Order of Draw

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Course Objectives
  1. Understand and discuss the importance of following the correct order of draw
  2. Identify the correct order of draw for evacuated tubes
  3. Determine the correct utilization of specific tubes in regard of the stopper color with the additive found in the tube
  4. Identify which tubes to utilize for common tests 
  5. Identify the order of collection for capillary punctures
Course Content
Course Creator: Kirsten Hermens, NCMA-P
Total CE Hours: 1 Credit Hour 
Pace Course #: 586-2302-24

Outline:
  • Introduction
  • Preparing for Venipuncture
    • Necessary supplies
    • Procedure
  • Preparing for capillary punctures
    • Necessary supplies
    • Procedure
  • Stopping and Resuming the procedure
  • Redrawing Partially Drawn Tubes
    • Pre-analytical Errors
    • Misidentifying a patient
    • Using the wrong collection tube for the sample
    • Improper collection time
    • Inadequate fasting
    • Tourniquet tied for too long 
    • Inadequate quantity of blood
    • Drawing tubes in the incorrect order
    • Failure to invert tubes
    • Hemolysis
  • Review Questions
    • Answers
  • Scenario
    • Answers
  • Importance of Order of draw
    • CLSI
      • CLSI Recommended Order of Draw
  • Blood Culture Bottles or Yellow Tube (This is not the same as the Gold top tube)
    • What is it
    • Common tests
  • Light Blue
    • What is it
    • Common tests
  • Red
    • What is it
    • Common tests
  • Royal Blue w Red stripe on the label
    • What is it
    • Common tests
  • Gold could also be (Tiger, Marble, speckled, or SST)
    • What is it
    • Common tests
  • Light (or mint) Green
    • What is it
    • Common tests
  • Dark Green
    • What is it
    • Common tests
  • Pink
    • What is it
    • Common tests
  • Royal Blue w Lavender stripe on the label
    • What is it
    • Common tests
  • Lavender
    • What is it
    • Common tests
  • Gray
    • What is it
    • Common tests
  • Review Questions
    • Answers
  • Scenario
    • Answers
  • Order of Draw Capillary Collection
    • Cappilary Specimens
    • Locations
    • Tests that CANNOT be performed
  • Specimen collection devices
    • Glass side
    • Glass capillary tube
    • Microtainer
    • Filter Paper
  • Capillary Order of Draw
    • Lavender: EDTA
    • Dark Green: Lithium Heparin
    • Light green: Lithium heparin with gel separator
    • Grey: Sodium fluoride/potassium oxalate
    • Gold: Clot activator
    • Red: No additive
  • Review Questions
    • Answers
  • Scenario
    • Answers

References: 
  1. Johnson, L., & Maffit, T. (2024). NCCT (p. 12). 2024 National Center for Competency Testing.
  2.  Mayo Foundation for Medical Education and Research (n.d.). Blood Culture. Bozeman Health. https://bozeman.testcatalog.org/show/LAB462-1
  3.  Anderson, G. R. (2022). A Fundamental Guide To Phlebotomy (E. K. Eaton, Ed.) (p. 53). NHCO-National Healthcare Certification Organization.
  4.  Staff, H. (2023, May 13). Blood Culture. MyHealthe.Alberta.Ca. https://myhealth.alberta.ca/Health/pages/conditions.aspx?hwid=stb117065&
  5.  Anderson, G. R. (2022). A Fundamental Guide To Phlebotomy (E. K. Eaton, Ed.) (p. 53). NHCO-National Healthcare Certification Organization.
  6.  Anderson, G. R. (2022). A Fundamental Guide To Phlebotomy (E. K. Eaton, Ed.) (p.54, 63). NHCO-National Healthcare Certification Organization.
  7.  Department of Pathology & Laboratory Medicine (n.d.). SPECIMEN REQUIREMENTS/CONTAINERS. University of California, Irvine School of Medicine. https://www.pathology.uci.edu/services/specimen-containers.asp
  8. Anderson, G. R. (2022). A Fundamental Guide To Phlebotomy (E. K. Eaton, Ed.) (p.47,56,57,58,60,61,62,75, 139). NHCO-National Healthcare Certification Organization.
  9.  Medline (n.d.). BD Vacutainer PST Tube with Hemogard Closure (Light Green). Dufort et Lavigne. https://www.dufortlavigne.com/en/produit/BEC367960
  10.  (2024). BD 367878 Vacutainer Sodium Heparin 6 mL Blood Collection Tubes 13mm x 100mm, 100/box [Photograph]. Mountainside Medical Equipement. https://www.mountainside-medical.com/products/bd-367878-vacutainer-sodium-heparin-6-ml-blood-collection-tubes-13mm-x-100mm-100-box
  11. “Black Top Tube." Hawach Scientific, www.hawach.com/vacuum-blood-collection-tube/black-top-tube.html
  12.  University of California San Francisco (2024, March 31). Sickle Cell Test. UCSF Health. Retrieved October 14, 2024, from https://www.ucsfhealth.org/medical-tests/sickle-cell-test
  13.  National Library of Medicine (2022, September 28). C-Reactive Protein (CRP) Test. Medline Plus. Retrieved October 14, 2024, from https://medlineplus.gov/lab-tests/c-reactive-protein-crp-test/
  14. Fibulas, Inc. (n.d.). What tests are typically performed using a dark blue top tube? Needle.Tube. https://www.needle.tube/resources-articles/what-tests-are-typically-performed-using-a-dark-blue-top-tube
  15.  Lenicek Krleza, Jasna & Dorotic, Adrijana & Grzunov, Ana & Maradin, Miljenka. (2015). Capillary blood sampling: national recommendations on behalf of the Croatian Society of Medical Biochemistry and Laboratory Medicine. Biochemia Medica. 25. 335–58. 10.11613/BM.2015.034.
  16.  (2021). Massive Selection for Plain Vacutainer Tubes - Glucose Tube – Kang Weishi [Photograph]. Gyros Protein Technologies. https://www.gyrosproteintechnologies.com/spinblog/matching-miniaturized-bioanalysis-with-microsampling-is-revolutionizing-pharma-biotherapeutic-development 
  17.  (2024). Order of Draw (p. 1). University of Nebraska Medical Center. https://www.reglab.org/reglab/assets/File/4%20Order%20of%20Draw.pdf  

Photo References:
 
P1. Commitment to privacy. (2016). [Photograph]. In Virginia Commonwealth University. Virginia Commonwealth University, United States of America. https://pathology.vcu.edu/media/pathology/catalog/UrineSpecimenCollectionGuiderev62016.pdf
 
P2. Tube Gray Top 4.0ml - Pathologists' Regional Laboratory. (2021). [Photograph]. In Pathologists’ Regional Laboratory. Pathologists regional Laboratory, United States of America. https://pathregional.com/product/tube-gray-top-4-0ml/
 
P3. BD Microtainer® Blood Collection Tubes. [Photograph]. 365992 | BD. Retrieved October 24, 2024, from https://www.bd.com/en-us/products-and-solutions/products/product-page.365992
 

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