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Phlebotomy Pages
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The Clinical and Laboratory Standards Institute (CLSI) sets phlebotomy standards that apply to those who draw blood either as full and part-time phlebotomists, medical assistants, or other health care providers and personnel with blood collection responsibilities in the United States of America.
Most blood tests are performed on anticoagulants whole blood, plasma, or serum. Blood specimens must be collected in the proper collection tubes and containers and in the right order of draw. The collection tubes must also be correctly labeled, and promptly transported to the laboratory. Needless to say, blood specimens should be refrigerated until placed in the courier box for transport to the laboratory.
If coagulation testing is the only laboratory work that needs to be drawn the phlebotomist should first draw a plain red top tube to remove tissue fluid contamination. This tube is then discarded into the biohazard receptacle. The next step is to draw the blood sample into a sodium citrate collection tube which must be filled to the proper level (filled to complete vacuum volume) and is then gently inverted to mix.
If additional laboratory work is ordered, including coagulation testing, the second tube would be the sodium citrate collection tube. Remember that all of the processes involved in specimen collection, from ordering supplies, to selecting the proper collection devices, to proper collection site and technique, to adhering to all in-house and legal requirements when handling and shipping the specimens are all important steps of obtaining valid and timely laboratory test results
The NEW Order of Draw
Based on CLSI* standard H3-A6
When Using Evacuated Tubes
The current order of draw according to CLSI standard H3-A6 is as follows.This should ALWAYS be followed to prevent erroneous results due to additive crossover:
1.) Blood cultures (yellow) SPS (sterile)
2.) Light blue (buffered sodium citrate tube)
3.) Red (plain), or Tiger-Top mottled red (gel separator tube)
4.) Green heparin and light green (sodium or lithium with or without separators)
5.) Lavender (EDTA)
6.) Pink, white, or royal blue (EDTA)
7.) Gray (Na flouride/potassium oxalate)
8.) Dark blue (FDP)
Read:
The current edition of the CLSI catalog and CLSI hematology standards are available upon request from either CLSI membership organizations as well as to non-members directly from CLSI.
Watch this video of multiple blood draws using different types of evacuated tubes:
Click here!
When Using The Syringe System:
The document by the then National Committe for Clinical Laboratory Standards (NCCLS*) from 1991established two distinct orders of draw for vaccum tube draws and syringe method. This is now obsolete! NCCLS revised these standards in 1998 because there was a lack of evidence that syringes need a separate order of draw.
*REMEMBER: NCCLS changed their name to Clinical and Laboratory Standards Institute (CLSI) on 1 January 2005.
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Title: Plebotomy Pages For Phlebotmists
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