What is the order of blood collection tubes

CLSI order of draw is as follows:

Sodium Polyanethol Sulfanate (AKA SPS)

Sodium Citrate

N0 Additive

Clot activator

Heparin (either sodium or lithium)

EthyleneDiamineTetraacetic Acid (AKA EDTA)

Potassium Oxalate with Sodium Fluoride

Color

Yellow

Blue

Red

SST

Green

Lavender

Grey

Many phlebotomists use a mnemonic device to make the memorization process a bit easier. A mnemonic device is a phrase or saying that is easy to remember and relate back to in the future. It’s a great way to remember order of draw (OOD) because you can modify the sentence to be most helpful to you. In this example, the tubes that make the order of draw are identified by color.

Mnemonic Example:

Color

Yellow top tube (or anaerobic/aerobic bottles)

Blue (AKA Lt Blue)

Red

SST (AKA as Gold or Tiger top)

Green (either dark or light)

Lavender

Grey

Mnemonic

Young

Bodies

Really

Should

Get

Large

Grains

The reason the tubes are assigned this order is to prevent the cross-contamination of chemicals into other tubes which may cause errors in testing. This process is called reflux, which means the chemical can move from the tube and enter the needle. Once the next tube is activated it will have the previous chemical enter the tube, causing the contamination. You will need to study the tubes at your facility to determine which products are used for which test.

If the mnemonic device is not working, you may have heard of another option of buying an order of draw phlebotomy bracelet or other wearable. However, we do not recommend or encourage buying the order of draw phlebotomy bracelets because the OOD is something you need to know without relying on a bracelet.

As a licensed phlebotomist, it is not only important to know the order of blood drawing but also the correct procedure and standard for drawing that blood. At PhlebotomyU, we value education because we want to provide hospitals, facilities, and laboratories with the best CPT-1 phlebotomy graduates. Our program not only provides teaching in the classroom but also real-time experience in the field. We offer abbreviated classes, weekday and weekend phlebotomy training from 5 to 9 weeks. At end of training, students have hours of hands on experience making it easy to go from

To avoid cross-contamination, blood must be drawn and collected in tubes in a specific order. This is known as the Order of Draw.

1. Blood Culture Tubes or Vials
2. Coagulation Tubes (Blue-Top Tubes)
3. Serum Tubes without Clot Activator or Gel (Red-Top tubes)
4. Serum Tubes with Clot Activator or Gel (Gold or Tiger Top Tubes)
5. Heparin Tubes (Green-Top Tubes)
6. EDTA Tubes (Lavender-Top Tubes)
7. Oxalate/Fluoride Tubes (Gray-Top Tubes)

Blood samples must be drawn by phlebotomists in a specific order to avoid cross-contamination of the sample by additives found in different collection tubes. Phlebotomy order of draw is the same for specimens collected by syringe, tube holder, or into tubes preevacuated at the time of collection. The correct order of draw follows:

1. Blood culture tube or bottle
2. Sodium citrate tube (eg, blue closure)
3. Serum tubes, including those with clot activator and gels (eg, red, red-speckled, gold closures)
4. Heparin tube with or without gel (eg, dark green, light green, speckled green closures)
5. EDTA tube with or without gel separator (eg, lavender, pearl, pink closures)
6. Sodium fluoride/potassium oxalate glycolytic inhibitor (eg, gray closure)

The placement of tubes not listed here should take into consideration the potential for their additive to alter results obtained from the next tube if carryover were to occur. Plastic serum tubes containing a clot activator may cause interference in coagulation testing. Only blood culture tubes, glass nonadditive serum tubes, or plastic serum tubes without a clot activator may be collected before the coagulation tube.

Numerous errors can occur during the collection and handling of blood specimens, which pose significant and avoidable risks to the patient and the phlebotomist. When global standards are not fully implemented, it is more likely that patients will be injured during the procedure, biologically representative specimens will not be obtained from patients, and test results will not be comparable from one facility to another.

CLSI’s GP41 —Collection of Diagnostic Venous Blood Specimens provides a descriptive, stepwise process and procedures reflecting the quality system essentials format for diagnostic venous blood specimen collection. Special considerations for collections from vascular access devices, blood culture collection, and collections in isolation environments are included, as well as how to handle emergency situations. An expanded appendix section provides helpful tips for collecting specimens from pediatric and other challenging patients.