ICU Advantage: Order of Draw in Phlebotomy

Introduction

• Importance of proper blood sampling and order of draw in patient care.
• Incorrect order can lead to cross-contamination and inaccurate results, affecting patient diagnosis and treatment.
• Video presented by Eddie Watson.

Question to Consider

• Do you know the proper order of draw? Reflect before and after the lesson.

Importance of Order of Draw

• Correct order prevents cross-contamination and inaccurate test results.
• Maintains integrity of blood samples for accurate diagnosis and treatment.

Types of Blood Collection Tubes

Blood Cultures

• Purpose: Sterile collection for identifying bacteria.
• Types: Aerobic and Anaerobic.
• Additives: Nutrient broth, anticoagulant, chemical to reduce bacterial killing.
• Order: Always drawn first to prevent contamination.

Light Blue Tube

• Purpose: Coagulation tests (PT, INR, PTT, etc.).
• Additive: Sodium citrate binds calcium to prevent clotting.
• Importance: Must be filled to a specific line for accurate results.

Red Top Tube

• Purpose: Chemistry panels, requires serum.
• Additive: Sometimes has silica clot activator for serum formation.

Gold/SST Tube

• Purpose: Chemistry panels, antigen/antibody tests.
• Additive: Gel to separate serum from cells.
• Use: Common for send-out tests.

Green Top Tube

• Purpose: Common chemistries, cardiac markers.
• Additive: Heparin (anticoagulant), sometimes requires ice.
• Variation: PST (Plasma Separating Tube) with fibrinogen for plasma separation.

Purple Top Tube

• Purpose: Hematology tests (CBC, ESR, A1C).
• Additive: EDTA, preserves cell morphology, high in potassium.

Pink Top Tube

• Purpose: Blood type samples.
• Similarity: Identical to the purple top.

Gray Top Tube

• Purpose: Tests like lactate, ethanol, fasting glucose.
• Additives: Sodium fluoride (prevents glycolysis), Potassium oxalate (binds calcium).

Proper Order of Draw

• Blood Cultures
• Light Blue
• Red
• Gold/SST
• Green
• Purple
• Pink
• Gray

Mnemonic for Order

• S L R S G P L G: "Stoplight Red Stay Green Power Light Go"
  • S: Sterile (Blood cultures)
  • L: Light blue
  • R: Red
  • S: SST (Gold)
  • G: Green
  • P: Purple
  • L: Light pink
  • G: Gray

Conclusion

• Vital to follow the order to avoid contamination and skewed results.
• Understanding the rationale helps in memorizing and implementing the order effectively.

Call to Action

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• Reflect and share how accurate your initial guess was.