The Clinical and Laboratory Standards Institute (CLSI) establishes guidelines so that every patient can expect a certain standard of care and laboratories can expect consistent samples.  Their standards indicate an order of draw based on certain categories:


1. Blood culture bottles and other sterile tubes: N/A

2. Nonadditive tubes: N/A

3. Coagulation tubes: (Light) Blue

4. Clot activator tubes: Red

5. Serum separator tubes: Gold

6. Sodium (and/or lithium) heparin tubes: Mint, Green

7. EDTA tubes: Lavender, Pink

8. Others based on additive: Light Yellow (ACD)
 

In this case and based on the CLSI standards, the (light) blue tube should be drawn first.  However, it is highly recommended to collect a nonadditive tube prior to any (light) blue tube if it is drawn first.  This particular brand of red tube contains a clot activator so it is not appropriate for drawing before the (light) blue, others may not, refer to your own supplies and protocols when addressing this concern.

 
ALWAYS CONDUCT PHLEBOTOMY FOLLOWING THE PROTOCOLS OF YOUR FACILITY.


KSCLS provides Skill Sharpeners as general and supplemental education and review.  They are not substitutions for training by your employer.


CLSI is expected to produce a revised venipuncture standard in March 2017, be on the lookout for any changes that may impact your facility.


​References:

Ernst, D. J. (2007). Procedures for the Collection of Diagnostic Blood Specimens by Venipuncture: Approved Standard (6th ed., Vol. 27, Ser. 26). Wayne, PA: Clinical and Laboratory Standards Institute.


Below, are eight of the more common collection tubes used for venous blood samples.  They are, from left to right: green, light yellow (not to be confused with the yellow SPS tube for fungal cultures), lavender, mint, pink, gold, (light) blue, and red topped tubes.


If all eight of the tubes need to be drawn, in what order should the samples be collected?

Skill Sharpener Solutions

Here, we hopefully confirm your clinical laboratory knowledge, but if you want to assert a better or more complete answer, or have something to add, speak up, so that we can help all of our fellow KSCLS colleagues and guests.



Skill Sharpeners for the Weeks of

2017 February 27 and March 06

This image to the immediate right is the result of a densitometric scan of a gel hemoglobin electrophoresis performed using acid citrate agar.  A magnified image of the individual bands separated in the gel is farther right.


Based on the point of origin and the type of gel, what common forms of hemoglobin are expected to occur in each of the four gated fractions designated by the four colors red,blue,green,andblack, from left to right.

Based on the location of the origin:

The red or first box is where one would find Hemoglobin A

The blue or second box is the typical location for Hemoglobin F

The green or third box can contain Hemoglobins S, D, and G

The black or fourth box is the expected location for Hemoglobins C, A2, E, and O


A fun pneumonic to remember this order is "A Fat Santa Claus"