lavender = CBC
    Green= C7
    Red= Troponins, hcg, etc
    Blood cultures to into culture bottles right from the Vacutainer
    Yellow/Gold top = SST tube, used for belly labs (lfts, amy, lip)
    Pink top=T+S

    When labs are ordered for a patient, the stickers for the tubes indicate what color tube needs to be drawn for said sticker.

    Call the lab and don't worry... because at the end of the day, if you order a lab to be added on.. the run it from whatever they have anyway! It can be done.
  13. Visit  JRD2002 profile page
    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.
  14. Visit  wabitczn profile page
    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.
  15. Visit  PICURN74 profile page
    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.


Nursing Jobs in every specialty and state. Visit today and find your dream job.

Top