Laboratory Medicine Updates - December 8, 2005

University of Virginia Health System

Medical Laboratories

“Quality You Expect, Service You Deserve”

LABORATORY MEDICINE UPDATE

December 8, 2005

Change in Recommendations for Order of Blood Tube Collections

The Medical Laboratories has changed the “order of draw” for collecting blood specimens to match the recommendations of the Clinical and Laboratory Standards Institute (CLSI, formerly known as NCCLS).  The following order should be followed for glass or plastic tubes or any combination thereof, effective immediately.

  • Blood Cultures
  • Coagulation Tube (Blue – sodium citrate)
  • Serum tubes with or without clot activator, with or without gel(tiger, red or gold)
  • Heparin tube with or without get plasma separator (green)
  • EDTA (lavender/pink)
  • Glycolytic inhibitor (gray)
  • Other

Phlebotomy Pointers:

  1. If a coagulation tube (blue top) is the first tube drawn and a winged infusion (butterfly) is used, a red discard tube should be drawn first.  The discard tube can be removed once blood flow has been established; it is not necessary to completely fill the discard tube.
  2. All tubes with additives should be gently inverted (mixed) 8 – 10 times to ensure that the additive mixes with the blood.  Mixing is necessary with any collection method.
  3. Check evacuated tube expiration dates.  The vacutainer tubes expire at the end of the month stamped on the tube.  Example 12/2005 would not expire until December 31, 2005 .
  4. For maximum bacteriostatic action the alcohol must be allowed to air dry (do not wipe) when cleaning the venipuncture site.  Be sure that the alcohol is completely evaporated prior to beginning the blood draw.
  5. Always check that the tubes and paperwork are properly labeled with all required information.