Venous Blood Collection Order of Draw

Laboratory Service
Invert
tubes
Order of Tube Collection Additive Comments (# of
times)

Blood • One set of blood cultures includes one aerobic bottle and one anaerobic
Culture bottle
Green • Remove plastic cap, then clean top of bottle with alcohol prior to sample
Aerobic collection
• Collect Aerobic bottle first, followed by Anaerobic bottle
Orange • Collect 8-10 mL sample into each bottle 8-10
Anaerobic
• Pediatric sample collection volume based on weight of child
Yellow • Maximum pediatric bottle draw volume: 4 mL
Pediatric

SPS • AFB/Mycoplasma culture

Sodium • Very similar in appearance to ACD-A tube 8-10
Polyanethol
Sulfonate
Light Blue • Completely fill tube to line indicated on label. Over- or under-filled tubes
1.8 mL will require recollection.
Sodium citrate • Avoid hemolysis for coagulation testing.
• 1.8 mL tube is sufficient for PT/INR, PTT, Fibrinogen, D-Dimer 3-4
Light Blue
4.5 mL • Collect 4.5 mL tube for all other Coagulation studies
Sodium citrate • Use a separate light blue tube or a non-additive tube to prime the tubing
when using a winged tubing collection set.
Sed Rate • For ESR testing only
*Sodium • Fill tube completely
8-10
citrate • May be collected following EDTA tube
• Place label lengthwise at bottom of tube
Clear • Very similar in appearance to Red top tube containing Clot Activator
No Additive • Can be used to prime (fill) winged (butterfly) collection tubing prior to 0
coagulation sample collection if necessary as a discard tube
Red • Preferred tube for most therapeutic drug testing
Clot Activator • Spray-dried clot activator is visible as a light coating inside of tube 5

Gold SST • Suitable for most routine Chemistry tests

Serum • Completely fill dedicated SST tube for ionized calcium
Separator • Allow to clot 30 minutes prior to centrifugation 5
tube • Gel creates physical barrier between serum and cells to ensure sample
Includes gel &
clot activator
integrity
• Not recommended for Tricyclic Antidepressant testing
Dark Blue • Very similar in appearance to Dark Blue EDTA tube
*Serum for • Label shows red triangle at top with red strip along side of tube
Trace Metal • Contains clot activator 5
analysis • Tube should be adequately mixed following collection. Minimize contact
with stopper by transporting and handling in upright position.
Light Green • Acceptable for most routine Chemistry tests
PST • Tubes are also available without the gel separator for venous blood gas
Lithium Heparin testing and other special tests 8-10
Plasma
Separator tube
Dark Green • Choose correct tube for test as Dark Green cap can be either Sodium or
Lithium Lithium heparin tube
8-10
heparin • Lithium heparin has no stripes across label
• Lithium heparin without gel must be used for Blood Gas
Dark Green • Sodium Heparin tube has green stripes across label
Sodium • Sodium Heparin tube follows Lithium Heparin in order of draw 8-10
heparin
Lavender • 3 mL sample sufficient for most on-site testing
3 mL 8-10
EDTA

Lavender • Transfusion Medicine samples

6 mL • Larger sample size may be required for specialty or referred-out tests 8-10
EDTA
Dark Blue • Very similar in appearance to Dark Blue Serum tube
*EDTA for • Label shows dark blue tab at top with light blue stripe below
8-10
Trace Metal • After complete mixing, minimize contact of sample with stopper by
analysis transporting and handling in upright position.
Tan • Protect from dust
EDTA for • Store tubes and supplies in zip-closed plastic bag 8-10
Lead • Handle only after thorough hand washing and when wearing gloves
ACD-A • ACD-A – 8.5 mL sample
Acid citrate 8-10
dextrose

