If a phlebotomist corrected you on order of draw, what would you do? - page 4

by pyriticsilence

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I currently work as a phlebotomist before entering nursing school. Today, a nurse tried to correct me on my order of draw (she thought I should draw a blood culture last). When I corrected her and tried to explain how she was... Read More


  1. 1
    I was always taught blood cultures first(from the first site) then red tops(no chemicals in tube), yellow, blue(and it better be the whole tube!), green then purple, and lastly the second set of cultures from a different site preferably from the other arm.

    If I am wrong please correct me!

    P.S. and to always use a syringe attached to the drawing needle when drawing from the hands. I was taught it was to prevent the vein from blowing and causing a hematoma.
    SopranoKris likes this.
  2. 2
    Quote from sunny3811
    I was always taught blood cultures first(from the first site) then red tops(no chemicals in tube), yellow, blue(and it better be the whole tube!), green then purple, and lastly the second set of cultures from a different site preferably from the other arm.

    If I am wrong please correct me!

    P.S. and to always use a syringe attached to the drawing needle when drawing from the hands. I was taught it was to prevent the vein from blowing and causing a hematoma.
    That's exactly what we were taught. Never use a Vacutainer on a hand draw or you'll blow the vein. BCs first, then red tubes (if using a vacuatiner), then blue (coags, full tubes), green (hep), then purple (CBCs). If a second set of BCs has to be drawn, use a different arm and do this last. If doing a syringe draw, then blue goes first (after BCs).

    However, order of draw varies so much by institution, so you really have to go by the chart the lab provides. I noticed that between the 2 hospitals they sent us to, some use a few different variations in color. Essentially the same order in terms of tests being performed, but the tops were slightly different (e.g. pink instead of purple, black instead of yellow, etc.)

    Bottom line: trust your phlebotomist
    pyriticsilence and sunny3811 like this.
  3. 0
    this thread brought me back to when I was in school for Medical assisting..... I always knew to draw cultures first, that reason is obvious... but one thing I remember but cannot remember the reason was never to draw a lavender tube first....

    so if you have to draw only a CBC you have to use a red stopper tube first, then you can draw the CBC

    I THINK the reason was air getting in the tube effecting the result but I'm not sure.... any one know the proper reason??
  4. 0
    [QUOTE=SopranoKris;6978065]

    However, order of draw varies so much by institution, so you really have to go by the chart the lab provides.


    As a student, I've noticed what SopranoKris indicates here: order of draw varies by hospital, and may not follow the order your phlebotomy text indicates as correct.

    In some cases, a specific hospital unit may have its own "correct" order of draw, differing from that of Lab.

    Therefore, it's difficult to know an absolute "correct" order.
  5. 0
    I wouldn't have a clue but would just be happy someone came to do the draw. I never have time to even go in with the plebotomist so telling them they arent' doing something correctly isn't even on my radar. I'll be the nurse 3 doors down trying to break up a fight. Who has the time?
  6. 0
    Seriously, there are more than one way to draw cultures, variables being whether you are using a syringe, butterfly, what other labs need drawn and tubed first or second. The blood culture doesn't matter where in the order of the draw...only if using a syringe, the aerobic container is last, so as not to inject air. It may also be better to make the culture second if using a butterfly as to to include surface cells. We always cultured last in the draw, very last is the aerobic bottle.
    Ask the pathologist where you work, they should be happy to tell you how to draw for quality control reasons.
  7. 0
    Quote from ecerrn
    Seriously, there are more than one way to draw cultures, variables being whether you are using a syringe, butterfly, what other labs need drawn and tubed first or second. The blood culture doesn't matter where in the order of the draw...only if using a syringe, the aerobic container is last, so as not to inject air. It may also be better to make the culture second if using a butterfly as to to include surface cells. We always cultured last in the draw, very last is the aerobic bottle.
    Ask the pathologist where you work, they should be happy to tell you how to draw for quality control reasons.
    The lab manual states the order of draw; blood cultures go first, not last. I'm pretty sure this is also per CLIA guidelines.
  8. 0
    From a CLIA brochure

    Routine order of draw (when the laboratory collects more than one tube of blood at a time on a patient):
    • Blood culture tube
    • Non-additive serum tube
    • Citrate tube
    • SST (serum separator tube), plastic serum tube
    • Heparin tube
    • EDTA tube
    • Glycolytic inhibitor tube
  9. 1
    I worked in clinic's for years and we always checked with the lab as often they would change tube colors on us. About 2 years ago I took a pleb course and took a national exam...that order of draw is very important and it's always best to check with the lab if there is a question. You might also see if the lab has a sheet for order of draw and post it on the Unit.
    pyriticsilence likes this.
  10. 0
    As a nurse if I'm told something different from what I believe to be true I am eager to learn what the truth of the matter may be. I would have gladly accepted the lab manual as it would have been a learning experience. Sounds like this nurse was trying to swing her weight around.


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