New Order of Draw

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New Order of Draw...

Setting Blood Draw Standards in USA...

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.

Blood Collection Rules

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.

Contact CLSI for the latest order of draw information

BD Vacutainer® Order of Draw for Multiple Tube Collection PDF

Proper Handling of BD Vacutainer ® Citrate Tubes (discard tube explained)

University of Iowa's illustration of the order of draw by tube top color

Watch this video of multiple blood draws using different types of evacuated tubes:

Click here!

ATTENTION: Please realize that this video (published form YouTube using YouTube code) is NOT HERE TO TEACH you phlebotomy techniques, but merely to show you different scenarios of the phlebotomist's daily routine. The video may contain techniques, or procedures that do not conform to proper, and safe venipuncture protocol. Viewer discretion is strongly advised. If you spot errors share your tip how to do better here! Remember to add which video it was.

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.

Are You Cut Out To Be A Phlebotomist?

The first step when deciding on a fitting career is to take time to assess what you do well. It's also important to explore the educational, training, and career opportunities available in your particular area first. Take the MAPP Career Assessment to identify your strengths.

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