ACD-B • ACD-B – 6 mL sample

Acid citrate • ACD concentration differs slightly from ACD-A tube 8-10
dextrose
Grey • Glycolytic inhibitor interrupts cellular processes
Sodium • Not suitable for Urea (BUN) analysis
Fluoride/ • Useful for glucose and lactic acid (lactate) analysis 8-10
Potassium • Lactate sample should be collected without the use of a tourniquet
oxalate
Order of Draw Guidelines:
Tubes must be collected in the order indicated according to the tube additive in order to prevent contamination or
interference from a preceding tube to a following tube.
Culture tubes
Sodium citrate
No additive
Clot activator
Lithium heparin
Sodium heparin
EDTA
Specialty tubes* – all types
Glycolytic inhibitor
*Specialty tubes containing the same additive as listed may be collected according to the additive, as shown for the
trace metal and Sed rate (ESR) tubes.
Collection Requirements:
Strict adherence to the follow ing requirements w ill help to ensure the accuracy and reliability of the patient test result.
Identify your patient:
Check that your inpatient is wearing a hospital identification band.
Ask the patient to state his full name and date of birth.
Verify that the patient information matches the requisition and/or labels and the hospital ID band (inpatients).
Verify additional primary identifier:
 For Inpatients: Medical Record Number on facility identification band matches labels/requisition
 For Outpatients: Other government–issued ID matches information on labels/requisitions
 i.e. Personal Health Number on Care Card matches labels and requisition
Fix any discrepancies before collecting a lab sample.
Place a Transfusion Medicine Service (TMS) ID band on the patient’s arm after the patient has been properly
identified when collecting a sample for possible transfusion.
Prepare for the collection:
Select the appropriate tubes for the tests ordered.
Check the tube expiration dates. Use only in-date collection tubes.
Collect the blood sample:
Vascular access device (VAD):
 Prepare VAD line for blood sample collection according to Clinical Practice (CPM) protocol.
 Discard appropriate amount of blood when collecting from an indwelling line (VAD):
 two times the dead space volume for non-coagulation testing
 5 mL or six times the dead space volume for coagulation tests
 Do not discard blood when querying Central Line Associated Blood Stream Infection (CLABSI).
First blood removed from line should go into blood culture bottles.
 Do not collect:
 coagulation samples through power-PICC line
 samples for diagnostic testing through lines that are also used to infuse medications or
therapies:
• Therapeutic drugs for therapeutic drug monitoring tests
• Heparin or other anti-coagulant for coagulation testing
• Parenteral Nutrition for chemistry analytes
 Follow CPM protocol for maintaining the patient lines (VAD collections only) when collection is complete.

Venipuncture:
 Follow the steps in the Collecting a Blood Sample by Venipuncture procedure.
Fill tubes in the correct order as indicated on the Order of Draw chart.
 When using a syringe for collection:
 transfer blood to Vacutainer® tube(s) using a tube holder that allows syringe attachment
 allow tubes to fill without placing additional pressure on the syringe plunger
 Never transfer sample from one sample tube to another.

Mix samples immediately following collection. One mix is 180° tube inversion, allowing bubble to travel the
length of the tube, followed by return to upright position.
Label the tubes at the time of collection in the presence of the patient with the following information:
 Patient last name, first name
 Patient date of birth
 Secondary identifier: Medical Record Number (MRN or Unit number) or Personal Health Number (PHN)
 TMS ID number (as read from the identification band) for Transfusion Medicine Service sample
 Collector mnemonic
 Date of collection
 Time of collection
Label each tube individually. Do not wrap a single label around multiple tubes.
Do not pre-label tubes with patient information prior to blood collection
Deliver tubes to lab:
Assess samples for acceptability (lab staff):
 Inadequate sample volume (includes under- and over-filled coagulation tubes)
 Presence of hemolysis or other interferent
 Wrong collection tube
 Wrong collection time (ie. therapeutic drug monitoring)
 Inadequate or improper tube labelling
 Prolonged delay in delivery to lab
 Other individual criteria related to the test requested
Recollect samples not meeting acceptance criteria.

Refer to: IH Lab Collecting a Venous Blood Sample Procedure

BacT/Alert® blood culture bottles are products of ©BioMerieux, Inc. www.biomerieux-usa.com. Images used by permission.
Vacutainer® tubes are products of ©Becton, Dickinson and Company. www.bd.com. Images used by permission.

Updated: November 12, 2014