Order of Draw

Order of Draw


When drawing blood for multiple tube collections, it is important to take into consideration proper venipuncture technique and correct order of draw. Taking these factors seriously can lessen discomfort and complications for your patient, lessen procedure time, and prevent errors in diagnosis caused by cross contamination of additives between blood collection tubes.

Please watch this video for information about order of draw.

Venipuncture Procedure

The first thing to consider when it comes to drawing blood is to ensure that proper aseptic technique is followed. Also, see to it that you have all the equipment you need for your specific phlebotomy procedure: these include your needles, syringes, tourniquets, collection tubes, cotton balls, plaster, and labeling tools. Lastly, before sending off your specimen for analysis, you should double-check your labels to confirm that the right names are on the right tubes, and that the tubes are sent off to the right diagnostic procedures.

Order of Draw, Phlebotomy

phlebotomy order of draw

Proper equipment and procedure is essential

The major reason behind establishing a certain order of draw when doing venipuncture for multiple tube collections is to avoid any cross contamination of the chemical additives between different tubes. Cross contamination of these additives can massively change the results and may consequently lead to misdiagnosis and mistreatment of the patient.

The basic order of draw followed by most phlebotomy laboratories is as follows:

  1. Yellow Top (or Yellow-Black). This tube is used for blood cultures.
  2. Light Blue. This tube contains sodium citrate, and is used for coagulation assays. A full draw is required with this tube.
  3. Red. This tube does not contain any additives.
  4. Gray (with Red) or Gold. This is the serum separator tube (SST) containing a clot activator and a gel separator.
  5. Dark Green. This tube contains sodium heparin anticoagulant.
  6. Light Green. This is the plasma separating tube (PST) containing lithium heparin anticoagulant and a gel separator.
  7. Lavender. This tube contains EDTA (Ethylenediaminetetraacetic acid).
  8. Pale Yellow. This tube contains acid citrate dextrose.
  9. Light Gray. This tube contains oxalate or fluoride.

Each tube should be thoroughly mixed by inverting the tube 8-10 times. Exceptions to this rule are the Light Blue tube, which is to be mixed by inverting 3-4 times, and the Red tubes (non-additive and SST), which are to be mixed by inverting 5 times.

Important Exceptions to the Basic Order of Draw

order of draw phlebotomy

You need to know the order of draw

Although not exactly an exception, one important thing to note about the order of draw is that the second and third tubes are often reversed. The non-additive tube (Red Tube) is often drawn first when there is a particular concern for the contamination of the red tube with tissue fluids or thromboplastins if it were to follow the light blue tube. In most cases, however, the light blue tube is drawn first, as it requires a full draw before any specimen can be sent for analysis.

When using a butterfly needle for collection and no blood cultures are being required, a discard tube should be the first draw. This discard tube, preferably a non-additive tube, serves to draw out the “dead space” of the tubing of the butterfly needle set. This ensures that the correct blood-to-additive ratio is maintained in the different collection tubes.

Basic Mnemonic for the Proper Order of Draw

Most phlebotomy laboratories have an order of draw chart that is either made by the laboratory itself, or one that is produced by the manufacturer of the phlebotomy tubes used by the lab. Without these charts, however, you need to know the basic order of draw from heart. This mnemonic, basically a phrase that holds true for all members of the medical industry, is a good way for you to easily recall the proper order of draw.

You Better Read, not Get Downright Lazy, LOVE, or You’ll Probably Lose Greatly.

Which stands for:

Yellow – Light Blue – Red – Gray (with Red) or Gold – Dark Green – Light Green – Lovender (Lavander) – Yellow (Pale) – Light Gray

Venipuncture Tips

A simple tip to take note when doing venipuncture for multiple tube collections is to keep your patient calm. Patients tend to be a little apprehensive when multiple tubes are taken, so it becomes your responsibility to assure them that you are there to do your job as best as you can, and that you will do your best to keep them as comfortable as possible. Also, you have to make sure that all of your collections use the right procedure and equipment. Using the wrong needle size, or drawing blood too quickly may cause your specimen to be unsuitable for analysis.

What is Venipuncture?

What is Venipuncture?


The most important diagnostic tools in the world of medicine often involve the usage of blood. This is due to the fact that blood is a rich source of information on the current state of a person’s body. Blood contains blood components (red blood cells, white blood cells, plasma, and platelets), enzymes, protein, and other elements that, in totality, either give someone a clean bill of health, or indicate certain pathologies and their corresponding intensity. It is, therefore, of utmost importance that the method with which blood is being drawn from a patient ensures that the blood samples taken are of the highest quality suitable for testing.

Venipuncture Definition

Venipuncture, a term often used interchangeably with phlebotomy, is defined by most sources as the surgical puncturing of a vein, as for the withdrawal of blood and administration of nutrients, fluid, and medication intravenously. Venipuncture definition doesn’t differ much across different sources, as it essentially holds the same meaning across different medical institutions. It is ranked to be one of the most common invasive medical procedures and is performed for a number of reasons, the most important of which is blood analysis.

Routine Venipuncture

what is venipuncture

Surgical precision is required

Based on venipuncture definition, it can be concluded that routine venipuncture is a delicate and invasive procedure. These being some of its identifying characteristics, it is imperative that a phlebotomist knows all the steps there is to its successful completion by heart.

Preparation

The first step there is to a routine venipuncture is to identify your patient. Make sure that the patient listed on your requisition form is the one waiting for you in your station. Check your patient’s disposition. If he or she is too distressed, get someone to calm the patient down prior to the procedure. Remember that drawing blood from a distressed, angry, or unwilling patient can only cause more harm than good.

Once you have your patient ready, prepare yourself and all the necessary equipment. Make sure that your hands are perfectly clean and sanitized. Check your requisition form for all the tests being called for, and prepare your tubes, needles, cotton balls, and other paraphernalia accordingly.

Lastly, prepare the puncture site. This is done by searching for the vein that is most palpable and by cleaning the puncture site using a cotton ball dipped in antiseptic. Clean your puncture site by rubbing it with your antiseptic-soaked cotton in a spiral motion, from the center towards the periphery. This is done to ensure that no recontamination of a previously cleaned section occurs.

Venipuncture

After cleaning your puncture site, apply a tourniquet 3-4 inches above the site. Anchor your chosen vein with the thumb of your free hand. Get your needle and syringe, and make sure that the needle is locked to the syringe. Insert the needle to the vein with the bevel side up.

Sample Collection and Processing

Place your sample in the appropriate sample container. If the procedure is done for multiple tests calling for multiple collection tubes, the correct order of draw should be followed. Assess the quality of your samples. If the samples are found suitable for analysis, make sure that you label them correctly first before sending them off to the laboratory. Otherwise, start all over again, beginning with the preparation of your patient for another round of blood withdrawal.

Venipuncture training

Like most things, practice makes venipuncture perfect. One of the best ways to achieving the skills necessary for this procedure is by undergoing venipuncture training. There are many ways to go about completing your training, the most effective of which has to be hands-on training.

If you are currently attending phlebotomy school, a good way to ensure that you get the most out of your venipuncture training is to attend all hands-on training arranged by your school. These training sessions are often held in hospitals or other related medical institutions. These sessions can help you not only perfect the art and science of venipuncture, but also get you exposed to the general setting of your future workplace.

If you, however, are enrolled at an online training program that does not make the arrangements for you, call nearby health institutions and make the arrangements for yourself. Remember that this is a task that involves your hand, and that no amount of watching videos of other people doing it can prepare you as much as hands-on training would.